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NCAA Football Rules Committee 2009 - 2010 Point of Emphasis

SICKLE CELL TRAIT:  Catastrophic sports injuries, including sudden death, are rare but tragic events.  Since 2000, football student-athletes with sickle cell trait have collapsed and died more often than with any other condition.  Following the recommendations of the National Athletic Trainers’ Association and the College of American Pathologists, the NCAA is recommending its member colleges and universities confirm sickle cell trait status of football student-athletes if that information is not already known.   Although most student-athletes complete their careers without any complications, screening and status knowledge can be used as a gateway to targeted precautions.

An important note to head coaches and their staff is that these incidents of collapse and death have been exclusive to conditioning exercises rather than game or practice situations.  In many situations, exercise intensity can be the leading factor for sudden collapse rather than the medical condition itself.  Coaches should conduct appropriate sport-specific conditioning and be ready to intervene when student-athletes show signs of distress.

During intense training sessions without adequate recovery time, red blood cells can change their shape, or sickle, and accumulate in the blood leading to exertional rhabdomyolysis that can be life-threatening.  Student-athletes can begin to experience symptoms in only two to three minutes of sprinting, or in any other all-out exertion of sustained effort, thus quickly increasing the risk of collapse.   Unlike heat-related or cardiac conditions, sickling athletes present as being fatigued, can often talk but may be experiencing ischemic pain and weakness in their muscles rather than muscular cramping or “locking up.” 

Sickle cell trait is not a barrier to outstanding athletic performance as student-athletes and athletics staff can incorporate precautions into intense training regimes.   Precautions can enable student-athletes with sickle cell trait to thrive in their sport. Student-athletes with sickle cell trait should be knowledgeable of these precautions and institutions should provide an environment in which these precautions may be activated. In general, football student-athletes with sickle cell trait should:

•   Set their own pace.

•   Engage in a slow and gradual preseason conditioning regimen to be prepared for sports-specific performance testing and the rigors of competitive intercollegiate athletics.

•   Build up their intensity slowly while training.

•   Use adequate rest and recovery between repetitions, especially during “gassers” and intense station or “mat” drills.

•   Not be urged to perform all-out exertion of any kind beyond two to three minutes without a breather.

•   Be excused from performance tests such as serial sprints or timed mile runs, especially if these are not normal sport activities. 

•   Stop activity immediately upon struggling or experiencing symptoms such as muscle pain, abnormal weakness, undue fatigue or breathlessness.

•   Stay well hydrated at all times, especially in hot and humid conditions.

•   Maintain proper asthma management.

•   Refrain from extreme exercise during acute illness, if feeling ill, or while experiencing a fever.

•   Access supplemental oxygen at altitude as needed.

•   Seek prompt medical care when experiencing unusual distress.

Knowledge of a student-athlete’s sickle cell trait status should facilitate prompt and appropriate medical care during a medical emergency.  Institutions should have an emergency action plan in place that is reviewed and rehearsed at least annually with all athletics personnel and all coaches and strength and conditioning staff should be certified in first aid and CPR.  Planned emergency response and prompt access to medical care are critical components to ensure adequate response to a collapse or athlete in distress.

The NCAA is preparing an educational video that will be made available on the NCAA’s Web site to help member institutions educate coaches, athletic trainers, and student-athletes regarding the impact of sickle cell trait during athletics. 


1.      NCAA Sports Medicine Handbook.  Available at

2.      National Athletic Trainers’ Association Consensus Statement: Sickle cell trait and the athlete, June 2007. Available at

3.      College of American Pathologists: Statement on sickle cell trait and the athlete, July 2007. Available at

Last Updated: May 8, 2013