May 2015

Participation in sport and physical activity can improve long-term health, both physical and mental. Nevertheless, many athletes do not participate or limit their participation because of chronic illnesses. Players can improve their health by playing sports and coaches can improve their teams by finding a way for everyone to get involved.

Important Legal Information

In Canada, discrimination is prohibited on a number of grounds. This includes direct discrimination (not selecting a player for a team or activity because of a medical impairment or disability) or indirect discrimination. The latter includes adverse effect, which may unintentionally single out or exclude a particular player. Also, systematic discrimination may affect one group disproportionately. Coaches have a duty to make reasonable accommodations, unless it is an undue hardship (Corbett 97-105).

In the United States, athletes with a may be entitled to participate if the organization is a “covered entity” under the law (such a publicly funded program, which includes the N.C.A.A.) and that they are “otherwise qualified” to participate (Weston, 2005, p. 141). The N.C.A.A. seeks to establish and maintain an inclusive culture which permits equitable participation by all athletes and to create the best practices to provide those opportunities (Hendrickson, 2013).

Certainly, coaches should not assume additional risk by allowing a player who seems ill to participate without supervision or medical clearance. Often, players who died of sudden cardiac arrest displayed signs and symptoms before their fatal attack. African-American athletes, females and taller athletes are more likely to suffer sudden cardiac death.

Routine precautionary screening has helped identify Marfan syndrome and other illnesses among high school, collegiate and professional athletes. Coaches should watch for signs and symptoms – especially during explosive movements in games and practices – and ensure that an automated external defibrillator is near the gym (Mossop, 2014).

Why Coaches Should Help

Enabling all athletes to participate in some capacity offers many benefits to players and the team. At the outset, coaches must communicate to parents and players how playing on a team will help the athlete in the long-term in order to gain trust.

Exercise and Illness

Structured aerobic and resistance training programs can aid youth with chronic illness (Morris, 2008, p. 357). Children who are active become active teenagers and adults who are living a healthy lifestyle (King, Tergerson, & Wilson, 2008, p. 374). By encouraging physical fitness at school or in the community, coaches can remove barriers to participation and improve the lifestyle of a struggling player for years to come.

Physical activity can provide another dimension for youth with chronic illness to establish a positive identity and relate to their peers (Snelgrove, 2015, p. 167). Sports are a leisure activity that permits players to become part of a group that they otherwise could not have joined.

Stress Relief & Mental Health

After the diagnosis of a chronic illness, youth face a period of acute stress followed by long-term anxiety as they deal with their condition, which can lead to emotional and behaviour problems (Compas, Jaser, Dunn, & Rodriguez, 2012, p. 457). For an athlete, this may include additional anxiety such as the inability to participate in an enjoyable activity or perform at the levels that they expect from themselves.

Exercise lowers levels of negative emotional states (anxiety, depression and post-traumatic stress disorder). For children and adolescents, an exercise program – such as aerobic exercise or resistance training – performed three times weekly reduces anxiety and improves physical self-concept (Motta, McWilliams, Schwartz, & Cavera, 2012, pp. 232-234). Participation in sport at school or the community is considered a normal youth activity, unlike psychotherapy, so more individuals are likely to take part.

Socialization & Team Building

Peer relationships influence whether children and adolescents feel well-adjusted but youth with chronic illness often have less social competence than their healthy counterparts. The visibility of the illness (for example those than affect the central nervous system) and the emotional and behavioural effects exacerbate this issue. Intervention can help build social skills and even a single meaningful peer-relationship can mitigate the impact of peer rejection (Martinez, Carter, & Legato, 2011, p. 886).

When athletes play on a team compromised of diverse players, they learn to recognize and collaborate with those who are different. After the season is over, all athletes will understand what those who are ill can achieve.

Also, watching others overcome adversity can provide a motivational boost to the team. Kevin Ware and the determination he showed after breaking his leg in an N.C.A.A. Tournament game inspired the Louisville Cardinals to overcome the adversity that they faced on the court.

