Jewish World Review August 15, 2001 / 26 Menachem-Av, 5761

Drs. Michael A.Glueck & Robert J. Cihak

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Consumer Reports

Time to take coaches to the woodshed -- If you think some football coaches are the same as you and me, we suggest you talk to a few. The sad truth is that many coaches, from high school to the big football colleges and the pros, will try to win at all costs. They're allowed -- and in some cases expected -- to do so. Why? Because it's all about winning, and winning is about money. And if somebody gets crippled or killed...well, "stuff" happens.

Let's say up front that we are not for discontinuing football or other sports because of injuries. However, as physicians, we are strongly in favor of minimizing these happenings, especially when they are preventable.

Heat related deaths, as in the case of Minnesota lineman Korey Stringer, are totally unacceptable, since they can be virtually eliminated with simple common sense precautions. Unfortunately, this latest incident is only the tip of the thermometer. We hear about it in the mainstream media only because death from a 108 degree core body temperature is so sensational and final. In the last week -- during the preparation of this column -- there are new revelations about the heat related deaths of two college and one high school student as well.

Every day during training, too many coaches push young athletes too hard, both physically and mentally. Most injuries are not reported in the daily press because they do not result in fatalities. Some coaches treat players like expendable commodities; too many players expect to be treated that way. Some players may not complain of pain, fatigue or shortness of breath because of fear of being called a "wimp," "wussie" or worse. It's pathetic that so many young men buy into a false "macho man" facade. Real warriors don't kill themselves on the training fields; they train so they can go to battle, win and survive. General Patton said, "The more we sweat in peace, the less we bleed in war." He didn't say, "let's go kill each other on maneuvers."

A relative of one of these writers was a high school quarterback 15 years ago. During a team weight lifting session, the players were strongly exhorted to top their personal best. Afterward, the QB suffered severe lower back pain. Conventional x-rays and other studies were negative. Unable to run or play, he heard insults and was called every imaginable name by the coaches, which was then imitated by the players. Three weeks later, nuclear bone and CT scans revealed multiple stress fractures of the lumbar spine. The players had the grace to apologize and wish him well. The coach never did.

Now, we hate lawsuits --- no need for one here. But perhaps the next time a player dies from heat stroke, the local DA might consider and publicly talk about filing a manslaughter charge. After all, these government prosecutors have no qualms about -- even seem to enjoy -- charging professionals such as psychiatrists and other medical specialists with malpractice or murder when they have done nothing wrong. One charge of manslaughter and this T and A -- testosterone and androgen -- laden situation would find a reasonable solution faster than Randy Moss catching a pass and running for a touchdown!

Lance Scott, a 300 pound lineman, who played two years for Arizona, three for the New York Giants, and one for New England, is sitting out this year to recover from a knee injury. Says Scott, "Sometimes the players won't tell their coaches if they are hurt or sick. However, in this case Stringer was obviously in trouble for several days and vomited the previous day. You think someone would have picked this up and had him sit out a day. After all, Stringer was an All-Pro and there was no chance of him being cut." In Stringer's case he did not suffer from the "few days to fight for a job" syndrome.

Brian E. Clark, reporter for the San Diego Union Tribune, told us, "Training kills and harms far more players than getting their heads busted -- immediately and in the long run." There are some fascinating stats about football players as a group dying early -- often in their 50's.

The "Annual Survey of Football Injury Research," 1931 - 2000, last updated March 23, 2001, is authored by Frederick O. Mueller, Ph.D., Chairman, American Football Coaches Committee on Football Injuries and Jerry L. Diehl, Assistant Director of the National Federation of State High School Associations. In this comprehensive survey, football fatalities are classified as direct and indirect:

DIRECT: Those fatalities which result directly from participation in the fundamental ACTIVITIES of football.

INDIRECT: Those fatalities which are caused by systemic failure as a result of exertion while participating in football activity or by a complication which was secondary to a non-fatal injury.

Here are some main points abstracted from Mueller's and Diehl superlative study:

  • There were about 1,800,000 total football participants in the United States during the 2000 football season.

  • There were three DIRECT fatalities related to football during the 2000 football season. All were associated with high school football. Most direct fatalities occur during regularly scheduled games. All three took place in September.

