IStock Photo 3877454 © Stephan Zabel

Can exercise land you in the hospital, or even worse, the morgue?

In 2008, Max Gilpin, a 15-year-old offensive lineman for his high school football team, was running sprints up and down the field at a practice held in blistering Kentucky August heat. Coach David Jason Stinson was so relentless that one player collapsed and another quit. Max persisted, but his body gave out. Stretched across the ground, he drifted in and out of consciousness, his pulse rate and body temperature skyrocketing. Twenty minutes passed before an assistant coach called 911. By the time Max got to the hospital, his core body temperature was 107. He died three days later of heat stroke, septic shock, and organ failure.

Max was the third high school football player to die that year of heat-related injuries, but it is just one of many cases in which coaches push their athletes to injury. In 2006, a middle school gym teacher assigned a class hundreds of squat-jumps and push-ups as punishment for talking. As one active 12-year-old boy dutifully jumped, bent, and stretched with rapid speed, his strained muscles broke down, seeping cell contents into his bloodstream and poisoning his kidneys in what is known as rhabdomyolysis, or “rhabdo,” as it’s called among extreme athletes. The next day, he was so sore that he couldn’t dress himself, and his urine was brown. His condition was so critical that when he arrived at the emergency room, he was transferred to another hospital for what turned into a weeklong hospital stay. He wasn’t the only one: twenty of his classmates were also admitted to the hospital.

The odds a person will wind up in an emergency room for an accident due to exercise are 1 in 1,137. In a "Biggest Loser" culture that glorifies timely and extreme weight loss, people are quick to push past their limits, ignore proper exercise form, and suffer injury. Although some post-workout skeletal muscle damage is normal—it always hurts to laugh after a few extra crunches—the muscle damage caused by a condition like rhabdo is excessive.

Historically, rhabdo has been linked with such physically traumatic experiences as WWI trench warfare and the 1940 Blitz bombings on London. Today, the causes of exertional rhabdo are still violent to the human body, affecting about 1 in 300 military recruits in their first week of training. Such intense physical demands come at a cost: rhabdo is treatable if caught early, but left unchecked can lead to cardiac arrest and death. What’s worse, some workout regimens downplay its severity, as can be seen in this cartoon accompanying an article in CrossFit Journal (Bear in mind that CrossFit is the controversial program behind the $300,000 awarded in 2008 to Makimba Mimms, who sued his gym after the workout sent him to the hospital and ultimately cost him full use of his legs).

Exercising to excess isn’t unique to those who are encouraged by trainers; plenty of complications arise among those who exercise on their own. If marathon runners and triathletes don’t drink enough fluids to replenish their electrolytes, they risk cardiac arrest. If they overcompensate and drink too much, they risk hyponatremia, a potentially fatal condition in which the body’s cells swell with the excess fluids. One study found that at least 13% of 2002 Boston Marathon runners suffered the condition by the end of the race.

And so the inevitable, unanswerable question: who is to blame? Although Mimms’s suit was successful, some thought he should be held personally accountable for how he acted with his body. He did not exercise under duress. With Max Gilpin, the jury went the other way. An authority figure trusted to guide his students in responsible athletic choices, Coach Stinson was charged with wanton endangerment and reckless homicide. He was acquitted in September 2009.

Either way, it puts a little more weight behind a familiar warning: “Talk to your doctor before beginning a new fitness routine.”