Frequently Asked Questions

Playing Rules

How do playing rules impact student-athlete health and safety?
Participation in competitive sports brings with it unavoidable risks of injury. The NCAA takes appropriate steps to modify safety guidelines, playing rules and standards to minimize those risks and provide student athletes with the best opportunity to enjoy a healthy career.

How does the SSI help determine if rules are needed to protect student-athletes?
The Institute holds meetings on key topics and conducts ongoing research involving student-athlete health such as sports injury. Research data is then used to inform policy and rules decisions made by NCAA committees, monitor injury rates and inform the NCAA membership on the need for protective equipment and/or medical care policy.

What are some examples of playing rules that have done this?
There are examples in every sport, but some notable changes include:

Sport protective equipment;
injury timeouts;
blood clean-up rules;
football rules prohibiting head-down contact, spearing and targeting a defenseless player;
mouth guards for dental protection;
concussion education;
skin infection policies in wrestling;
eliminating hitting from behind and to the head in ice hockey;
women’s lacrosse eye protection;
soccer skin guards;
pole vault landing systems, expansion of the box and collar padding;
swim start pool depths;
lightning safety standards.

What role does SSI play in shaping these rules?
The NCAA’s health and safety needs are addressed through the collaborative efforts of national office staff, governance committees, sports rules committees, sports issues committees and external associations.

Playing Rules sites:

Legislation

What is the committee on Competitive Safeguards and Medical Aspects of Sport?
CSMAS is the Association-wide advisory committee charged with providing leadership and expertise to the Association to assist member schools in creating environments that support student-athlete health and safety. The makeup and duties of the committee are found in the NCAA manual, and include oversight of injury surveillance and NCAA drug testing. The committee is assisted in its work by the staff from the NCAA Sport Science Institute.

Who makes up the Competitive Safeguards committee?
CSMAS is comprised of legislated seats that include team physicians, athletic trainers, coaches, athletic administrators, drug education and testing experts, sports science researchers, campus legal professionals and divisional SAAC representatives.

How do new health and safety rules get passed by the NCAA?
A health and safety recommendation generally is either sent through or initiated by CSMAS, which then forwards the recommendation to the divisional governing bodies to which it reports – the Division I Championship and Sports Management Committee, DII Management Council, and DIII Management Council. From there, if approved, the legislative recommendation is forwarded as “sponsored” legislation by these governing bodies and is placed in the legislative cycle. Generally that cycle begins in July with the posting of the legislative proposal for review by the membership, and then ultimately voted on by the membership at the NCAA Convention or during the Division I Board of Directors meeting. The staff liaisons to CSMAS, sport committees and NCAA governing bodies work together to assure that throughout this process there are many opportunities for review and comment by member schools and conferences.

What role does SSI play in the legislative process?
The staff of the Sport Science Institute works to assure that the best research and expert opinions are available to CSMAS members as they consider legislative and policy issues that impact student-athlete health and safety. The SSI strategic plan provides for periodic gathering of experts on critical issues in order to share knowledge and best practices with both the CSMAS committee and the NCAA membership.

Nutrition and Performance

Why is good nutrition so important to performance?
Nutrition is critical for both academic and sports performance. A diet that is adequate in carbohydrate, protein, healthy fat, vitamins, minerals, and fluid is the foundation of day-to-day eating for overall health. In order for student athletes to meet their daily energy needs, they need to fuel early and often. When and how often the student athlete eats impacts how nutrients will be used, health, body composition, athletic performance, and recovery.

What is the best way to learn about good nutrition?
The Sport Science Institute has partnered with Sports, Cardiovascular, and Wellness Nutrition (SCAN) dieticians to create nutrition resources for student-athletes, coaches and athletics administrators. The key to optimal meal planning is individualization. The best way to learn your individual nutrition needs is to consult a sports dietician.

Should a student-athlete avoid taking nutritional supplements?
The supplement industry is unregulated and student-athletes could be unknowingly placing themselves at risk. Unlike drugs, supplements are not required to go through FDA testing before they are sold. An important message for athletes is that they can obtain the performance enhancement they need through proper diet and training without supplements.

