New Braunfels ISD to consider altering its athletic training plan after rhabdomyolysis case

It’s been over a week since seventh-grader Gavin Hurd, who developed rhabdomyolysis following an extensive workout during a New Braunfels Middle School athletics period, was released from the hospital.

In response to the incident the district’s athletic department is pushing to alter some of its training guidelines.

“The recent unfortunate incident in athletics at one of our campuses is disappointing and has caused us to reassess some of our procedures to prevent another case of rhabdomyolysis,” NBISD Athletic Director Jim Streety said in a message to parents last Thursday.

Toward the beginning of athletics Hurd said he did over 300 push-ups as punishment for incorrectly performing assigned exercises over two days.

The 45-minute athletic period consisted of exercises such as bear crawls, crab walks and bar curls, paired with push-ups, the teen said.

As a result of the workout Hurd’s muscles became abnormally sore and he could no longer lift his arms — a common rhabdomyolysis symptom.

Hurd was later taken to the hospital where he was treated for rhabdomyolysis.

Rhabdomyolysis is a medical condition where damaged muscles release harmful proteins into the bloodstream.

It’s usually treated by a steady course of hydration, but if left untreated it can cause damage to the heart and kidneys, permanent disabilities or even death.

“After researching (rhabdomyolysis), the most common factors that lead to this condition for athletes are hydration and overexertion,” Streety said. “We are upgrading our training guidelines to place emphasis on these areas as well as other modifications to our training routines.”

Dr. David Tietze, who is a sports medicine specialist with UT Southwestern Medical Center, told the Herald that there are other factors attributed to developing rhabdomyolysis.

While hydration and overexertion play a large role in rhabdomyolysis, so do pre-existing medical conditions that affect muscle blood flow along with nutrition, heat and body conditioning.

“Making sure that you’re conditioned enough for the workouts that they’re trying to do, and making sure that they’re hydrated enough to take on the workload is pretty key,” Dr. Tietze said.

Those participating in athletics spent a few days learning the exercises prior to the workouts, which only last a week or two, Streety said.

In 2014 Dr. Tietze helped publish a paper on exertional rhabdomyolysis in athletes across several sports, including football and swimming.

Dr. Tietze and his colleague studied a case involving 22 football players who developed rhabdomyolysis at football camp. Twelve were hospitalized, citing dehydration, hyperthermia and repetitive eccentric loading.

“(For instance, in a bicep curl) eccentric is when you slowly move the weight down and you put a load through a lengthening muscle,” Dr. Tietze said. “Repetitive eccentric loading will put you at more risk for exertional (rhabdomyolysis).”

When examining the swimmers they found the athletes to be well-conditioned; however, increased activity stemming from an intense push-up routine and squats the week before contributed to rhabdomyolysis.

In some cases rhabdomyolysis can be difficult to diagnose.

Sometimes those with minor symptoms aren’t diagnosed at all, and can often be treated with hydration and rest.

In addition to muscle weakness and pain, athletes with severe cases will often have dark-colored urine and high kinase levels in the bloodstream.

Depending on a variety of factors, people possess an average kinase level of 100.

Patients presenting enzyme levels up to 5,000 to 10,000 would be easy to diagnose — Hurd’s levels were registering at 35,000.

At peak conditions, patients can reach 100,000 and above, posing serious threats for complications.

Rhabdomyolysis cases have decreased, according to Dr. Tietze.

With a focus on nutrition and optimizing training for peak performance, it’s become less of an issue.

One such advancement to athletic health and safety is the addition of athletic trainers.

Athletic trainers possess medical training that many coaches don’t have, and they work together with coaches to identify activities posing health and safety risks such as overexertion.

“Coaches are usually not focused on (risk factors for injury), coaches are usually focused on what they’re doing, they’re focused on winning the game and getting their athletes prepared,” said Texas Lutheran University Athletic Training Program Director Professor Brian Coulombe. “Having somebody … that is able to kind of intervene on behalf of the (athlete) is a huge asset.”

Coulombe has been working as an athletic trainer for 25 years and holds a doctorate in the field, and believes in having an athletic trainer in every school.

With athletic trainers present, injuries can be stopped before they happen — something Coulombe teaches his students.

“One (injury) is this rhabdomyolysis that should be 100% preventable,” Coulombe said.

Coulombe had no prior knowledge of details surrounding the incident at the middle school when conducting the interview, and only knew it occurred.

When asked how he felt about using rigorous physical activities as punishment Coulombe said it’s fairly common practice, but he doesn’t necessarily approve.

“As an athletic trainer I don’t like (exercise as punishment),” Coulombe said. “Those kinds of punishment exercises quickly get into a high risk category for injury … A lot of times the punishment exercise is done at a point in their progression where the athlete is already fatigued.”

However, Coulombe has some sympathy for coaches in these situations.

Many districts can’t afford a full-time athletic trainer at every campus, and their absence may cause some things to slip through the cracks.

“I feel bad for the coach in (this) situation because … they don’t have time to be able to identify … if they’re not paying attention and coaches aren’t in that mindset,” Coulombe said. “If they’re not in that mode, and there’s not an athletic trainer to kind of tell them (someone) is struggling and I’m going to relieve them of this activity — it’s hard for them.”

NBISD has two full-time athletic trainers at the high school, and hired two athletic training graduate students to work 20 hours per week at the middle school — mostly at games.

However, NBISD students are given access to the full-time athletic trainers when needed.

In the wake of the incident, the athletic department is working on a proposal to implement changes to all athletic programs in the district.

The proposal will enforce mandatory water breaks — even allowing students to bring their own water bottles.

It will also create alternative exercises rather than repeating the same ones, and vary types of punitive exercises while limiting them to a maximum of 10 repetitions, Streety said.