Navigating NCAA Regulations: The Urgent Need for Coaches to Prioritize Athlete Health and Safety During Summer Training "Dead Periods"
- Mo Frazier
- Oct 3, 2024
- 11 min read
By Mo Frazier, DNP, CNM, ARNP
Table of Contents
The summer training period is a challenging time for NCAA coaches, particularly in endurance sports like cross country and track. NCAA bylaws limit how much direct contact coaches can have with their athletes during this period, restricting their ability to offer feedback or oversee training.¹ While coaches can provide a general individual workout program, they cannot conduct or supervise the workouts. However, athletes can request voluntary workout assistance from coaches, giving coaches some flexibility as long as the athlete initiates it. Coaches can also provide summer training guidelines before they leave, but cannot check on their progress unless they voluntarily share that information. These restrictions pose a dilemma when athletes are at increased risk of injury, overtraining, or Relative Energy Deficiency in Sport (REDs).
Let me explain.
For example, imagine a coach with an athlete who has a known history of two bone stress injuries. Before summer break, the coach provides a general training plan, outlining a gradual build to 40 miles per week, one complete rest day, and 1-2 days of cross-training, along with some basic workout guidelines. The athlete logs all their workouts on Strava, where the coach can see their progress. Initially, everything seems to be on track.
However, as the summer progresses, the coach notices a red flag: the athlete’s mileage rapidly increases from 40 to 70 miles per week in just over a month. Despite this significant jump, the athlete posts enthusiastically about how great they feel, claiming this is the best training block of their collegiate career. According to NCAA rules, unless the athlete reaches out for guidance, the coach is unable to step in or provide feedback. The coach might also have 70+ other athletes to monitor and is doing their best to juggle training recommendations within the constraints of limited staffing. Since the athlete isn’t reporting any injuries or fatigue, they slip through the cracks.
What the coach doesn't know is that the athlete is still severely underfueling, has low bone mineral density, and is engaging in high-risk exercise behaviors. By the time the cross-country season officially begins, the athlete develops another bone stress injury—this time a stress reaction in their fifth metatarsal—making it their third bone injury in three years. This is a painful example of how these coaching limitations, combined with the athlete’s undetected behaviors, can lead to serious consequences.
So the real question is: How can coaches step in when they observe concerning patterns and behaviors without overstepping NCAA regulations?
NCAA Guidelines and the Gray Area
Saying it again for the people in the back: NCAA Bylaws 17.1.6.3.5.1 and 17.1.6.3.5.2 outline restrictions on coaching oversight during the summer. Coaches may develop general individual workout programs for athletes but are prohibited from designing specific day-to-day training plans or conducting the workouts themselves. However, strength and conditioning personnel are allowed to monitor summer workouts for safety purposes (Bylaw 17.1.6.3.5.1).¹ This exception for strength coaches exposes a double standard in the regulations, as running coaches, unlike their strength counterparts, are not allowed to oversee workouts to ensure safety by preventing overtraining or injuries—even when they spot warning signs on platforms like Strava or hear concerns from other athletes about their teammates' safety.
NCAA rules also permit voluntary individual workouts during the summer, but only under specific conditions. For example, athletes in individual sports like tennis or golf can request help from their coach for skill instruction, but this must be voluntary and initiated by the athlete themselves (Bylaw 17.1.6.3.5.2). While these policies aim to prevent coaches from overstepping boundaries and give athletes autonomy, they create challenges for coaches who want to protect athletes from preventable health issues.¹
Notably, wrestling coaches are allowed to oversee workouts to ensure certain maneuvers and skills are practiced safely to prevent injury (Bylaw 17.1.6.2.1). This exception again highlights a double standard, as running coaches, unlike wrestling, cannot supervise workouts to ensure safety.¹
The Strava Dilemma: Monitoring Without Overstepping
Many athletes voluntarily share their training data on platforms like Strava, where coaches can see daily mileage, workout intensity, and even performance metrics. However, even when coaches observe concerning signs—such as sudden spikes in mileage, signs of underfueling, or obsessive training patterns—they may feel limited in their ability to intervene. The question arises: If a strength coach can monitor weightlifting workouts for safety, why can’t running coaches do the same for endurance training?