How Coaches Can Help

Coaches should instruct, train and develop all athletes individually. What works for a healthy athlete may require modification for someone who is ill or returning to play. Every case is unique and these suggestions should not serve as a substitute for qualified medical advice.

Become Informed

When players display signs and symptoms of illness without a diagnosis, it is a frustrating experience for athlete and coach. For the coach, it is a (perceived) lackadaisical effort or someone who appears indifferent to improving themselves. For the player, they are struggling with their body twenty-four hours per day, most of which are away from the team.

DeAndre Jordan dealt with the signs and symptoms of asthma before he was diagnosed. Other basketball players struggled with other conditions such as diabetes, inflammatory bowel disease and more before finding out way. The athletes felt fatigued and frustrated that they could not live up to their personal standards but a diagnosis allowed treatment to begin so their careers could resume.

Finding the right diagnosis can help both sides. The player achieves some piece of mind and can begin to get better and the coach can create an individualized training plan for that player (Olson, 2014). Since coaches see student-athletes when they are under pressure, they may notice some signs and symptoms that others miss. When there appears to be a larger problem, coaches could encourage athletes to seek further medical help.

As a final note on this topic, coaches should learn about the illness in order to between understand players but they must remember that their expertise lies in sport and that they should not provide unsolicited treatment advice. Players play, coaches coach and doctors treat illnesses.

Create a Safety Plan

Every team should have an Emergency Action Plan and practice what to do in emergency situations. If someone has a known illness, there should be a specific part of the plan dealing with common situations. Medication should be stored in a safe and prominent place in the trainer’s bag. For players who use an inhaler, an assistant coach could keep it handy for use during timeouts or during time on the bench. Note the location of the Automated External Defibrillator in the facilities used by the team.

Build a Culture

The team environment entices the athlete to participate in the team. For those with limited physical capabilities, they are attracted to a team that exists away from the confines of the basketball court.. People want to participate in a strong family atmosphere where they feel welcome and supported. Jeff Green and Alonzo Mourning are among many professional athletes who credit the culture of their team’s as a motivating factor in their return. Team building activities, respectful communication and peer mentorships can bring a team closer together. Reach out to athletes who are ill or injured and retain them as valued team members.

All team members should be treated as basketball players first, not as someone with an illness or disability (Moffett, n.d.). When an illness manifests itself in practice or games, it is important for coaches to model understanding and tolerance. These moments might embarrass the player and cause others to treat them differently. However, if leaders and peers act as if nothing has changed and continue to treat each individual with respect, it helps that person feel normal (Snelgrove, 2015, p. 168).

When Magic Johnson attempted to comeback from his first retirement in 1992, other players ostracized him and acted as if they could catch H.I.V. by playing against him. Trainer Gary Vitti and other members of the Los Angeles Lakers tried to raise awareness with their words and actions (treating Johnson when he was cut during a game) but the stigma proved to be too much to overcome at the time. Today, Johnson says that he would not have retired if he knew the information that he knows now.

Create a Role

Coaches should value all contributions to the team. On a basketball team, someone may play limited or not minutes during games but remain able to help in practices and in huddles. It may take some trial and error and adjustments to find the right role. Once a role is determined, routines should remain the same for everyone, such as punctuality, being supportive of teammates and doing drills as well as possible (Moffett, n.d.).

Err on the side of caution but remember that even if an athlete cannot play (and must sit out a season or retire from the sport), they can still participate and make a positive impact on any program. Even if the athlete is suffering from a condition that makes them unable to perform at the same level as the rest of the group in games or drills, they can still achieve mental health improvements by participating in training with the team. If a player must refrain from participation, they could still on the bench as a manager or help coaches in drills.