How can a student-athlete tell if a supplement contains a banned substance?
The supplement industry is unregulated and products may contain substances not included on the supplement label. Student-athletes should be cautious of anything they ingest. If there is a question about a supplement, student-athletes should consult their athletic trainer before taking the product. NCAA member institutions have access to the Resource Exchange Center at the National Center for Drug Free Sport. The Resource Exchange Center is a subscription-based service that exists to provide up-to-date, confidential and accurate information on dietary supplements, dangerous and/or banned (prohibited) substances, and provide interactive tools and educational materials to empower athletes to make healthy and responsible decisions.

Eating Disorders

What is “disordered eating” and “eating disorders”?
Eating patterns that deviate from healthy nutrition — including severe restrictions on certain food groups or fad diets, or inadequate fueling for athletic performance that leaves athletes with an energy deficit — are considered disordered eating. When these patterns of behavior continue, they can negatively impact health and performance and devolve into an eating disorder, a serious medical condition that requires intervention and treatment. The two most common eating disorders are anorexia and bulimia. Anorexia involves calorie restriction to an extent that an individual’s weight falls 15 percent below the healthy range for their body size and type. Bulimia involves binging and purging behaviors. A good resource for additional information on eating disorders is the National Eating Disorders Association

What is Energy Deficit?
Energy deficit occurs when athletes do not take in adequate and appropriate energy (food) to account for their expenditure of energy during exercise and sports participation. Athletes need to maintain energy balance to fuel their performance and to avoid negative health impacts that may result from the body’s effort to adapt to energy demands of training and competition. When additional fuel/food is not provided to match exercise expenditure, this creates an energy deficit, which is a component of a condition called the female athlete triad.

What is the Female Athlete Triad?
The female athlete triad refers to the cascade of events that occur when the body attempts to adapt to the energy demands of training and competition without the benefit of added fuel – eating disorders, menstrual dysfunction and bone mineral deficiency, which can cause osteoporosis or “brittle bone.” Female athletes in particular need to maintain adequate energy to reduce the risk of these negative health consequences. A good resource explaining the triad can be found here.

How many student-athletes are at risk of developing disordered eating?
A number of studies have reported a higher frequency of eating problems in athletes than nonathletes, particularly in athletes competing in sports that emphasize leanness or a low body weight. Some studies have suggested a similar risk of eating disorders for female athletes in aesthetic sports,running and athletes at lower competitive levels. In a well-regarded study of this issue among elite athletes, more athletes (13.5 percent) than controls (4.6 percent; P<0.001) had subclinical or clinical eating disorders. Eating disorders were higher in female athletes than in male athletes, and more common among those competing in leanness-dependent and weight-dependent sports than in other sports.

How much of a problem is anorexia and bulimia among student-athletes?
Anorexia and bulimia are serious medical conditions that can cause a number of negative outcomes, both for health and performance. These chronic conditions can acutely impair health and performance by contributing to the following:

Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as the heart rate and blood pressure levels sink lower and lower.
Reduction of bone density (osteoporosis), which results in dry, brittle bones.
Muscle loss and weakness.
Severe dehydration, which can result in kidney failure.
Fainting, fatigue, and overall weakness.

Are there common signs and symptoms of an eating disorder?
Common signs and symptoms of an eating disorder are:

Physical/Medical Signs and Symptoms:

Amenorrhea
Dehydration
Gastrointestinal problems
Hypothermia (cold intolerance)
Stress fractures (and overuse injuries)
Significant weight loss
Muscle cramps, weakness, or fatigue
Dental and gum problems

Psychological/Behavioral Signs and Symptoms:

Anxiety and/or depression
Claims of “feeling fat” despite being thin
Excessive exercise
Excessive use of restroom
Unfocused, difficulty concentrating
Preoccupation with weight and eating
Avoidance of eating and eating situations
Use of laxatives, diet pills, etc.

What can reduce the risk of eating disorders?

Positive coaching styles that focus on individual well-being rather than negative, performance-oriented coaching style.
Promoting healthy environments and positive attitudes within teams that focus on effort and accomplishment rather than size and shape.
Coaching that emphasizes factors that contribute to personal success such as motivation and enthusiasm rather than body weight or shape.
Coaches and parents who educate, talk about and support the changing female body

A great resource to understand and support positive practices to reduce risk of eating disorders can be found here.

