CHARLESTON, W.Va. -- Dear Cindy,

My son has decided to play football. He played midget football, but now that he is entering high school I worry that the chance for injuries is higher. The other day I read about boys hospitalized for compartment syndrome because they had taken creatine, which many athletes take. I am torn between wanting to support his dreams and wanting to protect my son from harm. Any advice? Also, can you tell me more about compartment syndrome? -- Tina

Dear Tina,

Thank you for asking about something that must be on the mind of many parents.

It is true that as many as 30 high school football players in Oregon, complaining of triceps pain, were examined for what appeared to be compartment syndrome following an intense practice. A serious injury, compartment syndrome affects the body's soft tissue. Was it creatine? No. This legal supplement is simply protein in powder form, which actually hydrates muscles rather than dehydrates them.

Rather than blame a substance that no one took and could not cause this ailment, let's look at the causes of compartment syndrome.

Causes

Compartment syndrome occurs when pressure builds up in the compartments where muscle, blood vessels and nerves intersect. When this happens, blood cannot circulate to the muscles and nerves to supply them with oxygen and nutrients. As a result, they begin to die. Unfortunately, limbs are threatened because the muscle and nerve damage constricts blood flow. Just as frightening is the possibility of kidney damage.

Why? The Mayo Clinic says the condition is often induced by strenuous exercise -- in particular, repetitive exercise that works the same muscles over and over. Heat and dehydration play a huge role as well. While medications and infection can also be associated with compartment syndrome in isolated cases, this is certainly unrelated to the healthy high school boys who were in football practice in Oregon.

Symptoms

Compartment syndrome is often diagnosed by its symptom known as the Five P's. They are pain, pressure, paresthesia (numbness), pressure and pulselessness. It is a very rare diagnosis with 14 of the 30 players requiring hospitalization and three actually needing surgery for treatment. So rare, in fact, it made national news and set off an alarm to parents and coaches everywhere.

Mass muscle injury

What could have caused this injury on the same day to so many? Granted, some tried to point fingers at the protein supplement creatine because it was learned that these players had high levels of creatine kinase in their bloodstream.

Let's clarify something straight away. Creatine kinase and the supplement creatine are two entirely different things. This might have initially been the cause of confusion but should be put to rest.

Let's look at the common denominator among the high school boys involved. They were all in an overnight immersion camp. This included three extremely intense strength and conditioning practices that day in heat as high as 120 degrees with water available but without scheduled water breaks. The strength portion of the workout focused on the triceps, repeating pushups and triceps dips. They all performed to the best of their ability in a competitive environment. It saddens me to think of how conflicted they must have been with their bodies in pain while being coached to continue.

Training

Brandon Walters, MS, personal trainer at the YMCA of Kanawha Valley, says this about the football practice in Oregon:

"Creatine kinase is a metabolic byproduct produced during strenuous exercise and has nothing to do with the supplement creatine. The use of this supplement is to aid in the resynthesis of ATP, which supplies the body with quick energy and can improve your work capacity, For example, you may be able to do one or two more repetitions or sets than you would normally be able to do before the muscle fatigues.

"They always look for a scapegoat. In this case they're attempting to vilify creatine. However, what it boils down to is an ignorant first-year coach trying to make a name for himself using dangerous training practices."

Because of the incident, the executive director of the Oregon School Activities Association released a statement including recommendations for sports training. The recommendations called for gradual increases in physical training intensity, avoiding doing too much too soon, scheduling and ensuring all athletes are regularly and adequately hydrated and monitoring for signs of heat illness.

These recommendations point to a coach's poor training practices and make his knowledge of sports conditioning suspect. Understandably, every athlete arrives at camp in varying stages of condition. Those who might have been underconditioned or inadequately hydrated would be susceptible to such an injury given this type of exhaustive workout. Clearly the consensus is that this mass muscle injury was brought about by extremes, both in environment and training intensities.

Be aware of the training regimens of coaches who are in charge of your children because student-athletes will rarely question the practices of those in charge in a competitive situation.

Cindy Boggs, fitness presenter, author and Activate America director, has been an ACE-certified coordinator/instructor since 1989. Send your questions about fitness, training or health to YMCA of Kanawha Valley, 100 YMCA Drive, Charleston, WV 25311 or e-mail cindys...@aol.com. Look for Cindy's award winning fitness advice book, "CindySays ... You Can Find Health in Your Hectic World" on her Web site www.cindysays.com or contact the YMCA at 340-3527.