When Paul George was injured throughout the 2014-15 season, he could not travel with the team and had to sit at the press table for safety reasons. Still, he observed games closely and passed on his feedback to teammates whenever possible (Hotchkiss, 2014). Other N.B.A. players have participated in coaching huddles (such as Kevin Durant in Oklahoma City) or learned more about the game by assuming new duties while they were out of action.

Improve Physical Fitness

An athlete with a stronger physical fitness base will be able to play longer in games and battle against tougher opponents. When an athlete feels physically fit, they can focus on performing the skill. Programs should be individualized and adapted to fit the needs of the participants. A youth suffering from an illness will not respond well to a compulsory regiment or a program that is too intense at first. They will engage when they feel ready (Morris, 2008, p. 357).

Coaches should consider the initial level of fitness of the athletes and define unique standards to suit their capabilities. To convince a reluctant participant to join, the activity should include a fun component and may involve training as a group. When adolescents have a friend who exercises, they perceive greater benefits from physical activity than those who work out alone (King, Tergerson, & Wilson, 2008, p. 382).

Practice Mental Training

Interventions to promote mental health coping skills have positive effects on quality of life and metabolic control and reduce depression. Avoiding the illness can lead to greater stress and depressive symptoms (Compas, Jaser, Dunn, & Rodriguez, 2012, p. 472). Coping skills for somatic and cognitive anxiety, such as mindfulness and locus on control, assist adolescents competing in sports and those with chronic illness.

All teenagers must learn the difference between trying to influence the outcome of a situation and adapting themselves as best as possible to factors that they cannot control. However, like physical training, mental training should be individualized for each athlete because everyone’s executive functioning and ability to utilize coping skills is unique.

Acknowledge Successes

At first, even a small effort in a game may feel enormous and drain the athlete. Coaches should acknowledge and praise small successes, as the chronically ill athlete gets better, whether is the gains relate to personal fitness or sports performance. The Detroit Pistons and Chuck Daly knew that Dennis Rodman’s confidence was fragile so they focused on his defense and ensured that he took high percentage short so he could “heat up.”

Putting a player in a position to succeed is important. If someone is struggling with stamina, a series of small shifts may optimize their performance. Help the athlete to ascertain their limitations and work around them. For example, when Larry Bird lost his explosiveness due to a back injury, he emphasized shooting and passing instead of driving to the hoop.

Successful Case Studies

In some cases, accommodation might not be possible and an individual’s participation may be limited. For example, if a person cannot reasonably perform the activities required for the sport or cannot demonstrate the skills and abilities needed for selection to the team, they may have to participate in a different format. There may also be a risk of injury to self or others, supported by medical opinion (Weston, 2005, p. 151).

This article is meant to empower coaches to reflect on their philosophy and encourage participation by all athletes. In basketball and other sports, a number of athletes have overcome significant health barriers in order to succeed.

DeAndre Jordan (Exercised-Induced Asthma)

When DeAndre Jordan first arrived in the N.B.A., he struggled with the increase in intensity. Blood tests and chest X-Rays revealed that he had developed exercise-induced asthma over time, although it had only recently manifested itself. The diagnosis was a surprise to Jordan but it was also a relief as he had been losing confidence due to his poor performance.

Trainers helped Jordan monitor his condition, refine his diet and watch for triggers so that he could prevent attacks before they became severe. Jordan also watches his weight to reduce fatigue and trains for explosiveness, mimicking how he plays in game situations (Patten, 2014).

Explosiveness on the Court: DeAndre Jordan explodes vertically to block shots and dominate the paint.

When an athlete suffers from asthma, coaches need to monitor them carefully. A player may need to quickly sub out in order to use their medication or may have to play more shifts or a reduced length. If a coach sees that a player is struggling with their conditioning over the long-term, they could suggest that they visit the doctor. The Washington Wizards staff observed that Javale McGee was tiring easily in games and practices and encouraged him to visit his doctor. It was revealed that McGee was breathing at seventy-five percent but a medication adjustment allowed him to regain his energy (Lee, 2013).