Given the inherent risks of overtraining, coaches face an ethical dilemma. While NCAA Bylaw 17.1.6.3.5.2—commonly referred to as the "health and safety exception"—allows coaches to provide assistance during voluntary individual workouts under specific conditions, the guidelines are vague.¹ This exception permits coaches to intervene when there are legitimate safety concerns, such as preventing injuries or overseeing activities where improper execution could lead to harm, like ensuring safe techniques in sports such as wrestling. However, the ambiguity in the rule often leaves coaches uncertain about when it's permissible to step in, potentially delaying critical interventions aimed at safeguarding an athlete’s health.
Safety vs. Autonomy: Weighing Health Risks
The tension between respecting athlete autonomy and ensuring safety is particularly problematic when it comes to athletes at increased risk of injury or REDs.
Relative Energy Deficiency in Sport (REDs) is a condition caused by low energy availability, where the body doesn't receive enough fuel to meet the energy demands of exercise and basic physiological functions. According to the International Olympic Committee (IOC), REDs affects multiple body systems, disrupting the balance between energy intake and expenditure. This imbalance can lead to hormonal dysregulation, particularly affecting reproductive hormones such as estrogen and testosterone, resulting in menstrual irregularities in women and reduced testosterone levels in men.²
Additionally, REDs compromises bone health, leading to decreased bone mineral density and an increased risk of stress fractures. The condition also impairs cardiovascular function, immune response, and gastrointestinal health, and can result in mental health challenges such as anxiety and depression.
Athletic performance is directly impacted as REDs can lead to a loss of endurance, strength, and coordination, further increasing the risk of injury. The IOC emphasizes that REDs is not only a short-term issue but can have long-lasting effects on an athlete's overall well-being and career if not addressed. Athletes, especially those with a history of eating disorders or energy imbalances, may be more vulnerable during unsupervised summer training.
In this context, the challenge for coaches and sports organizations is to find a balance between promoting athlete autonomy and ensuring safety. While allowing athletes the freedom to manage their own training can foster independence and personal responsibility, it also carries the risk of overlooking vital health signals. Coaches must be vigilant in monitoring training patterns and remain proactive in addressing any signs of distress, all while respecting the autonomy of student-athletes to make informed decisions about their training and health. Ultimately, fostering a culture of open communication can empower athletes to seek help when needed, prioritizing their safety without undermining their independence.
Coaches’ Responsibility: Safeguarding Athlete Health
Coaches have a profound ethical duty to protect their athletes' health, which extends beyond regulatory constraints. This responsibility includes identifying signs of distress, such as compulsive exercise, disordered eating, or behaviors indicative of overtraining, and intervening even when an athlete may deny any issues. The coach-athlete relationship is multifaceted, encompassing not only performance but also ensuring that athletes thrive both physically and mentally throughout their careers.
