ST. LOUIS His workout was routine, but the pain that streaked through Rodger Saffold's chest hinted at something severe. First, there was no alarm: The scare was a sign of fatigue, he told himself; everything would be fine.
It was shortly after Saffold's sophomore season at Indiana. He started all 13 games in fall 2007 at left offensive tackle, helping the Hoosiers average 157.4 rushing yards per contest in a 7-6 campaign that produced an Insight Bowl berth. During the workout, he had completed a set of 10 sprints on Memorial Stadium's bleachers. The task followed a full schedule in the weight room.
Earlier in the day, Saffold had guzzled an energy drink, figuring it would give him a boost to balance football and academic demands. The caffeine coupled with the conditioning session, however, produced dangerous effects: Hard breathing, questions from a trainer about his welfare, and after he was stabilized following 10-15 minutes in a cold shower, knowledge that he could have suffered a heart attack.
"Eventually," said Saffold, who was drafted in the second round by the St. Louis Rams in 2010, "they helped me become a what-if instead of a what-was."
The training staff saved Saffold, and the 6-foot-5, 314-pound Bedford, Ohio, native stressed proper conditioning techniques Wednesday at America's Center Convention Complex as part of a six-member panel titled, "Preventing Sudden Death In Collegiate Conditioning Sessions: Best Practice Recommendations." The event, part of the 63rd annual National Athletic Trainers' Association Annual Meeting & Clinical Symposia, revealed guidelines for how to prevent tragedy in college football conditioning.
Numbers shared by the panel were sobering. Twenty-one players died from conditioning workouts between 2000 and 2011. Ten players passed from sickle cell trait, six from cardiac issues, four from heat stroke and one from complications with asthma. Of those, sixteen fatalities came from Division I programs.
"The university presidents' commission was able to meet to figure out how to make as much money as humanly possible from a playoff system," said Dr. Douglas Casa, director of athletic training at UConn, referring to a four-team college football playoff approved Tuesday. "But they have never met when it comes to athlete safety. The university presidents have to be held accountable.
"Most of these conditions are preventable. Heat stroke, preventable. Exertional sickling. But you can't prevent all these things from happening. I understand that. But when they do happen, almost all of them are survivable."
To promote survival, the panel stressed timing is crucial. Eleven of the deaths happened in the first two days of offseason workouts, because intense drills were introduced too soon.
Some experts said the problem rests in football's culture. Dr. Jay Hoffman, president of the National Strength and Conditioning Association, blamed unrealistic training goals and the fact that some coaches use conditioning as "punishment" for poor performance. He mentioned a January 2011 incident in which 13 Iowa players were hospitalized after a grueling workout following an 8-5 season with rhabdomyolysis, a muscle syndrome caused by stress that can lead to kidney problems.
Meanwhile, Dr. Jolie Holschen, a task force member representing the American College of Emergency Physicians, said a machismo atmosphere prevents athletes from speaking out about overexertion. To her, only time can produce change.
"We have to create a culture where it's OK for athletes to say, No, I can't do that,'" Holschen said. "That's going to require a long time and a lot of changes in the culture of the sport itself and the hierarchy of power between a coach and an athlete. I think particularly at the college level it's even worse than it is at the professional level. The athletes have to be educated about what their problem is, what their risk is, how to recognize their own symptoms when they know something is wrong."
For Saffold, though, such a transition would be hard to introduce. After all, football became America's passion because of its brutal reality. The fascination is as old as Walter Camp, leather helmets and the flying wedge.
Still, there's room for progress. Like Saffold, Rams trainer Reggie Scott understands action must be taken before another life is lost.
"It's a lot of layers, especially in the NCAA and college level," Scott said. "In the NFL, we don't have as many layers. There are so many layers (in college). So it's getting through the layers and getting to the proper ears and getting up there. I think that is going to be the key to (changing the culture)."
That's a development Saffold would like to see. An alert Indiana training staff helped him prolong his career. Now he wants others to benefit in a similar way.
"That really helps you understand how important it is for athletic trainers to be able to have such education to be able to point out things that, as student-athletes and professional athletes, we can't seem to see," Saffold said. "Something that feels like an ache can be a broken bone. Sometimes heavy breathing can be almost a panic attack. You really have to be able to know what you're doing and tell these players that you really have to take care of your body."