Dennis Rodman (Allergies)

While preparing for the 1986 N.B.A. Draft, Dennis Rodman was wildly inconsistent. At the time, there were more events than today’s combine and individual workout and teams were uncertain what to make about Rodman. The Detroit Pistons trainer Mike Abdenour took the time to find out more and discovered how allergies, combined with hot and humid weather had rendered Rodman unable to breathe properly. General Manager Jack McCloskey re-evaluated his player rankings, selecting Rodman with the twenty-seventh pick overall (Corp, 2012).

The Pistons were successful because they developed a plan that would maximize Rodman’s performance, including medication. He played limited minutes off the bench, as part of a very energetic unit that could match his intensity and share defensive and rebounding duties. Detroit acknowledged and celebrated Rodman’s defensive contributions and encouraged him to focus on what he could do best. Rodman won the Defensive Player of the Year Award twice and the team capture two World Championships.

To improve his rebounding, Rodman trained fanatically and developed great cardiovascular fitness. Rather than push against other players in a test of strength, he watched the flight of the ball and studied tape. Rodman claimed to use judo and other maneuvers to improve his positioning as the ball came off the rim (Foster, 2011).

Alonzo Mourning (Kidney Disease)

After an explosive start to his N.B.A. career and two consecutive Defensive Player of the Year awards, Alonzo Mourning was diagnosed with focal segmental glomerulosclerosis (a kidney disorder) in 2000 and was forced to miss five months of action. He played the next season and was selected to play in the 2002 N.B.A. All-Star Game but was forced to miss the entire following season. He returned for the 2003 season with the New Jersey Nets but was forced to retire because of a high risk of heart attack.

After a kidney transplant, Mourning began practicing again and rejoined the Miami Heat in 2005. He became a reliable backup player and contributed to the team’s 2006 N.B.A. Championship. Mourning retired in 2009, having played as many years professional after his diagnosis as he had before.

Throughout his career, he often spoke about how Pat Riley created a culture of winning and self-actualization. This philosophy appealed to Mourning’s discipline and inspired him to come back. Seeing that the Heat were focused on the same goals as he was, Mourning was willing commit to the team during this difficult time. Had the two not had a strong relationship, Mourning may not have come back.

Mourning coped by adjusting his expectations, understanding that he no longer possessed the same athleticism and altered his game – from his style of play to the length of his shifts on the court. This new perspective provided piece of mind but he was also forced to adopt a tougher attitude towards adversity, determined to overcome this illness (Wise, 2014).

Larry Nance Jr. (Crohn’s Disease)

Larry Nance Jr. went from a high school player who was unable to put on weight or grow. He had low energy and seemed disinterested. His father, a former N.B.A. player, thought that he might have been lazy or did not enjoy basketball. Visiting a clinic led to a diagnosis of Crohn’s disease and a new medication. After the diagnosis, there was a sea change: Nance grew seven inches, gained weight and signed with the Wyoming Cowboys.

Learning about the illness or assisting the athlete to find role models who have overcome similar adversity can also prove helpful. Nance found inspiration in the career of David Garrard, a quarterback who played for the Jacksonville Jaguars. Despite sparse experience playing basketball prior to college, Nance became the Mountain West Player of the Year (Prisbell, Wyoming’s Larry Nance Jr. grows beyond a disease’s constraints, 2015).

Mahmoud Abdul-Rauf (Tourette’s Syndrome)

When two-time All-American entered the N.B.A., teammates, coaches and fans were not sure what to make of Chris Jackson (as he was known at the time). Although Abdul-Rauf had been upfront about Tourette’s Syndrome throughout his college career, it was not understood by many at the professional level.

He arrived to his rookie training camp “out of shape” although this may have been due to a medication that he was taking and a desire to bulk up. Abdul-Rauf was prone to involuntary verbal outbursts which offended coaches and netted technical fouls from referees. For his first two seasons, he was relegated to the bench in Denver until a new coach provided an opportunity and a conversion to Islam some peace of mind (Reilly, 1993).

