Friday, August 27, 2010

When athletes are injured

By Tom Grant
PhD student, Center for ETHICS*

A coach in McMinnville, OR, is struggling with the burden of whether something he did caused harm to his athletes. It’s a burden many coaches face in their careers.

During an intense series of football practices, 24 players became ill and sought treatment at a hospital. Media reports say the 21 of the players were treated for high levels of creatine kinase (CK) in their blood, and three had surgery for compartment syndrome in their upper arms.

An investigation has been launched into the cause of the injuries, because outbreaks such as this one are rare. A state health official said many of the athletes were diagnosed with rhabdomyolysis, which is characterized by elevated CK and can lead to compartment syndrome. Rhabdomylosis is often associated with muscle injury or strain, and most commonly manifests in crushing injuries.

The media and some doctors have already begun speculating that the players were using the over-the-counter supplement creatine, which both players and coach deny. But the coach — the adult who ran practice — has been on the hot seat. A high school coach is responsible for the well-being of the players. Coaches in all sports are charged maintaining a safe environment for athletes.

In an interview, the coach described practice immediately preceding the injuries as including repeated sets of wind sprints, dips, push-ups and sit-ups. The temperature outside was over 90 degrees, and part of the practice took place in the wrestling room, where some reports put the temperature at 115 degrees.

The McMinnville instance may be rare, but similar outbreaks have occurred. One group of female lacrosse players developed rhabdomyolysis following the first weight training session of the year, where each athlete performed three sets of biceps curls with a 15-pound load.

In Taipei, 119 high school students developed rhabdomyolyis after being required, on a very cold day, to perform 120 push-ups within five minutes. Dehydration and electrolyte abnormalities may predispose athletes to rhabdomylosis. Sudden and drastic changes in muscle activity may also contribute to the condition.

The condition even gets attention in professional football and some say it’s more common that we know in the NFL.

No coach can predict all the circumstances in which a player may be harmed. And we don’t want to speculate in this case. However, a high school coach can be expected to have a moral value system that places great emphasis on the health and safety of the players. The philosopher William Frankena argues that one of our primary values should be beneficence. Beneficence means four things, Frankena says: Inflict no harm, prevent harm, remove evil and promote good.

Regardless of what caused the outbreak in McMinnville — and in this case we begin with the assumption that the coach did nothing to inflict harm to the athletes — a coach who subscribed to the principle of beneficence would still have a duty to prevent harm now and in the future. What should a coach do to prevent harm when next summer’s football practice opens or when other teams begin intense practices in preparation for the season? Do coaches on other teams, having seen what happened in McMinnville, now have a duty to do something more to prevent harm on their own teams?

If a coach accepts the responsibility for preventing harm to the players, that coach must also take responsibility to be fully educated about the risks posed by the coaching practices he or she employs. Good coaching practices require that we demand a full explanation of what happened in McMinnville, educate ourselves, and use our knowledge to prevent other athletes from suffering similar consequences.

Here's what Dr. Sharon Kay Stoll says on that subject.

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