The dog days of summer and the opening of training camp can prove a fatal combination for high school football players as researchers have discovered August can be the deadliest month of their season.
At the American Orthopedic Society for Sports Medicine annual meeting, Dr. Barry P. Boden of the Orthopedic Center in Rockville, Md., presented numbers revealing most nontraumatic fatalities among high school and college players do not occur while playing the game of football, but rather during conditioning sessions.
Of the 187 reviewed fatalities occurring between 1998 and 2018, more than half, 52%, were because of cardiac issues; 24% were caused by heat and 5% from asthma.
“The majority of deaths occurred outside of the regular season months of September through December, with the most common month for fatalities being August,” Boden said.
Additionally, football was found to be associated with the highest number of fatalities of any high school or college sport.
Dr. Todd Franco recommended simple solutions to help reduce the risk for area athletes as training camps officially start Monday in the WPIAL after three days of heat acclimatization drills this past week.
Franco, who practices with Allegheny Health Network, specializes in sports medicine and physical medicine and rehabilitation. The Mt. Lebanon resident serves as the team physician for Chartiers Valley High School. He also fills in at Upper St. Clair, Bethel Park and Peters Township in the absence of Dr. D.J. Phillips and Dr. Bob Schilken.
Franco abides by the adage an ounce of prevention is worth a pound of cure. He said a healthy outcome on the football field begins with the pre-participation physical. The PIAA, the state’s sports governing body, requires this of all athletes prior to their designated season.
“For me, the pre-participation evaluation is the most important thing. You can’t control the weather and you can’t control what coaching staffs do, but you can identify a preventable event provided participants and their parents are honest when filling out their family history.”
He said too often parents are seeking the fastest way to get through the paperwork. Additionally, the athletes are not anxious to reveal too much.
“They think, ‘oh wow, they won’t let me participate,’” Franco said.
According to Franco, the pre-participation physical is a great way for doctors to gather clues.
“It is not a fruitless venture,” he said. “If you do identify a risk, then you can get a further workup. No matter what you do, it’s still possible to miss something. But the idea is to identify risk factors so that we can prevent things from happening and so we can let them participate safely.”
Since the WPIAL instituted its heat acclimatization program prior to training camp, football players have been participating a little more safely in their conditioning drills.
Noting the athletes are participating in their “most intense practices” during the hottest month of the year, Franco advocated at least seven days rather than the designated three to adjust to climate conditions prior to donning full gear.
“I would love for a longer period, but (three days) is a start,” he said.
While the 365-day training engaged in today is a “challenge,” Franco noted football players are not going full gear during the summer months prior to training camp.
“That doesn’t happen until Day 1,” he said. “When you put on the pads and helmets that changes the core body temperature. And, obviously they are doing it when the heat is more pronounced. August is the hottest month and for sure that’s when temperatures are at their warmest and humidity levels are highest.”
Franco said it is imperative to be aware of the heat and the level of exertion during periods of intense workouts.
“Because of the time of year, the intense training in a condensed period of time and all the equipment, which decreases the ability to sweat, football is a high-risk sport,” he said compared to cross country, soccer, tennis, volleyball and field hockey, all of which commence with the onset of the school year.
“We can’t change when football is played,” Franco continued, “but we can prevent exposure to heat and humidity.”
Avoiding training during the day’s most intense temperatures is critical. However, athletes can do simple things to successfully navigate football training camp.
According to Franco, nutrition, hydration and proper rest play critical roles in a healthy outcome for all athletes, particularly football players.
“No. 1, certainly is hydration. Not just during active workouts, but prior to and post activity because dehydration increases the rate for heat issues,” he said. “Hydration is essential. So, hydrate, hydrate, hydrate.
“Appropriate nutrition and sleep are important. Sleep is when our body rejuvenates itself,” he added.
While it is “easy to fix” those three areas, Franco also recommended listening to the team trainer. Even coaches should heed the advice of trainers.
“Depend of their expertise,” he said. “That’s what they are trained to do. We are lucky to have well-trained folks on the sidelines so we should listen to them. All the players and the staff should listen to the trainers.”
Then perhaps, August can become just another month in the football season for avid athletes.
“Most of it is heat-related and dealing with the level of exertion during this peak training period. It’s important to be honest. Athletes need to be honest with their physician and in practice, if they are exhibiting symptoms, they need to be honest with the coaching staff and trainers,” Franco said. “It’s a matter of being safe than sorry.”
Boden agreed with that assessment as part of his report.
“Conditioning-related fatalities are preventable by establishing standards in workout design, holding coaches and strength and conditioning coaches accountable, ensuring compliance with current policies, and allowing athletic health care providers authority over medical decisions,” he said.