National Collegiate Athletic Association

The NCAA News - News and Features

July 20, 1998

Competitive-safeguards group cites summer medical issues

The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports issued two recommendations regarding summer medical issues during its meeting June 22-24 in Kansas City, Missouri.

The first recommendation was that NCAA legislation be changed so that schools would be allowed to cover medical expenses for student-athletes during the summer. The committee will forward this recommendation to the Division I Championships/Competition Cabinet, Division II Management Council and Division III Management Council with the rationale that such a change would enhance continuity of health care for student-athletes. The committee noted that while there would be no financial impact to the NCAA as a whole, member schools might incur additional costs, depending upon their individual medical insurance policies. Therefore, the committee advised member schools to review these policies to determine if their student-athletes would be covered under such a plan, and if the recommendation passes, to be prepared to adjust their insurance policies to ensure that summer coverage is included.

The committee also recommended that institutions not be permitted to provide weight-gain supplements to student-athletes. To support this position, the committee cited guideline 2J, "Nutritional Ergogenic Aids," of the NCAA Sports Medicine Handbook. That guideline documents concerns about supplement-product efficacy, purity and medical necessity, as well as institutional liability and cost. The guideline warns further that some of these products have caused positive readings in drug tests, which have resulted in the ineligibility of student-athletes who may not have been aware they were taking a banned substance since ingredient lists of those products are either not provided or not complete.

The committee requested that the Association change the legislative interpretation that states that providing those products to students during the school year is permissible. The committee believes that this interpretation has allowed concern for competitive equity to overpower that for safety and cost-effectiveness. In addition to increasing safety, such a change would provide the indirect bonus of reducing costs to member schools. Anecdotal evidence indicates that some institutions spend thousands of dollars annually on those products.

Wrestling

As part of the discussions of its sports sciences subcommittee, the committee reviewed and modified a wrestling educational piece to be distributed to directors of athletics, wrestling coaches, athletic trainers and team physicians. The piece will detail the rationale of the rules changes that were approved by the Division I Championships/Competition Cabinet, Division II Championships Committee and Division III Championships Committee to make the sport safer after the death of three student-athletes during weight-loss activities this past season.

In addition to the educational piece, the committee developed a form that will be distributed to team physicians, coaches, athletic trainers and student-athletes that will assist them during the official weight-certification weeks of October 1-7 and December 1-7. As part of the weight certification, each student-athlete must be weighed while fully hydrated, the determination of which is made by a specific-gravity urine test.

In its discussion of the form, the committee defined the cut-off point for being hydrated as a reading of 1.020. If the student-athlete's hydration level is above this figure, the student-athlete must wait 48 hours to rehydrate before trying again. The rationale is to discourage student-athletes from getting an artificially low initial weight. The committee's health experts agreed that it takes 48 hours to regain full hydration once dehydrated.

Assessment of percentage of body fat also will be used in determining how much weight a student-athlete can lose gradually (that is, no more than 1.5 percent of his body weight and not below his minimum wrestling weight, which is the student-athlete's lean body weight plus 5 percent body fat). The committee recommended that schools' sports medicine personnel use the Lohman equation (three sites -- triceps, subscapular, abdomen) to determine the percentage of body fat. Underwater weighing with direct measure of residual volume also is acceptable.

In a related issue, the committee evaluated the NCAA Wrestling Committees' request to institute random year-round drug testing during the wrestling weight-evaluation weeks. The proposed drug-testing plan for wrestling and other drug-testing matters will be covered when the national office sports sciences staff meets with the Championships/Competition Cabinet this fall. If approved, such testing would be limited to that for steroids, diuretics, urine manipulators and stimulants.

As part of its continuing research and education on wrestling and weight, the committee reviewed an educational piece on nutrition that will be presented to the NCAA Wrestling Committees when completed. The committee also outlined various subjects for research and asked that bids/proposals for these projects be submitted by Bob Oppliger and Jim Scott, two researchers in attendance at the meeting who have done extensive work on the sport. One of the goals of this research is to strengthen correlation between specific gravity and hydration.

The committee also would like to gather data from matside weigh-ins and two-hour weigh-ins at various tournaments. Other potential topics include calculation of body composition at the respective NCAA wrestling championships, validation of litmus stick versus refractometer values with regard to specific gravity of urine, and validation on skin-fold tests for body fat with regard to ethnicity.

Ice hockey

The committee also reviewed two requests from the NCAA Ice Hockey Rules Committee. One request, which was approved, asked that the penalty structure for players not wearing mouth guards (Rule 3-4-c) be changed so that for an initial violation, the offender shall be immediately replaced on the ice, and the referee shall warn that team that subsequent violations by any player of that team shall result in that offender being assessed a misconduct penalty.

Under the old rule, a player in violation of the rule is assessed a misconduct penalty and replaced on the ice. A second violation by the same player in the same game results in that player being assessed a game misconduct penalty.

The other request, which was not approved, asked that a goaltender be recommended, but not required, to wear a mouth guard. Current rules require a mouth guard for all student-athletes. The committee noted that while goaltenders may experience less player-to-player contact than student-athletes at other positions, contact still occurs. Further, goaltenders are exposed to other head impacts from pucks, sticks, the ice or the goal posts to which players at other positions are not exposed under typical playing conditions. Each of those factors presents a potential oral risk that can be minimized by the wearing of a mouth guard.

