Lessons from the Texas High School Rhabdomyolysis Lawsuit: When Discipline Crosses the Line

The Case at a Glance

In early 2023, several players from Rockwall-Heath High School in Texas were hospitalized after being forced to perform 300–400 push-ups without rest or hydration during an offseason conditioning session. One student developed rhabdomyolysis, a potentially life-threatening breakdown of muscle tissue that can lead to kidney failure.

The head football coach and two assistants were later suspended, and in late 2024, a lawsuit was filed by the player’s mother, alleging negligence, gross negligence, and infliction of emotional distress. The claim asserts that the coaching staff failed to provide adequate supervision, hydration, and medical oversight, and that the workout constituted punishment rather than training.

The Merits of the Case

From a legal perspective, this case hinges on whether the coaches and school district breached their duty of care to student-athletes. That duty includes:

• Designing safe and age-appropriate workouts,

• Providing rest and hydration opportunities,

• Ensuring medical oversight (via an athletic trainer or emergency plan), and

• Recognizing and responding appropriately to signs of distress or overexertion.

While coaches have broad discretion in conditioning programs, that discretion does not extend to reckless disregard for player safety. If the allegations are accurate — that hundreds of push-ups were mandated without breaks or water, leading to hospitalization — the case for negligence is compelling.

Key Learning Points

1. “Toughness” is not a substitute for safety.
   Conditioning should improve resilience and fitness, not test pain tolerance. Workouts that risk harm under the guise of discipline are medically indefensible.

2. Medical staff must have a voice.
   Athletic trainers should be empowered to stop unsafe sessions — without fear of reprisal. In settings without a trainer present, there must be a designated safety officer or coach trained in emergency response.

3. Hydration and environmental monitoring are non-negotiable.
   Even indoors or in mild temperatures, dehydration and exertional illness can occur rapidly with excessive workload. Regular hydration breaks and workload limits are essential.

4. Documentation matters.
   Schools should maintain written records of workout design, attendance, and any medical events. These documents can demonstrate adherence to standard of care — or, conversely, their absence can imply negligence.

5. Education prevents escalation.
   Coaches, athletes, and parents should all receive annual education about exertional illness, including rhabdomyolysis and heat-related emergencies.

Sports Medicine & Youth Sport Guidance Against Punitive Exercise

Importantly, major sports medicine organizations and youth-sport guidance documents explicitly warn against using physical exercise as punishment.

The American Medical Society for Sports Medicine (AMSSM) states that:

“Exercise and conditioning should not be used as punishment.”
(AMSSM Collaborative Solutions for Safety in Sport)

Similarly, the National Association for Sport and Physical Education (NASPE) position statement notes:

“Administering or withholding physical activity as a form of punishment and/or behavior management is an inappropriate practice.”
The statement further calls such actions “unsound … from a legal liability standpoint.”
(SHAPE America – Physical Activity Used as Punishment)

Additionally, the Move United / TrueSport initiative emphasizes that using exercise as a disciplinary tool “is considered corporal punishment and thereby illegal in more than half of U.S. states.”
(Move United: Alternatives to Exercise as Punishment)

A peer-reviewed article in the British Journal of Sports Medicine further underscores the physiological risk:

“Exercise as punishment invariably abandons sound physiological principles and elevates risk above any reasonable performance reward.”
(BJSM, 2020)

In light of that guidance, the conditioning session in the Texas high school case — which reportedly required hundreds of push-ups without rest, hydration, or medical oversight — appears not merely harsh, but inconsistent with accepted sports medicine norms.

Proactive Steps for Schools and Athletic Organizations

• Review and standardize conditioning protocols: Establish safe workload limits, built-in recovery, and hydration plans.

• Integrate sports medicine oversight: Require athletic trainer or physician review of conditioning programs for safety.

• Empower whistleblowers: Create confidential reporting channels for athletes or staff who feel a session is unsafe.

• Conduct an annual “Safety Audit”: Review emergency action plans (EAPs), documentation procedures, and staff training.

• Simulate real-world emergencies: Practice EAP drills for exertional illness, heat stroke, and cardiac arrest — the same way fire drills are conducted.

Closing Thoughts

This Texas case isn’t about a single bad workout — it’s about the culture of coaching and the systems that protect athletes. Courts increasingly view “foreseeable” injuries as preventable when clear safety standards exist. By embedding sports medicine best practices into training programs, schools can protect not only their athletes but also their reputations and legal standing.

Seconds Save Lives: Why Visible, Maintained, and Accessible AEDs Are Critical for Every Sports Venue

Seconds Matter When Lives Are on the Line

When a player, coach, or spectator collapses suddenly at a sporting event, every second counts. Most sudden cardiac arrests occur without warning, and survival rates drop by about 10% for every minute without defibrillation. That means if an automated external defibrillator (AED) isn’t close at hand and ready to use, precious time — and lives — are lost.

