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February 4, 2020 • Strength & Conditioning

Powerline: Health & safety in conditioning programs

Michigan State athletes running
Photos: Ken Mannie

Without question, the top priorities in athletics are the health, safety and welfare of our student-athletes. This responsibility is shared by administrators, sport coaches, athletic trainers and, most certainly, strength and conditioning coaches.

Unfortunately, in strength and conditioning environments we are intermittently witness to catastrophic events involving athletes. While some of these incidents are the result of congenital abnormalities that slipped under the screening radar, or questionable personal life-style habits by the athletes, others were either directly or indirectly the result of poor judgement by the coaches in implementing a protocol that was inappropriate for the athlete’s current conditioning level. Let’s examine a couple of the most significant health and safety issues confronting the athletic population, along with some preventative measures.

Exertional heat illness

Elevated body temperature (hyperthermia) can lead to a variety of physiological disorders that include muscle cramping, heat syncope (fainting), heat exhaustion (HE) and a very serious condition known as exertional heat stroke (EHS).

In general, hyperthermia is defined by a core body temperature of 104 degrees Fahrenheit (40 degrees Celsius). Core temperature is determined by metabolic heat production and the transfer of body heat to and from the surrounding environment. The body’s natural mechanism to dissipate heat is the vaporization of sweat, though this process can be severely hampered when the humidity level is elevated or athletes are wearing heavy gear. Lack of an appropriate acclimatization process to allow for adaptive physiological responses to heat and humidity exposure also can be a culprit.

While it’s possible for HE issues to surface in all temperature ranges, it usually occurs more readily in hot and humid environments. HE normally causes cessation of exercise due to extreme fatigue, and it can be a precursor to EHS. Symptoms of HE include an elevated pulse, low blood pressure, and sweaty or pale/ashen skin.

EHS is a serious condition and is ranked as the third highest cause of death among collegiate athletes. Football has the highest incidence rate among intercollegiate sports. EHS is defined by a rectal temperature of greater than 104 degrees Fahrenheit and central nervous system disturbances. Key symptoms of EHS range from cessation of sweating, red/dry skin, dizziness, vomiting, inability to walk, collapse and seizure. Don’t be fooled — athletes can be sweating profusely and still be a victim of EHS.

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It cannot be overstated that EHS is a life-threatening medical emergency. The first priority is to cool the victim’s body on-site prior to evacuation to the hospital. Cold/ice water immersion offers the fastest whole-body cooling rate. When water immersion isn’t available, ice water towels on the head, trunk, and extremities, along with ice packs to the neck, groin, and armpits offer slower but helpful cooling rates.

Acclimatization is a crucial element in in preventing EHIs. It involves a series of adaptive physiological responses to heat exposure of the course of approximately 10 to 15 days. The body will adapt to gradual, progressive exercise in the heat by reducing rectal temperature, lowering cardiovascular strain and increasing blood plasma volume. Obviously, an athlete’s ability to acclimatize is dependent upon the initial level of fitness, and the intensity and frequency of the training sessions.

Exertional Rhabdomyolysis

Michigan State athleteExertional Rhabdomyolysis (ER) is the result of the breakdown of skeletal muscles and the release of muscular biochemical substances (e.g., myoglobin, potassium, creatine kinase and other intracellular components) into the blood stream.

Athletes who have sickle cell trait — which is the occurrence of sickle-shaped red blood cells that may block small blood vessels — are more prone to ischemic ER. ER may result in nausea, vomiting, mental confusion, cardiac arrhythmias and kidney damage. Common symptoms of ER include muscle pain (aching and throbbing), muscle weakness (inability to stand up), muscle swelling and disorientation. Urine is often very dark in ER cases — cola or tea colored. If not judiciously and immediately attended to, ER can become a life-threatening situation, as kidney failure and liver problems can ensue. Hospital treatment is paramount, where IV fluids and management of electrolyte abnormalities to protect the heart and other vital organs may be put in motion. Dialysis may be necessary to help the kidneys filter waste while recovering.

Precautionary measures

A joint consensus by the Collegiate Strength and Conditioning Association (CSCCa) and the National Strength and Conditioning Association (NSCA) recommends a 50/30/20/10 conditioning protocol for returning from an extended break in activity. Simply put, for returning athletes coming off a break two weeks or longer — or with new athletes — there should be four consecutive weeks of introductory training approached in the following manner:

  • Week 1: A minimum of a 50% reduction in the uppermost volume of the conditioning program with at least a 1:4 work-to-relief ratio. If a test is conducted for assessment purposes, it would be no more than 50% of normal test volume (e.g., the 16x110s test would be reduced to at least 8x110s) with at least a 1:4 work-to-relief ratio.
  • Week 2: A minimum of a 30% reduction in the uppermost volume of conditioning with a 1:4 work-to-relief ratio.
  • Week 3: A minimum of a 20% reduction in the uppermost training volume of conditioning with a 1:3 or greater work-to-relief ratio.
  • Week 4: A minimum of a 10% reduction in the uppermost training volume of conditioning with a 1:3 or greater work-to-relief ratio.

Conditioning frequency can be gradually increased from two to three days per week during the first two weeks to three to four sessions in weeks three and four.

Hydration strategies and cooling breaks are also imperative, especially in environments where the wet bulb globe temperature exceeds 82 degrees Fahrenheit and activity last more than one hour. Dehydration as little as 2% of body weight can negatively affect an athlete’s performance and adversely compromise the thermoregulatory system. Fluid deficits in excess of 3% to 5% of body weight reduce sweat production and decrease cardiac output, raising internal core temperature.

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In general, athletes should drink early and often, and fluid breaks should be scheduled during conditioning activities and practices. Electrolyte balance is a key player in the hydrations game. While water is undoubtedly a vital component, electrolyte-laden drinks should also be in the mix. A basic rule of thumb is that athletes need to consume about 24 ounces of fluid for every pound lost during conditioning sessions, practices or games.

A cautionary note: Hyponatremia is a condition that occurs when the level of sodium in the blood is abnormally low. There have been reported cases of hyponatremia attributed to drinking too much water prior to, or during, athletic events. This happens primarily in long distance, endurance-type competitions like marathons. This is why fluid intake and weight monitoring should be directed, administered and evaluated under the auspices of certified athletic trainers or other licensed professionals.

Precautions and strategies also should be in place for possible respiratory conditions. That includes chronic obstructive pulmonary disorder, exercise induced asthma and exercise induced bronchospasm. Cardiovascular events also are a major concern, and it’s important to understand the signs, symptom and actions to be taken in response.

Final rep

It’s the responsibility of athletic department personnel at every level to adopt an emergency action plan and review it on an annual basis. It should include a list of proper protocols and important phone numbers other than 911. Automated external defibrillator (AED) placements should be clearly marked in easily accessible areas and known by everyone in responsible positions. Everyone who works with athletes in a training environment should be First Aid and CPR/AED certified.


Ken Mannie is the head strength and conditioning coach Michigan State University. His column, Powerline, appears regularly in Coach & Athletic Director magazine. 


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