When Dan Issel became the coach of the Nuggets, Abdul-Rauf earned a starting spot and became the team’s leading scorer. His contributions per thirty-six minutes did not change but he experienced greater success because of the expanded role. During the prime of his career, he twice led the league in free throw shooting percentage. During his sophomore season, Abdul-Rauf generated 0.018 win shares per forty-eight minutes but this increased to 0.091 and later 0.125 under Issel’s tutelage (Basketball Reference, n.d.).

Part of Abdul-Rauf’s success is due to Tourette’s as he is obsessive during workouts. Growing up in Gulfport, Mississippi, he would play for hours irrespective of inclement weather. He diligently hones his shooting form, refusing to leave a workout until he has swished ten consecutive shots (Reilly, 1993). Coaches can harness this work ethic by creating meaningful goals and showing a path to success. When Issel replaced Paul Westhead and declared all starting positions open, it proved to Abdul-Rauf that there was a light at the end of the tunnel.

Sensitivity is also critical. Team members must understand how Tourette’s affects the athlete. In Abdul-Rauf’s case, he might be late because he felt that his gear needed to be perfect or stayed overtime in the gym because he had not made his shot. When a tic occurs, it should not be a big deal as it is not a conscious action. Before a game, it is necessary to speak with referees discreetly so they understand that the player does not mean any disrespect.

Jeff Green (Heart Condition)

When Jeff Green first learned that he would require surgery to repair an aortic root aneurysm, he was disappointed that he would not be able to finish the season with his teammates. It was difficult for Green but eventually he realized that his health needed to come first. The shock from the diagnosis led Green to re-evaluate his priorities and put basketball in perspective. He found support from Chris Wilcox and other athletes who had dealt with similar illnesses.

After the procedure, he had to relearn the game from scratch and he doubted that he would return to action. Green became determined to come back better than he had been before. Now, toughness is a key component of Green’s attitude. He shows off his scar when possible to demonstrate what he’s overcome and uses fake-combat before games to get hyped up. Green did not want player to treat him differently as he recovered as he wanted a honest test of his abilities (Springer, 2012).

Overcoming Adversity: Jeff Green stays focused and makes a tough game-winning shot against Miami.

The Boston Celtics organization supported Green, even though he was not playing and alleviated many of his concerns and anxieties. The team permitted Green to recover in Washington, so that he could also attend classes at Georgetown. Consequently, Green was very motivated to return to the game and rejoin the team. Green was also assisted by other N.B.A. players with similar conditions, such as Chris Wilcox, Ronny Turiaf and Chuck Hayes. When someone is newly diagnosed, the support group is frank and honest and provides a realistic outlook and practical strategies. As the player returns to action, they remain in touch and provide positive messages throughout the comeback (Associated Press, 2014). Now Green returns the favourite by visiting others in the hospital and serving as an inspiration on and off the court.

Isaiah Austin (Marfan Syndrome)

In some cases, the risk of injury is so high that a player must sit out for an entire season or give up the sport. Isaiah Austin was expected to be a first-round pick in the 2015 N.B.A. Draft before he failed a physical examination and it was discovered that enlarged arteries might cause his heart to rupture if he played professionally. Austin retired but the N.B.A. allowed him to participate in the Draft, making him a ceremonial selection. Gestures that acknowledge the hard work of every athlete can provide an emotional boost.

Now, Austin is a student assistant at his alma mater Baylor, helping with practices and mentoring players. Seeing the former teammate, who overcame blindness in one eye, a shoulder issue and discipline issues in order to continue playing basketball, is a source of inspiration for the Bears. Initially, Austin made up excusing about why he could not attend practice but coach Scott Drew insisted that he come, reinforcing that he was making a difference. Austin’s message about seizing the day and his unwavering support of the program motivated the team to overcome adversity and exceed expectations (Prisbell, Isaiah Austin is a factor for Baylor, even without playing, 2015).

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