  • In many cases, football itself is not directly responsible for fatal injuries, such as deaths from heat stroke or heart related. In 2000 there were twelve INDIRECT fatalities. Ten were associated with high school football, and two were associated with college football. Both of the college indirect fatalities were heat-related.

  • Four cases of heat stroke death occurred in 2000. In the past five years, 13 young football players have died from heat stroke.

Mueller and Diehl recommend the following measures for training staff to reduce these needless deaths:

  • Before organized practice begins a qualified medical practitioner should examine each athlete, and evaluate the significance of the medical history for previous heat illness and other training illness or injury.

  • Acclimatize to seasonal athletic activity with graduated warm-up practice sessions for the first seven to ten days.

  • Because it is more difficult for the body to cool itself in high humidity, know both the temperature and the humidity. On hot or humid days, such as when the wet-bulb temperature is over 78 degrees, moderate the training drills to reduce exertion appropriately.

  • Provide frequent rest periods. Rest in cool, shaded areas with some air movement and remove helmets and loosen or remove jerseys. Rest periods of 15-30 minutes should be provided during workouts of one hour.

  • Provide adequate cold water replacement during practice.

  • Salt should be replaced daily; liberal salting of the athletes' food will do this. Coaches should not provide salt tablets to athletes and should warn athletes about using them on their own.

  • Athletes should weigh in each day both before and after practice. Participants and trainers should check weight charts in order to identify and treat athletes who lose excessive weight. Generally, a three percent body weight loss from sweating is safe, but a five percent loss is in the danger zone.

  • Players should avoid use of long sleeves, long stockings, and any excess clothing. Never use rubberized clothing or sweat suits because they prevent the normal cooling effect of sweat evaporation.

  • Athletes with previous heat problems should be closely watched.

  • Watch for trouble signs of possible heat illness, such as nausea, incoherence, fatigue, weakness, VOMITING, cramps, weak rapid pulse, flushed appearance, visual disturbances, and unsteadiness. Contrary to popular belief, victims may sweat profusely.

In addition there are some things that coaches say that really scare us.


  • During weight training when you hear a coach or trainer say, "No pain -- no gain." WRONG. Pain means injury has occurred or is being incurred. Continue too long with the pain and you may miss the next game or season! Don't forget our 'no brain -- no pain" heads up alert.

  • "Suck it up. Play through it." WRONG AGAIN. This time you may complete the job of totally destroying your knee, ankle, shoulder or elbow and never play again.

  • "Men, it is time for a gut check." The next time you hear one of those dimwitted coaches use this phrase pick him up and take him to the nearest hospital for his brain check or a CT/MRI head scan.

Our last point is that some of this "endurance training" may be overdone. A few years ago the first author did a study at the insistence of his wife, Mimi, who complained that most of the time there is no action in football. As a disbeliever and armed with a stopwatch he precisely measured the time the football was in play during a 60 minute game that lasted four hours one long Super Bowl Sunday.

He was embarrassed when he found the time to be 13.5 minutes. That left 3 hours and 46.5 minutes for players to recover between plays. Also consider that each team has units for offense, defense, kick offs, kick off return, punts, punt return, field goals, field goal defense, extra points and extra point defense. So in actuality each gladiator only plays a portion of the 13.5 minutes. This is partially because of television time-outs for endless commercials, which you don't have in high school and most college games

As a small aside, the team owners and mainstream sports writers don't want us to know this because then we will realize what fools we are. A decent seat to see the replacement Cleveland Browns at home costs $252.00. That's for one game -- not season tickets! Do the math to see how many dollars per minute of play you pay. [In fairness, we must say that there are many excellent and concerned coaches who look out for all aspects of their athletes' welfare. However, to some coaches, players and avid fans, sports has become more important than life. We disagree. We think life is more important than death.]

Those who prefer permanent injury and death can always take up the Pankration, an ancient "no rules to speak of" Greek Olympic combat event which used boxing gloves with metal studs, among other things!

Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes on medical, legal, disability and mental health reform. Robert J. Cihak, M.D., of Aberdeen, Wash., is president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists who write numerous commentaries and articles for newspapers, newsletters, magazines and journals nationally and internationally. They thank Phil Gould of Seattle, WA for his contribution to this commentary. Comment by clicking here.


08/10/01: Blood, Guts & Glory: The Stem of the Stem Cell controversy

© 2001, Michael A. Glueck & Robert J. Cihak