Boston Sports Medicine and Performance Group, LLC Blog

Off-Season Workouts Need Changes Before The Next Funeral by Dennis Dodd

Posted by Boston Sports Medicine and Performance Group on Mon, Jan 31, 2011 @ 06:01 AM

This article originally appeared on by Senior Writer Dennis Dodd on Jan. 26, 2011

This is The Kill Season. It operates mostly out of mind and certainly out of sight. It has claimed 19 lives since 2000. The annual window of death in college football basically opens this month. And it's all completely accepted. It is a part of the football culture -- winter conditioning, offseason conditioning, summer conditioning. All of it. More specifically, The Kill Season begins in January and stretches to the beginning of fall drills in August. That's a long time for anyone to be at mortal risk, but it's true. There are 21 souls practically screaming from the grave. They represent the number of non-traumatic deaths in NCAA college football since 2000. All but two have come in that January-August window. Jordan Bernstine posted on Facebook last week about the rigors of Iowa's workouts.

That's non-traumatic as in, no game, no hitting. Mostly just ... working out. Eleven of those deaths are clustered at the top level, Division I-A. The latest death, Ole Miss' Bennie Abram, isn't even a year old. Still, the Kill Season moves on, largely unregulated judging by the early returns from Iowa on Tuesday. Twelve Hawkeyes were rushed to the hospital Monday with what the Cedar Rapids Gazette described as exertional rhabdomyolysis. It's a condition caused by overexertion that leads to the breakdown of skeletal muscle. As the muscle breaks down, it releases toxins into the urine. One Iowa player reportedly involved posted this on his Facebook page according to reports: " ... in the hospital ... turns out its bad news bears wen ur wiz is brown."

I'm pretty sure that when parents and players signed those scholarship papers, there was no disclaimer about brown urine. An Iowa release said the players were in "safe and stable condition." That sounds reassuring. But post-winter conditioning news shouldn't have to be reassuring. It's never a good thing when athletes who go into a workout come out "responding well to treatment."

To be fair, there is a long way to go figuring out exactly what happened at Iowa. As of Wednesday morning, the school said that the hospitalizations were "likely related" to the program's offseason drills. Per NCAA rules, players can participate in supervised, two-hour workouts daily. There is a limit of eight hours per week. No one has died in a I-A game in that time frame. No one has died during that period in a formal practice at a I-A program during that time. The deaths have been clustered in the offseason and at big-time programs.

In the past year, noted Oklahoma head trainer Scott Anderson has spoken before the American Football Coaches Association, the National Athletic Trainers Association, the National Association of Collegiate Directors of Athletics and the National Strength Coaches Association. His message:

"The way we're training college football players in this day and age is putting them at risk," said Anderson, also current president of the College Athletic Trainers Society.

Anderson was not speaking specifically about Iowa but it's clear the culture has to end. There is example after example of players being driven too hard, too fast and for too long in offseason conditioning. It's a macho thing for the coaches. It's a badge of honor for (some) players to throw up in a trash can. Thursday marks the 10th anniversary of the Oklahoma State basketball team's plane crash that killed 10 men on the way back from a road trip. Schools across the country have changed their travel and safety policies when it comes to flying. As for offseason conditioning ...

"Twenty-one dead football players and we're still today training them the same way as we did dating back to at least January, February of 2000," Anderson said.

The rash of recent deaths basically started in 2001, when Florida State player Devaughn Darling died during a so-called "mat drill," an intense series of training stations. In 2004, the family settled with FSU for $2 million but contended in the suit that Darling was not provided water during the drills. There is still disagreement about Darling's cause of death but both Devaughn and surviving brother Devard, who transferred from FSU to Washington State after the death, were found to have the sickle cell trait. A portion of those 21 deaths can be traced to the condition that causes blood cells to "sickle" during overexertion.

The first known case of sickle cell trait causing a death at the NCAA level was discovered at Colorado in 1974. It wasn't until last year -- after a lawsuit involving a deceased Rice player -- that the NCAA mandated schools test for the condition.

"The intensity with which it [offseason drills] is done is not sport specific," Anderson said. "The intensity becomes irrational. The intensity, if not the drill, is wholly, fully irrelevant to sport. It's just purely, openly punishment, not performance."