When athletes engage in harmful behaviors—be it overtraining, underfueling, or ignoring injury signals—coaches must exercise "reasonable care," a principle that mandates preventing foreseeable harm. Ignoring serious health risks, especially during voluntary training or the off-season, can lead to long-term damage and potential liability for both the coach and the institution.³
To fulfill this duty, coaches play a critical role in monitoring athletes’ training logs and identifying changes that may indicate overtraining. By prioritizing balanced nutrition and recovery, coaches can create an environment that supports athlete health. When signs of overtraining are observed, it’s essential for coaches to collaborate with athletic trainers or healthcare providers to address their concerns.⁴ These professionals can screen for unhealthy behaviors and refer athletes to appropriate resources for immediate assistance.⁵
Despite the clarity of their responsibilities, confusion often arises about whether coaches should flag athletes when suspicions arise. The answer is unequivocally yes. Research underscores the instrumental role of coaches in recognizing athletes at risk for overtraining and related health issues. Coaches' observations are crucial in identifying early signs of fatigue and energy deficiency.⁶ Furthermore, the National Athletic Trainers' Association stresses the importance of effective communication between coaches and healthcare providers to safeguard athletes' health and performance.⁷
For example, if an athlete shows signs of overtraining, a coach may not be able to provide direct training guidance without the athlete volunteering information. However, by expressing concern for the athlete’s well-being and reiterating best practices for recovery, a coach can still take proactive steps. This becomes even more critical for athletes with a history of serious injuries from overtraining. Organizations like the American Academy of Pediatrics advocate for early identification and prevention of overuse injuries to protect young athletes from long-term consequences.⁸
Recognizing the symptoms of eating disorders also falls within the coach's duty of care.⁹ If coaches identify these symptoms, they must act as a reasonable and prudent professional would, seeking medical attention to safeguard the athlete from further harm. Both coaches and institutions share the obligation to ensure athletes' health and safety, anticipating potential risks and taking action when there’s a reasonable chance of harm.
In essence, coaches must act in the best interests of their athletes when they observe signs of potential harm. They are not expected to predict exact injuries but to recognize that a reasonable person would foresee potential dangers. As the severity of possible harm increases, the threshold for intervention lowers, emphasizing the need for vigilance and proactivity in safeguarding athletes from avoidable risks. In doing so, coaches foster an environment that not only promotes athlete autonomy but also prioritizes their safety and well-being.
Revamping Pre-Participation Medical Screening Forms: A Necessity for Athlete Health
In collegiate athletics, coaches hold significant influence, particularly concerning medical oversight. NCAA Bylaw 17.1.5.2 mandates a pre-participation medical examination for athletes before they engage in voluntary summer conditioning workouts. This regulation ensures that athletes are fit to compete and presents a vital opportunity for coaches to spot potential health issues early on.¹ Medical screenings play a crucial role in identifying risks associated with conditions such as REDs and overtraining.¹⁰ By uncovering these potential issues, coaches and athletic trainers can guide athletes to essential resources tailored to their needs. For instance, if an athlete is classified as high risk according to the International Olympic Committee (IOC) Category 2 REDs guidelines, they may be referred for nutrition counseling, customized training plans, sports psychology support, and access to medical professionals.¹¹ This proactive approach not only enhances athlete well-being but also optimizes performance, ensuring that individuals receive the appropriate care and intervention before health issues escalate.
Despite the importance of these screenings, many athletic departments often lack adequate screening forms that effectively assess critical aspects of athlete health. Current medical forms frequently omit essential questions regarding menstrual health, overtraining, injuries, and eating disorders.¹² Research indicates that this oversight can lead to severe health implications, as athletes are at heightened risk for conditions related to compulsive exercise and overuse injuries when these factors aren’t properly evaluated.¹³
To address these gaps, the Female and Male Athlete Triad Coalition has developed an 11-question screening tool that could be integrated into pre-participation physical examinations.¹⁴ This assessment targets crucial areas such as body weight preoccupation, dietary restrictions, menstrual dysfunction, and bone health. Utilizing these screening tools can help athletic departments identify at-risk athletes and provide immediate support before the competitive season begins, fostering a healthier environment for all athletes. Such proactive measures not only comply with NCAA requirements but also empower coaches to make informed decisions about training loads, especially for athletes with a history of risk factors.
Effective collaboration among coaches, sports medicine professionals, medical practitioners, and certified athletic trainers is vital for providing athletes with the necessary care and support. This multidisciplinary approach ensures that athletes receive comprehensive guidance tailored to their unique needs, enhancing their overall health and performance. By working together, these professionals can identify health risks, implement preventive measures, and facilitate appropriate interventions, fostering a safer athletic environment. Research underscores the importance of this teamwork, emphasizing that coordinated care leads to better health outcomes for athletes.¹⁵
A Call for Reassessing NCAA Policies
The current regulations create an unclear boundary between permissible oversight and prohibited feedback. By allowing strength and conditioning personnel to monitor workouts but not running coaches, the NCAA sets up a discrepancy that overlooks the dangers of overtraining and REDs. Why should the safety of endurance athletes be treated differently than those lifting weights in a gym?
