Kids and Rhabdo

The Dangers of Pushing to the Limit

Some news stories stay local, some make it national. As we all know, it’s typically a negative reason when a story gets extra attention. We had a story local to the Dallas-Fort Worth Metroplex (where King Sports is based out of) that ended up making national news.

Rhabdo in the News Again

I’ll briefly reset, but I’m not trying to pile on so I’ll refrain from mentioning the coach or the school because that’s not what’s pertinent to the discussion. We all make mistakes, and the coach involved is dealing with the consequences.

During a workout in the beginning of January, high school athletes from a local school were instructed to do an excessive amount of push-ups as a punishment. As a result, several players were hospitalized for what is known as rhabdomyolysis, or “rhabdo” for short.

That’s all the context you really need.

Failing to Prepare is Preparing to Fail

It was the first week of January, so school had just resumed from Christmas break - a break where most kids do little to no training. This included a football team, and football players at this time are typically coming off of a long season. Winter break is rightfully a good time to rest before the start of a new semester and new off-season grind.

The timing alone stood out. Week one is not the time to test kids in this manner. You’re only going to prove that water is wet.

I can understand the perspective. Coaches want to develop mental toughness. They want discipline. However, if you are going to shock their system, you better have a set of checks and balances in place.

You obviously don’t have an independent third party observing high school workouts like the NFL has with concussion protocol during games. I get that budgets often lead to challenging ratios. Even if it’s just an assistant, you need somebody who doesn’t just go along because you're in charge to help monitor the training session.

An athletic trainer comes to mind. Most schools have at least one. If you have a workout that intends on having certain parameters (such as x amount of punishment for y amount of mistakes) with the intent similar to this story, then communication alone can be a safeguard.

Are Push-Ups Safe?

The obvious answer is yes. Some movements, like Olympics, such as cleans, jerks and snatches are more technical and dynamic, thus having greater risk. Push-ups are one of the safest movements in training.

Push-ups are a great exercise and testing activity. Don’t let this keep you from using this universally beloved exercise. Like other body weight exercises, they are self-limiting, that is, the range of motion is clearly set.

They easily expose a person's weakness in the upper body. Push-ups are not automatic. Even a fresh athlete can reach failure quickly. It’s that much more different when somebody is already fatigued. It’s important to understand that stress is cumulative. So even after a running workout, the body has been experiencing stress that must be accounted for.

The signs are clear if you pay attention. Struggle is easy to observe. This doesn’t even account for crossing what should be a clear threshold of volume or load. I’m referring to the general point of physical exhaustion which is hard to hide. Smiling and nodding can't hide labored breathing, deteriorating posture and poor technique. This is when you’ll see athletes “kip” to get through each rep or the hunching over or hinging at the hips to breathe.

If a kid is struggling with a movement, have a protocol. Sometimes there is a modification. I encourage scaling as often as appropriate. Scaling a push-up is simple. My preferred way of modifying to keep work going is to assign the number of push-ups and if they reach a point of not being able to do correct push ups, say after 5, I have them hold their bodies in the up position of the push up and finish the count until 10. Works every time, but if no amount of modification helps, live to train another day!

If the goal is to achieve something “mental” or otherwise, then the method is incompatible with King Sports Training if it’s compromising quality or safety.

How Rare is Rhabdo?

It’s rare because thankfully most coaches and trainers understand when to cease and desist.

The most recent newsworthy instance I recall before this year was of female athletes at a North Texas university participating in a workout that generated cases of rhabdo. You hardly heard of this happening before 2017 after all my years of playing, training and doing things no one should do working out.

Yet, around the same time then, I had a client who had retired from competitive athletics and joined a facility that did a style of competitive training. He came to me and told me how he was hospitalized due to rhabdo after a certain workout so he decided to withdraw from that style.

Whatever the reason, it’s becoming more frequent, but what bothers me is when it happens to teenagers.

How at this point in our advancement of sports medicine and athletic performance training do we even get close to something like this? We educate coaches and parents to help you develop athletes, but it just so happens to also protect kids from potentially reckless training when applied properly. Carefully planning training sessions to match the ability of the athletes is a responsibility we have when working with kids.

We have accidents and make well-intentioned mistakes, but we need to control what we can control. I understand the isolated incidents may be the outliers, but what about unreported incidents? Just don’t let it come to this.

Control what you can control

Now what can we control?

The five words I deal with all the time: volume, load, intensity, frequency and duration.

These must be accounted for in your programs. You can evaluate strength and fitness without casualties. No one needs to get off easy, mind you, but it is unlikely they will need medical attention.

My first high school head coaching job was for an expansion program that had never played varsity football before. I knew these kids were in for a physical shock not just for the first day of August practice but for the 4th quarter of their first varsity game. Not only were we going to have many two-way players, most were going to have to play special teams. They had to be in shape.

We (my staff and I) put together a grueling conditioning program for training camp. We knew the volume was capped, the load was reduced (equipment off), intensity was a set pace, frequency was a set rest and duration was not to be extended under any circumstances.

When it was time to condition, I had an athletic trainer nearby with assistant coaches watching as well as we administered the program.

We had consistent water and timeouts, which in reality just imitates every sanctioned sport. Supervision was taken very seriously as we constantly watched players to make sure they were succeeding. At any time if there was ever a player who said they were injured or sick or whatever, I wouldn’t argue. Off to the trainer they went for evaluation - an automatic.

Coaches, parents and trainers: let’s be smart. “Weeding out” the weak ones is a coaching practice that can be done in a way that nobody gets hurt.

The Junction Boys

A story that comes to mind relating to this was turned into a book, then a movie.

One of the most famous football coaches of all time is Paul “Bear” Bryant. One thing he was known for was the time he took his college football team to Junction, Texas, for a training camp some 70 years ago. Long story short, many players “retired” due to the conditions of the training camp.

Knowing what we know now about the heat and hydration and other physiological science alone, it’s fair to say that the means probably didn’t justify the ends. At the very least, if an athlete nearly dies, let’s just assume there are mistakes being made. Besides, I don’t think the SEC schools winning national championships almost every year nowadays are using the same methods.

I often say, “train aggressively, train intelligently.”



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