JOHN DOHERTY: Kansas coach Bill Self made the right choice

Given Self’s two national championships (2008 & 2022) and 14 consecutive regular season Big 12 titles (2005-2018), it’s no surprise.

As the NCAA Men’s Basketball Tournament was getting underway, the Jayhawks were a one seed but Self, 60, was not on the sideline. That was a surprise.

With his team scheduled to start play in the Big 12 Tournament on March 9, Self checked himself into a University of Kansas Health System emergency room the night before, complaining of “chest tightness and balance concerns,” according to a statement from the Kansas athletic department. A cardiac catheterization procedure followed, during which two coronary artery stents were placed to open blockages.

Self was released from the hospital on March 12, the day after his squad lost to Texas in the conference championship game.

While he then accompanied the team to Des Moines, Iowa, for an NCAA Tournament first-round game with 16-seed Howard on March 16, Self stayed in the team hotel while his players and acting head coach Norm Roberts took care of business. Two days later, Self’s doctors decided it would be best that he wait a bit longer to return to the sideline. He would not get the chance — at least this season — because the Jayhawks came up one point short against eight-seed Arkansas, losing 72-71.

In hindsight, did they miss their head coach? If you believe The Athletic’s poll, they most certainly did.

Was Self’s post-procedural course typical?

“If the procedure goes straightforward” said Community Care Network interventional cardiologist Dr. David Stewart, “you can get back to normal activities in one week. But you have to ease into it.”

Furthermore, coaching basketball is not a “straightforward” occupation. “You don’t want to go right back to coaching on a sideline where your heart rate and blood pressure are going way up,” said Stewart, who often prescribes cardiac rehabilitation following angioplasty.

It makes sense that those vital signs rise, especially during big games. Remarkably, though, there has been little real research on just how stressful coaching is to the heart.

The Physician and Sportsmedicine came close in 2003, when it published a heart-related study of game officials. That investigation found baseball umpires’ heart rates often exceed 135 beats per minute (bpm) and soccer officials’ 165 bpm, with the latter group maintaining a heart rate more than 85 percent of predicted maximum for most of the game. Given that a soccer official travels an average of 5.8 miles per 90-minute match, that’s no surprise at all. Such stress would be hard enough on the circulatory system of a well-conditioned teenager.

The PSM study looked specifically at football officials from the Southeast Conference over the course of four years. With a mean age of 45.5 years, 87 percent were considered overweight, 32 percent actually obese, and 44 percent had elevated cholesterol.

A 2019 article published by the American Heart Association did not report on a scientific study but chronicled anecdotal evidence of heart trouble among NFL coaches. The story cited Mike Ditka’s heart attacks in 1988 and 2018, Dennis Green’s fatal cardiac arrest in 2016, Bill Parcell’s 1992 bypass surgery, and the cardiac procedures Dan Reeves underwent in 1991, 1992, and 1998.

It was not until last year that a medical journal truly studied the heart health of coaches. The Clinical Journal of Sports Medicine investigation looked at 28 coaches (17 heads and 11 assistants) of professional soccer teams in Germany. Their average age was 46.

Similar to game officials, the soccer coaches registered an average heart rate of 127 during the first half of matches and 132 in the second half. While they had cardiac risk factors in line with the general population, they displayed superior cardiovascular conditioning during an initial screening process. Despite the elevated heart rates, the coaches developed no in-game arrhythmias. Nor did they display any abnormal cardiac chemistry values post-game.

“Head and assistant coaches of German professional football teams do not show any match-induced cardiac damage, despite considerable cardiocirculatory stress,” the authors of the study concluded. “Possibly, their above-average fitness level saves them from detrimental outcomes.”

While conditioning is valuable, it is not a guaranteed vaccine against heart disease for coaches — or anyone else.

“If you have a family history of heart disease,” said Stewart, “that’s one risk factor where you should sit down with a cardiologist once you are middle aged.”

Other risk factors are more controllable. Stewart listed smoking, diabetes, elevated blood pressure and high cholesterol. “Smoking is far and away tops on the list,” he said. And entirely controllable.

Unfortunately, even absent all risk factors, there will still be times when care from a cardiologist will be necessary. Stewart mentioned tightness or pressure in the chest. “When you notice an inability to do activities you used to do,” said Stewart, “you should come in.”

Fortunately, Self heeded such advice and, having done so, he should be back on the sideline next season making a difference in big games for his players.

John Doherty is a licensed athletic trainer and physical therapist. This column on reflects solely his opinion. Reach him at jdoherty@comhs.org. Follow him on Twitter @JDohertyATCPT.