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Voices & Opinion

POV: It’s Unthinkable That Athletes End Up Hospitalized by Workouts Designed to Make Them Better

Exertional injuries are one of the leading causes of death in collegiate sports: most of them are preventable

Every year in my Methods of Coaching class I show a clip from the movie Miracle on Ice, about the 1980 Olympic hockey team. The scene shows the coach furious with the team’s distraction during a game. He decides afterwards to skate the players until they’re exhausted—some are even vomiting. This is portrayed as a pivotal point: the coach builds them into a unified, “mentally tough” team that then goes on to win Olympic gold. Some students accept this as an inevitable way forward, while others have questions.

Recently, I asked students, “What is the leading cause of death in collegiate sport?” Using the National Standards for Coaching, I explained the difference between catastrophic injuries and exertional injuries. With catastrophic injuries, the leading causes of death are traumatic injuries to brains, spinal cords, and internal organs. Exertional injuries are the “result of exertion while participating in a sport activity or by a complication that was secondary to activity.” Surprisingly, exertional injuries are one of the leading causes of collegiate sport deaths.

While sport carries risks, the rate of death from exertional injuries, incredibly, outweighs the rate of death from catastrophic injuries in the sport of football by a ratio of 5:1. And that ratio has stayed steady for decades. In class, I try to make the case that most of these exertional deaths are preventable simply by doing two things: providing appropriate work-to-rest ratios coupled with modifications for individual risk and precautions.

Tragically, a few days after that class the Tufts men’s varsity lacrosse team participated in an optional off-season workout led by a former teammate who had recently completed Navy Seal BUDS training. Twelve members who took part in a 45-minute “workout” ended up hospitalized with a life-threatening condition called rhabdomyolysis, where muscles heat up and overwhelm the kidneys. I am deeply saddened for the entire Tufts community, the team, and their families, and am praying everyone recovers fully.

But what is the deeper reason in our sport system that these incidents keep happening? And why do we fail to correct it? It should be unthinkable that athletes end up hospitalized by workouts designed to make them better.

What changes might provide a way out of this coaching morass?

First, change the mindset about toughness. While the Tufts incident did not happen under the direct supervision of coaches, many coaches are trying to transform their players to be “mentally tough” through a Special Ops approach. As a former college football coach, I heard this incessantly from fellow coaches. To be fair, mental toughness is a required attribute of anyone who is successful. But there are many reasons teams have success: skill, teamwork, trust, technique, understanding the game plan, timing and execution, communication, etc. Button down all of those as a coach and you are likely to be seen as a pretty “mentally tough” team. Toughness influencers like former Navy Seals Jocko Willnik and David Goggins are all over the internet of dudes. We can learn something from the tactical warrior grindset, but an educated coach would be unwise—even negligent—to expose players (or children) to some of the methods of military boot camps.

Second, expand supervision of coaches. Young coaches trying to establish a new team culture seem drawn to these sorts of toughness-hardening methods and use exercise as punishment. At every level of sport there is inadequate supervision of coaches. Athletic directors are so busy attending to fundraising, facilities issues, and dealing with difficult parents that most do a poor job of even monitoring—let alone guiding and developing—young coaches to ensure the health and safety of the players.

Third, work with athletic trainers. Certified athletic trainers are healthcare professionals in college sport. Working with them to follow guidelines for heat exposure and adequate recovery and spotting those players that are not likely to tolerate highly demanding workouts would prevent the worst sorts of outcomes. Also, we now have tools that monitor physiology, like Fitbits, Whoop watches, and Catapult vests that measure training load. These should be used.

Combined, these three changes would ensure that at the least, coaches could avoid doing this sadly preventable harm.

John McCarthy is a clinical associate professor of applied human development at Wheelock College of Education & Human Development and director of Wheelock’s Institute for Athletic Coach Education. He can be reached at coaching@bu.edu.

“POV” is an opinion page that provides timely commentaries from students, faculty, and staff on a variety of issues: on-campus, local, state, national, or international. Anyone interested in submitting a piece, which should be about 700 words long, should contact today@bu.edu. BU Today reserves the right to reject or edit submissions. The views expressed are solely those of the author and are not intended to represent the views of Boston University.