Mental Health

How common are mental health issues among student-athletes?
The full range of mental health issues found in the general student population can also be found in the life of a student-athlete. Some examples include:

Mood disorders like depression and suicide ideation;
Anxiety disorders such as panic attacks, stress, and obsessive compulsive disorder;
Eating disorders and disordered eating;
Substance-abuse and related disorders.

Are there signs or symptoms that someone I know needs help?
Although not all-inclusive, concern is warranted when the following behaviors for a student-athlete change from their normal lifestyle:

Changes in eating and sleeping habits;
Unexplained weight loss;
Drug and/or alcohol abuse;
Gambling issues;
Withdrawing from social contact;
Decreased interest in activities that have been enjoyable, or taking up risky behavior;
Talking about death, dying, or “going away;”
Loss of emotion, or sudden changes of emotion within a short period of time;
Unexplained wounds or deliberate self-harm;
Problems managing anger.

How can a student-athlete with a mental disorder seek treatment?
Contact a campus, community or athletics department mental health provider or clinical psychologist. The sports medicine staff is often a reasonable first resource for student-athletes who are not at imminent risk, yet who do not feel comfortable going directly to a mental health provider.

What is the best way to help someone who needs mental health treatment?
Refrain from attempts to “counsel” a student-athlete who may be experiencing a mental health issue. Instead, encourage them to seek a mental health professional. Approaching anyone with a concern over their mental well-being can be an uncomfortable experience. However, the health and wellness of the student-athlete is paramount. It is important to have correct facts, with context, before arranging a private meeting with the student-athlete. The conversation should focus on the student-athlete as a person, not as an athlete. Empathetic listening and encouraging the student-athlete to talk about what is happening is essential.

Wellness

What areas of life does the concept of wellness address?
Wellness is as a dynamic process of learning new life skills and becoming aware of and making conscious choices toward a more balanced and healthy lifestyle across seven dimensions: Social, Physical, Emotional, Career, Intellectual, Environmental, Spiritual.

What are some ways in which student-athletes can improve their wellness?
Student-athletes can improve their overall wellness across all dimensions by utilizing campus, community and NCAA resources.

Social Wellness – This refers to one’s ability to interact with people around them. Student-athletes can improve in this area by becoming more engaged with their community through various campus and community programs, seeking positive, interdependent relationships with others and by developing healthy behaviors.
Emotional Wellness – Involves being attentive to your thoughts, feelings, and behaviors (whether positive or negative). Student-athletes can improve awareness of their thoughts and feelings by using a positive attitude, seeking support, learning time management skills, setting priorities and maintaining life balance. Improving emotional wellness may also involve seeking support from a mental health professional when needed and gathering information to make informed value decisions.
Spiritual Wellness – While individuals may have different views of what spiritualism is, it is generally considered to be the search for meaning and purpose in human existence, leading one to a state of harmony with oneself and others while working to balance inner needs with the rest of the world. Student-athletes can improve their spiritual wellness by exploring what they believe is their own sense of meaning and purpose. The path to spiritual wellness may involve prayer, meditation, affirmations or specific spiritual practices that connect one to their belief system.
Environmental Wellness – Involves trying to live in harmony with the Earth by understanding the impact of your interaction with nature and personal involvement, and taking action to protect the world around you. Student-athletes can improve their environmental wellness by becoming aware of the effects of their daily habits on the world around them and recognizing the need to keep a healthy personal environment.
Career Wellness – the pursuit of personal satisfaction in a career. Student-athletes can improve their career wellness by working with their campus career center to identify their personal career goals and map a path to achieving those goals.
Intellectual Wellness – This is a measure of the degree to which one engages in creative, stimulating mental activities. Student-athletes can improve their intellectual wellness by utilizing resources available to expand their knowledge and actively challenge the mind with creative endeavors.
Physical Wellness – optimal physical wellness is developed through the combination of physical activity, exercise and healthy eating habits.

How does SSI promote wellness?
SSI promotes student-athlete health, wellness and quality of life through research, education and practical application of sports medicine and health promotion principles. SSI is committed to promote and develop safety, excellence and wellness in college student-athletes, and to foster life-long physical and mental development by continually improving student-athlete health, safety and performance resources.

Cardiac

Are heart disorders common?

