High school football practice is ramping up in Kansas and Missouri as the hottest part of the summer sets in.
As football season approaches, two national organizations last week called on coaches to change practices to prevent exertional heatstroke in linemen.
Big linemen account for 97% of exertional heat stroke deaths. "Linemen heat up faster and cool down slower than other players," according to research published last year.
The National Federation of State High School Associations and the Sports Medicine Advisory Committee last month called for a "paradigm shift" on how to condition linemen.
The recommendation says linemen should be "excluded from certain preseason performance testing, such as mile runs," a memo to state high school athletic associations said.
"Post-practice sprinting puts linemen at greater risk for exertional heat illness," the organizations also warned.
Kansas has certainly seen its share of linemen put at risk.
Most recently, in 2024, 15-year-old Ovet Gomez Regalado died of complications of heat stroke after an August workout at Shawnee Mission Northwest.
The first in recent memory happened in August 2018 when 19-year-old Braeden Bradforth died after his first practice as a freshman at Garden City Community College.
A KCUR investigation discovered Bradforth struggled during sprints and stumbled off the field before he collapsed.
The new guidelines would prohibit that.
"A struggling athlete is immediately withdrawn from training and conditioning for evaluation and treatment," the recommendations say.
In August 2021, 19-year-old Tirrell Williams died at Fort Scott Community College after a grueling preseason workout where players were being punished by the head coach because there was trash on the field.
The new recommendations would ban that.
"Exertion drills are never used as punishment as this accounts for 37% of football EHS (exertional heat stroke) deaths," the memo said.
And in August 2023, Myzelle Law, also 19, died after a workout at MidAmerica Nazarene University in Olathe. The cause of his death has not been made public.
Experts say none of the victims should have been subjected to repeated sprints in hot weather.
"Linemen do not sprint like wide receivers and running backs, either in practice or games," former University of Oklahoma football head trainer Scott Anderson wrote. "The game demands for linemen are to spring up from a stance, take a few fast steps forward or backward, and maneuver or grab a heavy object."
Anderson told KCUR that much of this information has been around since 2022.
Just recommendations
The potential problem is that none of this is required of high school football coaches in either Kansas or Missouri.
"As the NFHS states it is a recommendation that we have been operating under for two seasons now," Jeremy Holaday, assistant executive director of the Kansas State High School Activities Association, told KCUR in an email.
The Missouri State High School Activities Association said it sent out the new guidance this year.
"We do not mandate specific heat-related protocols, as we are not in a position to directly supervise all practices and contests across the state," MSHSAA spokesman Andrew Kaufman said.
Anderson said he is optimistic coaches will embrace the new guidelines. "My belief and experience is that coaches, once educated and aware, will make necessary corrections to prevent EHS," he said in a text.
Despite greater awareness of exertional heat stroke over the past 20 years, players still die. "If we look from about 2000 to present, they've gone from about 2.1 per year to 2.6 per year," Anderson told ESPN.
In just the past two months, two 14-year-old linemen were hospitalized for heat-related incidents.
In July, a lineman fell ill in Rison, Arkansas. He was airlifted to Arkansas Children's Hospital in Pine Bluff and was just released Wednesday.
In June, a freshman at Ruston High School in Louisiana collapsed during football practice. Lux Smith was unresponsive when he first arrived at a local hospital. He continues to recover.
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