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Linemen across the youth, high school and college football levels should be subject to different training methods to the point of putting them in air-conditioned spaces to avoid exertional heat stroke, according to a study released over the weekend in Sports Health: A Multidisciplinary Approach.

The two-year study, authored by a collection of trainers, physicians, researchers and academicians, concluded offensive and defensive linemen are an "at-risk" population, having accounted for 97% of exertional heat stroke deaths (EHS) from 1998 to 2021.

They called for head coaches and strength coaches to "change how they train linemen."

One of the authors, retired Oklahoma trainer Scott Anderson, said it was important to single out linemen. Anderson said youth, high school and college football still use what the study termed "reckless" drills that are inappropriate for players at those positions.

The drills include traditional sprints at the end of practice and those not modified for "heat load" that impacts linemen more significantly.

"We've done all the things [to get better], but until you account for who is at risk and why, [there is more to be done]," Anderson said. 

In what was termed a "paradigm shift," the study said linemen should be trained "for the game they actually play." That process includes linemen moving to air-conditioned areas for training in an effort to prevent EHS. From 1995-2021, there were 159 EHS deaths (2.4 per year) at all three levels. From 2000-2021, that average rose to nearly three per year. In the summer of 2021, nine players at the youth, high school and college level died. 

Since the study began, 100% of the deaths have occurred during offseason training and conditioning.

The study concluded a review of EHS deaths in football "lacks a basis in exercise science, is not specific to the demands of competition required for how linemen play the game. This is a recipe for disaster in the heat."

Awareness increased after Minnesota Vikings lineman Korey Stringer died of EHS 2001. It is a condition that's avoidable and easily treated. Since Stringer's death, Anderson said EHS deaths have actually increased. The study also reiterated that punishment drills should be banned from football.