Again, Anderson was speaking in general, not about Iowa. Hawkeyes strength coach Chris Doyle, 42, has been at the school since 1999. He previously worked in strength and conditioning at Utah and Wisconsin. Doyle did not immediately return a phone call seeking comment. Anecdotally, though, the picture is becoming clearer. The Des Moines Register reported that six days ago the Facebook page of Iowa player Jordan Bernstine stated, "Hands down the hardest workout I've ever had in my life! I can't move!"

The NCAA Manual states that a member of the "sports medicine staff" must be present at all voluntary conditioning drills conducted by the strength coach. That medical staff member must have the "unchallengeable authority" to cancel or modify workouts for safety reasons. An Iowa spokesman said Wednesday he did not know whether a medical staffer was present at the workout.

We probably won't know the Iowa details for a while, but one player going to the hospital is unacceptable. When 13 players go to the hospital, all with the same condition, I'm not the only one who thinks someone should be fired. The workout culture of a football program must be changed. The shame of it is, none of this is new. It's no secret that most of college football's deaths in the past decade largely haven't resulted from playing college football.

The question is why coaches feel compelled to carry on this brutal practice. Mat drills. Throwing up. Championships may be won in the offseason but lives are put at stake, too. Depositions in a wrongful death lawsuit against Missouri showed "trainers and strength coaches ... knew little about warning signs of exercise-induced trauma brought on by sickle cell trait," according to a 2009 wire story.

Players are being worked to death and there is no reason. When the Iowa story broke, a highly placed source involved in student-athlete health care e-mailed me Tuesday night to say, "We are at the onset of the most dangerous and deadly season -- NCAA off-season football conditioning ... or what passes for conditioning."

Until the culture of football changes, might as well call it what it really is: The Kill Season.

Topics: rhabdomyolysis, iowa football, football off-season workouts

Mental toughness training meet your good friend Rhabdo

Posted by Boston Sports Medicine and Performance Group on Thu, Aug 26, 2010 @ 06:08 AM

Just in case you missed it, earlier this week 19 Oregon Football Players were hit with a “very weird” illness after a  workout session.  One doctor called it a compartment syndrome, I’m guessing this one smells a bit more like Exertional Rhabdomyolysis (RAB-DOE-MY-O-LIE-SIS) or Rhabdo. 

What is this strange animal you may ask? Simply stated, Rhabdo is a rapid breakdown and destruction of skeletal muscle resulting in the release of muscle fiber contents or myoglobin into the bloodstream. Symptoms include:muscle pain, weakness and swelling along with cola colored urine.

No problem right? That’s how you build big muscles, you tear um down first to then build them bigger and better! What doesn’t kill you makes you stronger!

dunk shot
Well, not exactly. You see, Rhabdo can ultimately lead to death via kidney failure.

So what causes Rhabdo?

The list includes but not limited to:

• muscle trauma or crush injury
• severe burns,
• physical torture or child abuse
• prolonged lying down on the ground (people who fall or are unconscious and are unable to get up for several hours)
• prolonged coma,
• severe muscle contractions from prolonged seizures
• cocaine use with related hyperthermia (increased body temperature),
• extreme physical activity (running a marathon),
• low circulating phosphate, potassium, or magnesium levels in the blood (electrolytes)
• prolonged drowning or hypothermia (low core body temperature)
• lack of blood perfusion to a limb

Pretty extreme stuff isn’t it?  Here is some more info:

Other contributing factors include: initial fitness level at the beginning of a training program, extreme heat and levels of dehydration.

Now I wasn’t in Oregon this week, nor do I have any additional information regarding the type of training these young men were doing and for the purpose of this rant it doesn’t matter.  My only goal is to provide a basis for conversation between your Sports Medicine and Performance Departments on how to recognize the onset of Rhabdo, and better yet avoid it all together.  And although there’s plenty of football and hockey dads out there that pay good money to coaches around the country to make their kids puke during workouts, I hope that a culture of “superdiscipline” and common sense instead becomes the standard conditioning test this fall.

Now drop and give me 500!


Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at

Topics: athletic training, Strength & Conditioning, Health, mental training, rhabdomyolysis, discipline, evidence based medicine, mental toughness