The Life-Saving Role of the AED

An AED is a portable device that analyzes heart rhythm and delivers an electric shock if needed to restore a normal heartbeat. Modern AEDs are designed for anyone to use — they literally talk you through the steps with clear voice and visual prompts. Once you open the lid, the device takes over the guidance, making it possible for bystanders, coaches, or parents to act before EMS arrives.

Even with no prior medical training, AEDs are built to be fail-safe — they won’t deliver a shock unless it’s needed. Combined with early CPR, they can double or even triple the chances of survival from sudden cardiac arrest.

Placement and Accessibility: Every Minute Counts

AEDs should be visible, labeled, and reachable within three minutes from anywhere in a sports facility — that’s the standard recommended by the American Heart Association (AHA) and most state athletic associations.
They should be:

• Clearly marked and mounted in public areas, not locked away.

• Included on emergency maps and signage.

• Portable, when necessary, so they can be brought quickly to fields or courts.

• Tested and checked regularly, with battery and pad expiration dates tracked.

Too often, AEDs are hidden behind office doors, stored in locked cabinets, or forgotten until an emergency arises. Visibility saves lives.

Maintenance: A Working AED Is a Ready AED

AEDs require basic but consistent upkeep. Batteries and electrode pads have shelf lives and must be replaced every few years or after use. Many facilities assign staff — athletic trainers, coaches, or administrators — to conduct monthly checks and document them in a maintenance log.

Many modern AEDs perform self-checks, flashing a green light if ready or red if service is needed. Still, human oversight is critical. An AED that’s not charged, has expired pads, or isn’t where it’s supposed to be is effectively useless when seconds matter most.

Training: The Human Link in the Chain of Survival

While AEDs are easy to use, training builds confidence. Every sports organization should ensure that coaches, staff, and athletes know where the AEDs are and how to operate them. Regular drills reinforce muscle memory so that, in a real emergency, no one wastes time looking for instructions or hesitating to act.

Don’t Forget the Most Important Step: CPR and Early 911 Activation

As vital as AEDs are, the first and most important response is activating 911 and starting CPR with chest compressions. The person who calls for help, begins compressions, and keeps blood flowing until the AED arrives is often the real hero.

The chain of survival is simple but powerful:

1. Recognize cardiac arrest and call 911.

2. Start chest compressions immediately.

3. Use the AED as soon as it’s available.

4. Continue CPR until help arrives.

Together, these steps can raise survival rates from single digits to over 70% in some organized sports settings where AEDs and trained responders are ready.

Bottom Line

AEDs save lives — but only when they’re visible, functional, and used quickly. Every sports venue should have an AED within three minutes, a maintenance plan, and people trained in CPR and AED use. The combination of early 911 activation, prompt CPR, and immediate AED access is the most effective way to turn a tragedy into a life saved.

Baseline Testing: Useful, But Not the Gold Standard

By Jason M. Matuszak, MD, FAAFP, FAMSSM
Baseline Sports & Performance Medicine

Every concussion is unique — and so is every athlete. That’s why baseline neurocognitive testing can be a helpful addition to a school’s or team’s concussion management program, but it’s not the foundation of one.

Over the years, many programs have invested in computer-based or sideline neurocognitive tests that measure memory, reaction time, and processing speed before a season starts. The idea is straightforward: if an athlete later suffers a concussion, their post-injury performance can be compared to their personal baseline to help guide recovery.

When used appropriately, these tools can offer valuable information. They can help track progress and support return-to-learn and return-to-play decisions. But it’s important to understand what they are — and what they aren’t.

Concussion Is a Clinical Diagnosis

Concussion remains a clinical diagnosis, not a test result.
No computer score, balance test, or eye-tracking system can replace a thorough evaluation by a clinician trained in concussion assessment.

A proper evaluation considers:

• The mechanism of injury

• Immediate and delayed symptoms

• Neurologic and vestibular function

• Cognitive performance

• And most importantly — clinical judgment

That’s why the gold standard for concussion assessment is an in-person examination by a qualified healthcare professional, not any single testing tool.

Where Baseline Testing Helps

When integrated into a larger, evidence-based program, baseline testing can:

• Establish a personalized reference point for post-injury comparison

• Support individualized recovery decisions

• Reinforce athlete education and awareness

• Improve communication between athletes, coaches, and clinicians

For athletes with complex profiles — such as those with ADHD, learning disabilities, or prior concussions — baseline data can sometimes clarify whether post-injury results truly represent new changes.

Where Baseline Testing Falls Short

Baseline testing should never be used as a stand-alone clearance or diagnostic tool.
It has limitations:

• Results can be influenced by effort, fatigue, or distraction

• Test–retest reliability varies across platforms

• Interpretation requires clinical context

• False reassurance (a “normal” score despite ongoing symptoms) can delay recovery

In short: a good test helps guide decisions — it doesn’t make them.

The Right Way to Use Baseline Testing

Think of baseline testing as one piece of a comprehensive concussion management plan, not the plan itself.