As the dialogue around NCAA policies grows louder, it is clear that a reassessment of summer training oversight is urgently needed. Coaches, sports medicine professionals, and athletes are increasingly raising concerns about the implications of these rules. By empowering coaches to prioritize athlete safety—not just performance feedback—many injuries and long-term health issues could be prevented.
Guidelines for Athletic Departments
Colleges and universities must take proactive steps to address a range of health concerns among athletes, including eating disorders, overtraining, REDs, compulsive exercise, and exercise addiction. To fulfill their duty of ordinary care, institutions should implement a comprehensive education, intervention, treatment, and prevention program that includes:
Education for Athletic Personnel: Training for athletic staff to ensure they provide competent supervision and recognize the signs of various health issues, including those related to nutrition and exercise behaviors.
Pre-Participation Screening: Establishing thorough physical and medical examinations and screening programs that assess athletes for risks associated with eating disorders, overtraining, and REDs before participation. Tools such as the Female Athlete Triad Coalition's screening questionnaire can be effective in identifying at-risk athletes.
Intervention Protocols: Developing clear intervention strategies and treatment plans tailored to address a range of issues, from eating disorders to compulsive exercise, ensuring that timely medical assistance is available when needed.
Prevention and Education Programs: Implementing comprehensive programs focused on preventing not only eating disorders but also overtraining and compulsive exercise behaviors. This includes promoting nutritional awareness and healthy exercise habits among athletes to mitigate risks associated with these conditions.
Athletic department personnel must remain vigilant and proactive, ensuring that they do not overlook warning signs or allow athletes to engage in harmful behaviors. Coaches and staff should advocate for necessary interventions if an athlete's symptoms suggest a serious problem. In cases where an athlete denies an issue yet exhibits concerning signs, the athletics department should have access to trained clinicians who can assess the situation and recommend appropriate actions.
By adopting these guidelines, institutions not only safeguard the health of their athletes but also demonstrate a commitment to their overall well-being, aligning with best practices endorsed by organizations such as the NCAA and the National Athletic Trainers' Association. This multidisciplinary approach will foster a safer and more supportive environment for all student-athletes.
Conclusion
In the evolving landscape of collegiate athletics, coaches must prioritize open communication with their athletes, fostering an environment where discussions about overtraining, REDs, and injury risks are the norm. Encouraging athletes to voluntarily share their training data and providing them with resources on nutrition and recovery can empower them to take charge of their health.
However, we cannot continue to let athletes slip through the cracks. The long-term consequences of neglecting these issues can be detrimental, impacting athletes not only during their collegiate careers but also for years to come. As both a coach and a clinician, it is devastating to witness a culture where intervention is often avoided due to discomfort or the misguided belief that it is not a coach's responsibility. Some may even consider injured athletes replaceable, overlooking the significant toll that injuries can take.
It is heartbreaking to see talented athletes suffer, often forced to leave their sports due to chronic injuries before they have a chance to compete. This ongoing cycle can lead to lifelong consequences, including REDs, infertility, osteoporosis, and mental health challenges like anxiety, depression, and disordered eating. Coaches must advocate for their athletes and take a stand against these issues, recognizing that their influence can shape not only athletic careers but also the long-term well-being of their athletes.
While mandatory medical examinations and voluntary training monitoring serve as essential safeguards, they alone are not enough. A reexamination of policies around coach oversight during the summer months is crucial for effectively protecting athletes' well-being. Revisiting these guidelines will help align the NCAA's commitment to athlete health with the demands of modern training and competition, ultimately fostering a culture that prioritizes the holistic health of all student-athletes. As we move forward, it is essential that the dialogue around these policies continues, ensuring that the safety and well-being of athletes remain at the forefront of collegiate sports.