More common than might be expected in a population group that is perceived to be healthy. Three in every 1,000 athletes may have an underlying heart disorder, which can lead to an incidence of sudden cardiac death in one of every 40,000 student athletes per year.

How does the NCAA protect athletes from them?

The NCAA has taken action steps including mandating medical examinations and requiring CPR, first aid, and automated external defibrillator (AED) training for coaches. The NCAA Sports Medicine Handbook also outlines guidelines for emergency preparedness.

What are the signs of a heart condition?

A physician or athletic trainer should be consulted if one or more of these symptoms are noticed: Fainting or seizure during or after exercise, emotional excitement, emotional distress or being startled (e.g., diving into a pool); chest pain during exercise; unexplained fainting or seizures; unusual shortness of breath during exercise; unusual fatigue during exercise; a racing heartbeat; dizziness or lightheadedness during or after exercise.

Does race, gender or ethnicity play a role in sudden cardiac deaths (SCD)?

It can to a degree. Incidences of sudden cardiac death have been more prevalent among African-Americans (one in every 17,000 student-athletes per year) than Caucasians (one in 58,000). Additionally, men have been shown to be at greater risk (one per 33,000) than women (one in 76,000). It is important to note that the reasons for these disparities are unknown and more study is needed before risk for SCD is understood.

Concussion

What is a concussion?

It’s a brain injury that changes a person’s behavior, thinking or physical functioning. They are typically caused by forceful blows to the head or body that result in rapid movement of the head.

What are the signs of a concussion?

They can be difficult to spot since most don’t lead to a loss of consciousness, and other symptoms can show up hours, or even days, after the injury. They can include: Amnesia; confusion; headaches; loss of consciousness; balance problems; double or fuzzy vision; sensitivity to light or noise; nausea; feeling sluggish; concentration or memory problems; slowed reaction time; feeling unusually irritable.

How can they be prevented?

Concussions can’t be eliminated completely, but precautions and proper treatment can reduce the risks of injury and help student-athletes recover. To those means, the NCAA adopted legislation in Aug. 2010 that requires each member institution to develop its own concussion management plan for reducing the risks and safely treating the injuries.

What if a student-athlete gets a concussion in a game?

First, they should be removed from play as soon as a concussion is suspected and evaluated by an appropriate health-care professional, such as a certified athletic trainer, team physician or a health care professional experienced in concussion evaluation and management. Athletes with a concussion are not allowed to return to the game that day. They should not return to play until all symptoms have been resolved during rest and exertion. A health care professional with experience in evaluating concussions should clear the student-athlete before returning to play is considered.

Drug Testing

What drugs are banned by the NCAA?

The NCAA bans drugs by class, along with any substance chemically related to those classes. The banned drug classes are: anabolic agents; stimulants, alcohol and beta blockers (for rifle only), masking agents such as diuretics, street drugs, peptide hormones and analogues, anti-estrogens and Beta-2 Agonists.

Who is responsible for testing student-athletes?

The NCAA and its member schools share the responsibility of not only testing, but also educating student-athletes to prevent drug usage. The NCAA conducts testing at all of its championships, and programs in Divisions I and II through its year-round testing program. In addition, the majority of institutions conduct their own institutional testing programs independent of NCAA drug testing. The NCAA spends more than $5 million annually on drug testing and education in an effort to deter the use of banned and harmful substances.

What is the penalty for a positive drug test?

The penalty for positive tests of both performance-enhancing and street drugs is strict and automatic. Student-athletes lose one full year of eligibility for the first offense (25 percent of their total eligibility) and are withheld from competition for a full season. A second positive test for street drugs results in another lost year of eligibility and year withheld from competition. A second positive result for PED usage will render the student-athlete permanently ineligible.

What is the penalty for failing a school-issued drug test?

Each NCAA member is responsible for determining whether to establish an institutional drug-testing program, at which time the school would be responsible for determining applicable penalties. If a testing program is established, though, the school is obligated to enforce the penalties. Failure to do so can lead to NCAA sanctions.

Can student-athletes appeal a positive test?

Yes, student-athletes can appeal the result and, if ruled in their favor, either have the sanction reduced or eliminated.

Sickle Cell Trait

What is sickle-cell trait?