That plan should include:

• Preseason education for athletes, parents, and coaches

• Clearly defined sideline recognition and removal protocols

• A structured, clinician-supervised return-to-play process

• Coordination between healthcare providers, athletic trainers, and schools

When these elements work together, athletes get the safest, most effective care possible — with or without baseline testing.

Final Thoughts

Baseline testing can be a valuable adjunct, especially when resources and trained personnel are available.
But the most important factor in concussion care is still the clinical expertise of the person performing the evaluation.

Technology can support decision-making — it just can’t replace clinical judgment.

Guardian Caps: What We Know, What We Don’t, and Where They Fit in Sports Safety

By Jason M. Matuszak, MD, FAAFP, FAMSSM
Baseline Sports & Performance Medicine

Over the past few years, you’ve likely noticed more athletes wearing padded helmet covers — commonly known as Guardian Caps — during practices and, increasingly, games. They’re easy to spot: a soft shell that fits over a football helmet, designed to absorb and disperse impact forces before they reach the head.

The concept is appealing. If a simple add-on can reduce the risk of concussion or repetitive head trauma, it seems like an easy decision. But as with most things in sports medicine, the real answer is more nuanced.

What Are Guardian Caps and How Are They Supposed to Work?

Guardian Caps are lightweight, padded outer shells made from closed-cell foam that attach to the exterior of a football helmet. Their design aims to reduce linear and rotational impact forces by providing an extra layer of energy absorption before the helmet itself deforms.

Laboratory impact testing conducted by the manufacturer and some independent labs has shown that Guardian Caps can reduce measured impact forces by roughly 10–20% in certain conditions. This may help decrease the cumulative stress experienced by the head and neck during repeated contacts — especially in practices, where contact frequency is high.

What the Testing Data Actually Shows

Most of the published data to date comes from laboratory impact testing, not real-world studies. These tests measure force attenuation under controlled conditions — not actual concussion incidence in athletes.

The NFL introduced Guardian Caps during preseason practices in 2022, initially for linemen, tight ends, and linebackers. Their own data showed a roughly 50% reduction in reported concussions during practice for those positions compared to previous years. However, the NFL cautioned that the sample size was small and that other factors — such as practice rules, contact limits, and coaching emphasis — could have influenced the results.

To date, no large, peer-reviewed real-world studies have demonstrated that Guardian Caps independently reduce concussion rates in high school or college athletes. The physics make sense — less force is better than more — but the translation from lab to field remains unproven.

Legal Use in NFHS, NCAA, and NFL

NFHS (High School): Guardian Caps are permitted for practice and competition as long as they are NOCSAE-certified and used according to manufacturer instructions. Some state associations may have additional guidance.

NCAA: Currently allowed for practices, but not universally adopted in games. Teams are responsible for ensuring that helmet integrity and certification are not compromised.

NFL: Required for certain position groups in preseason practices and optional for games. The league continues to collect data and evaluate broader use.

Safety, Maintenance, and Replacement Considerations

Like any piece of protective equipment, Guardian Caps require proper use and upkeep to maintain safety benefits.

• Ensure each cap is securely attached per manufacturer instructions before each session.
• Inspect regularly for rips, cracks, or worn straps that could alter performance.
• Clean with mild soap and water; avoid harsh chemicals that can degrade foam integrity.
• Replace caps when they show visible damage, have compressed padding, or at least every two seasons per manufacturer recommendation.
• The manufacturer warranty typically covers 12 months of normal use against material defects.

Failing to follow these steps can actually increase risk — if the device shifts, detaches, or adds unexpected weight to one side of the helmet.

The Missing Piece: Real-World Concussion Data

While Guardian Caps show promise in reducing impact forces, there’s still a gap between biomechanical data and clinical outcomes. Reducing measured force doesn’t always translate to fewer concussions, since concussions depend on more than impact magnitude — including individual vulnerability, rotational acceleration, and timing.

Until larger, independent studies confirm a meaningful reduction in concussion incidence, it’s best to view Guardian Caps as an adjunctive protection tool, not a guaranteed preventive measure.

Budget Priorities: Where to Invest First

For most schools and organizations, safety budgets are limited. Before investing thousands of dollars in purchasing, maintaining, and replacing Guardian Caps, make sure the core elements of athlete safety are fully funded:

• Certified athletic trainer coverage at all practices and games
• Well-trained staff in concussion recognition and emergency response
• Updated Emergency Action Plans (EAPs) for every venue
• Access to qualified healthcare providers for concussion evaluation
• Education for athletes, parents, and coaches

If those fundamentals are in place — and resources allow — Guardian Caps can be a reasonable secondary safety measure. But without strong systems and trained people behind them, even the best equipment can’t guarantee better outcomes.

Final Thoughts

Guardian Caps may help reduce impact forces, but they don’t eliminate concussion risk — and they shouldn’t replace the basics of sound sports safety. Programs should weigh their potential benefits against cost, maintenance, and current evidence. As more real-world data emerges, their role will become clearer, but for now, they should be viewed as one small piece of a much larger safety picture.