Other actions

In other action, the committee:

  • Noted that, in response to its request, the American Heart Association has issued an addendum to its original 1996 statement recommending that a cardiovascular examination be performed on collegiate student-athletes every two years. The addendum, which will address the frequency of such screenings for collegiate athletes, is consistent with what is currently customary practice at most NCAA schools and with current medical knowledge. Under that addendum, the AHA has recommended that student-athletes be given a cardiovascular examination upon entry into an athletics program. This exam would be complemented by keeping a detailed medical history throughout the student-athlete's career. A copy of the new statement will be distributed to schools this fall.

  • Expressed concern about the potential of serious injury in baseball and softball from batted balls, and support for the continued related research. The committee noted that it was pleased that bat manufacturers and administrative bodies had come together to address the issue in an objective manner, which included the development of an appropriate bat standard.

  • Reviewed a recommendation from the Division I Football Issues Committee that football be designated as a skill-instruction sport. The committee cited its past concern about the proliferation of out-of-season skill/practice opportunities in all sports. The committee noted that athletic trainers had reported that these opportunities often are added without proper consideration for the adequate medical coverage that is described in guideline 1A of the NCAA Sports Medicine Handbook. The addition of skill-instruction practice opportunities in football would have both direct and indirect cost implications to schools. Implementation of such practices would require additional sports-medicine support, including athletic trainers and supplies, and would lead to additional injuries and medical expenses. The committee asked that the Championships/Competition Cabinet consider this concern when evaluating any requests for additional out-of-season practice opportunities, in any sport.

  • Recommended to the Division I Championships/Competition Cabinet, Division II Management Council and Division III Management Council that noncontroversial legislation be added to expand the committee by one so that a coach representing a sport other than football could be included. The committee noted that during restructuring, the current position for a coach was replaced by a representative from the Division II Management Council. The football rules committee can only nominate representatives to the competitive-safeguards committee who are coaches, which limits the available pool for that position. It also noted that health and safety issues occur in a variety of sports and a coach's position not earmarked for football would improve the committee's ability to address such issues.

  • Formulated plans to mail a survey on emergency medical care to athletic trainers with the new edition of the sports medicine handbook in the fall. The survey will ask about compliance with the emergency-care issues in handbook guideline 1-A. If the committee determines that current compliance is insufficient, it may recommend that portions of this guideline become NCAA legislation.

  • Reviewed the educational outreach activities during which it exchanges information with the following groups: American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopedic Society for Sports Medicine, National Athletic Trainers' Association, Inter-Association Task Force on Cervical Spine Injuries, Joint Commission on Sports Medicine and Science, NCAA CHAMPS/Life Skills Conference and various conference sports medicine meetings.

    Sports sciences safetyThe NCAA Committee on Competitive Safeguards and Medical Aspects of Sports took the following actions as a result of the discussions of its sports sciences safety subcommittee:

  • Recommended a selected call for proposals for concussion research. The goal of the research would be to establish return-to-play criteria using objective measurement techniques for student-athletes who suffer concussions.

  • Reviewed the NCAA Women's Gymnastics Committee's concerns about injuries in that sport and how they are reported in the Injury Surveillance System (ISS). The committee welcomed the Women's Gymnastics Committee's input and recommended that efforts be made by both groups to continue to address relevant injury issues.

  • Recommended minor revisions to nine sports medicine handbook guidelines.

    Drug-testing and educationThe NCAA Committee on Competitive Safeguards and Medical Aspects of Sports took the following actions as a result of the discussions of its drug-education/drug-testing subcommittee:

  • Voted to modify NCAA Bylaw 31.2.2.1.1-(e) to allow for screening for both banned and nonbanned drugs for nonpunitive research purposes. The change was brought about by the desire of some in the membership to make testing for marijuana part of the year-round random drug-testing program. The committee hopes to determine the level of marijuana use among student-athletes to see if such testing is necessary.

  • Reacted to the concern of some coaches at individual championships that some student-athletes were using short-acting drugs that were not being detected because of the protocol, which deferred testing in those sports until after the completion of all competition. The committee agreed to require some random same-day testing.

  • Affirmed protocol for student-athletes who are selected for institutional drug tests despite having quit teams. That situation occurs because of institutional errors on squad lists. The committee affirmed that such student-athletes cannot be cleared to play any sport until they pass an NCAA drug test administered at the school's expense.

  • Reviewed the Division III planning document and agreed to add plans to expand the year-round drug-testing program to include Division III football in 1999-2000.

  • Approved a request for proposals to retain an outside firm to conduct a review of the NCAA drug-testing programs. The committee will select the top two or three groups and invite them to present their plans for evaluation at the committee's January meeting.

  • Noted that the National Football League had been contacted to share the expense of acquiring carbon isotope ratio (CIR) equipment at the UCLA laboratory that both it and the NCAA use for drug testing.

  • Reviewed changes to the screen (opiates) and confirmation (morphine) cutoffs established by the U.S. Department of Health and Human Services. As a result, the committee will raise the NCAA cutoffs from 300 ng/ml to 1,000 ng/ml. The DHHS level is 2,000 ng/ml. The committee did not go the the DHHS level because the 1,000 ng/ml figure is used by other athletics drug-testing programs, which have different goals from the workplace testing typically done under DHHS guidelines. The committee also noted that it will not begin testing for 6-acetylmorphine (heroin metabolite) because such testing is not cost-effective due to the substance's short duration in urine.

  • Budgeted $120,000 for 1999 APPLE Conferences and agreed a component on supplement education should be added to the program.

  • Agreed to support National Alcohol Screening Day.

  • Agreed that persons who cancel after enrolling in the Betty Ford Center Program within two weeks or less before the start of the program be assessed a $500 penalty.

  • Noted the need to expand spit tobacco outreach activities to officiating groups, whose members are included in the NCAA tobacco ban for all sports.