by Tom Billups, C.S.C.S.

The “dog days of August” are almost upon us and it’s the time of year across our country when collegiate athletes return to campus. Football teams open training camp and practice fields are full of athletes going full tilt. In this column offering, I encourage all rugby players and coaches to be diligent in following standardized medical protocols before their team training sessions begin. The most common of these protocols is a pre-participation physical exam. Athletes should be required to complete a PPE before they are allowed to train with the team. Additionally, beginning August 1st, for the first time ever, the National Collegiate Athletic Association (NCAA) will begin mandating that member colleges and universities know the sickle cell trait status of their student-athletes. Although rugby is not governed by the NCAA, I humbly suggest that rugby coaches and players confer with their team’s medical professionals about whether they should incorporate this additional screening test into their team’s medical protocols.

This new mandate by the NCAA is, in part, due to the litigation surrounding the sudden death of a college football player during post-practice wind sprints. Unfortunately, this athlete was unknowingly positive for sickle cell trait.

Sickle cell trait is not a disease, but rather a condition where an individual inherits one abnormal hemoglobin gene and one normal hemoglobin gene. Normally, the hemoglobin gene produces round-shaped red blood cells, which carry oxygen to our muscles during physical activity. When sickle cell trait is present, however, the presence of the abnormal gene results in red blood cells that can become misshapen. During intense physical exertion, normal round blood cells become "sickled" and curved in shape, blocking blood vessels and causing tissue damage. Because sickling is brought on by physical exertion, rugby players should consider being tested.

Sickle cell trait is something any athlete could have, but some ethnicities are more at risk than others. It is reported that one in every twelve African Americans have sickle cell trait while one in every two to ten thousand Caucasians carry this abnormal gene. Sickle cell trait is most commonly found in people of African, Mediterranean, Middle Eastern, Indian, Caribbean and South/Central American ancestry.

Currently, sickle cell trait is tested for in all fifty states via blood analysis as part of a newborn’s health screening. States across the country began sickle cell trait testing in different years, so results may or may not be available from the athlete’s pediatrician. In the case when a player’s results are unknown, the test can be completed at a physician’s office or on most university campuses at the student health center for a nominal fee.

It is important to note that sickle cell trait is not something that an athlete can train to overcome, but it is also not something that will hinder a rugby player from reaching their potential. There are athletes competing at every level, from high school to the Olympics, who have been identified as having the sickle cell trait. It is possible that when an athlete with sickle cell trait goes all out in training, the symptoms they may experience include, but are not limited to, muscle weakness, cramping, shortness of breath, fatigue, and pain. Although many of these symptoms are associated with hard physical exertion, especially in excessive heat, athletes with sickle cell trait are still able to communicate, something athletes are usually unable to do when suffering a heart attack or heatstroke.

The sickling of blood cells and onset of symptoms can happen within the first two to three minutes of an all out effort. Sickling and related complications of sickling is brought on by intense exertion, but can be adversely influenced by heat, dehydration, altitude, and asthma. When a player identified with sickle cell trait begins to experience symptoms, activity should immediately be stopped. Athletes typically experience a full recovery within a few minutes when the symptoms are properly identified and treated with oxygen, hydration, and rest.

Generally, athletes who have sickle cell trait have productive athletic careers and long healthy lives. This is often the case because the trait is dormant and the athletes are unaware that they have the sickle cell trait. However, as a safety measure, it is still an important piece of a player’s health history to have on file.

As coaches, knowing which of our players possess this trait provides us critical data while challenging players to work hard in training. Allowing trait carriers to self-regulate their efforts is a practical way to keep these athletes out of danger while completing their most difficult workouts.

Rugby is a physically demanding sport, one of the reasons why so many of us are drawn to it. Using a pre-participation physical exam and sickle cell trait screening are two cost effective ways to assure everyone is able to train hard and stay safe.  

Tom Billups began his rugby career in 1984 and has spent time as a player in New Zealand (Bay of Plenty), the U.S. (The Old Blues), England (London Harlequins), and Wales (Pontypridd) for domestic teams as well as representing the U.S.A. at international tournaments with the Eagles. After hanging up his boots, Billups got into coaching leading the Eagles and now with University of California – Berkeley. Read the entire bio of Tom Billups as well as Billups first column My Rugby Path and then check out what Billups is saying about the game of rugby in The Billups Column on Rugby Rugby.