It’s a generally benign condition in which a person inherits from their parents one gene for the oxygen-carrying element in their red blood cells – hemoglobin – and one gene for sickle shaped hemoglobin. It is not the same as the more severe condition, sickle cell disease, in which both genes for sickle hemoglobin are inherited. Those with the trait experience normal healthy lives. Only in situations where the body is pushed to extreme conditions, as athletes do, can the trait sometimes cause red blood cells to sickle and block blood vessels, denying oxygen to muscles and organs. But in most cases, carriers of the trait live normal, healthy lives without incident.

How common is it?

About 8 percent of the African-American population in the U.S. carries the trait, but it is rare (around 1 in 2,000 to 1 in 10,000) in Caucasians. It is present in athletes at all levels, from high school through the professional ranks.

Are student athletes tested for the trait?

Actually, tests for sickle cell trait are currently performed on all newborns in the U.S., but few are aware of a positive result because the condition is not considered life threatening in most of the population. All athletes at NCAA institutions are required to be tested for the trait or sign a written release declining the test before competing. This is to make coaches and athletic trainers aware that some athletes may need to take precautions.

Are athletes with sickle cell trait allowed to compete?

There is no reason they shouldn’t be allowed to compete. Sickle cell trait only becomes a threat in certain rare situations in which athletes push the limits of their physical conditioning. Being aware of the trait and taking proper precautions can help trait carriers enjoy successful and healthy athletic careers.

Skin Issues

What is MRSA?

MRSA is methicillin-resistant Staphylococcus aureus, a potentially dangerous type of staph bacteria that is resistant to certain antibiotics and may cause serious skin and other infections.

How do skin infections (MRSA) spread?

MRSA is spread by: having direct contact with another person’s infection; sharing personal items, such as towels or razors, that have touched infected skin; touching surfaces or items, such as used bandages and equipment, contaminated with MRSA.

What are the signs and symptoms of a staph (MRSA) skin infection?

Most staph skin infections, including MRSA, appear as a bump or infected area on the skin that may be: red; swollen; painful; warm to the touch; full of pus or other drainage; accompanied by a fever.

How can I prevent an infection?

If you see a spot, check the spot.
Know the signs of MRSA and get it treated early.
Keep cuts and scrapes clean and covered.
Encourage good hygiene such as cleaning hands regularly, regular showers, wash clothing and equipment.
Discourage sharing of personal items such as towels, razors, equipment.

Sports Injuries

Why does the NCAA track sports injuries?

Because while injuries are an inherent risk in any sport, understanding the cause of the injuries can help minimize those risks.

How does it help prevent sports injuries?

Once we know how they occur we can take the necessary steps to reduce student-athletes’ exposure to situations that cause injuries. For instance, we can make adjustments to rules – such as eliminating tackling techniques in football or high-sticking in ice hockey – to reduce situations that expose student-athletes to high risks of injury. Or we can adjust equipment requirements and standards to increase safety.

Heat Illness

What are Exertional Heat Injuries (EHI)?

EHI refers to serious injuries caused by heat, which include heat stroke, heat exhaustion and muscle cramps.

How can I prepare for the hot and humid conditions?

Prevention of heat illness begins with gradual acclimatization to environmental conditions. Student-athletes should gradually increase exposure to hot and/or humid environmental conditions during a minimum period of 10 to 14 days.

When does heat stoke most likely to occur?

Exertional heat stroke (EHS) has the greatest potential of occurrence at the start of preseason practices and with the introduction of protective equipment during practice sessions.

What should I watch for to prevent heat illness?

You should watch out for athletes who are experiencing muscle cramping, decreased performance, unsteadiness, confusion, vomiting, irritability, pale or flushed skin and a rapid or weak pulse. Symptoms can also include high body temperatures, nausea, headaches, dizziness, unusual fatigue, sweating has stopped, disturbances of vision and fainting.

What should be done if someone is suffering from heat illness?

First aid response should be implemented immediately, including the removal of all equipment and moving the student-athlete to a cool, shaded environment. Fluids should be given orally, and core temperature and vital signs should be taken. The student-athlete should be cooled with iced towels, and if necessary a team physician should replace body fluids through the use of an IV. Although recovery can occur rapidly, the student-athlete should not practice or compete for the remainder of the day.

Last Updated: Jun 5, 2013

National Collegiate Athletic Association

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