Agnes Mansaray arrived on the UNLV campus in September 2018 as a highly touted transfer from Iowa Central Community College, where she had been a dominant force in cross country and track. First-year UNLV coach Angelina Ramos quickly saw why. A native of Sierra Leone, Agnes crushed every workout Ramos threw at her, bolstering the team’s prospects for the season ahead.

Then it all went sideways. Agnes began to develop severe pain in her lower back. The problem came and went, but when it came it really came, to the point of stopping Agnes in her tracks, and with each passing day the issue worsened. Before long she was suffering migraines in addition to blinding back pain. Things came to a head at the Mountain West Conference Championships in San Diego, where Agnes collapsed at 800 meters, grabbing her back and howling piteously, and was rushed to the hospital.

Long story short: Agnes had a bunch of tumors growing on and around her kidney. Don’t worry, she’s fine now—a new mother, in fact. But before we get to the happy ending, let me tell you about how Angelina Ramos coached Agnes through the experience. “Coaching the exception” is my term for the playbook coaches use to help athletes facing unique challenges for which there is no playbook. In a recent phone conversation, Ramos shared ten rules she has for coaching the exception:

Do research.
Ramos had no earthly idea what was wrong with Agnes initially. But instead of passively waiting for the mystery to solve itself, she read up and consulted experts about her struggling athlete’s symptoms, proactively seeking answers.

Always be learning.
Coaches are less likely to be caught unprepared by unique problems in athletes when they are continuously engaged in learning, and also when they learn from each unique problem itself. Ramos came away from her experience with Agnes—whose family in Sierra Leone suggested that her tumors were the result of a curse, in response to which Ramos took her to see a shaman—with a new appreciation for the importance of understanding and validating the athlete’s own perspective on their problem. “At the end of the day, it doesn’t matter what the coach believes,” she told me.

Review/question the basics.
When a coach is presented with a weird problem, it is tempting to assume a weird cause. But it’s entirely possible for a weird problem to be caused by something fundamental, such as poor sleep or a dietary gap. In Agnes’s case, Ramos took a close look at biomechanics, core strength, and hydration. As it turned out, Agnes’s dehydration was related to her kidney tumors, but the changes Ramos made to her core strength program and biomechanics were not a waste of time, as they aided her running both before and after the real problem was discovered and addressed.

Revisit past decisions and outcomes.
Coaches must also not be too quick to rule out the possibility that something they did created the problem their athlete is now dealing with. Taking this possibility seriously requires that the coach review their history with the athlete, reevaluating key decisions and the outcomes of these decisions. Because Ramos had a very limited history with Agnes, this particular rule for coaching the exception didn’t really apply in her case, but Ramos is not afraid to own her bad decisions, nor should any coach be, in her view.

Ask what changed/what’s new.
Not always, but quite often, new problems are the result of new stressors. For this reason, it’s helpful for coaches to scrutinize an athlete’s recent history with special rigor. In some cases, this requires that the coach quiz the athlete about things like life stress that are not under their direct observation. Agnes’s recent transfer, and all that came with it, was the most salient change to focus on in her case, but of course it had nothing to do with her symptoms, which were all tumor-related.

Remember Maslow’s hierarchy.
In 1943, psychologist Abraham Maslow introduced a theory of human motivations whose centerpiece was his now-famous hierarchy of human needs. Maslow argued that humans have distinct categories of needs that exist in a clear order of relative priority. Of the five categories of needs he identified, physiological needs are the first priority, followed by safety needs, love needs, esteem needs, and self-actualization needs. Athletes have the same needs as other humans, and when an individual athlete is struggling in some way, it’s important for coaches to assess which of their needs, if any, aren’t being met, and what can be done about it. In Agnes’s case, Ramos went out of her way to make her feel safe, for example by accompanying her to all of her doctor’s appointments.

Consult your brain trust.
No coach knows everything or is expert in every subject. Even mediocre coaches know this, but mediocre coaches lack the humility to confess their limitations to others by asking for help in helping a struggling athlete. Angelina Ramos is not a mediocre coach, so she maintains a “brain trust” of other coaches and experts she consults in situations like the one she faced with Agnes Mansaray. You should too (if you’re a coach).

Identify patterns, look for discrepancies between self-reports and data.
While it’s important to seek input from athletes, coaches should not have blind faith in the information they get from them. Discrepancies may exist between an athlete’s perceptions and objective measurements. For example, an athlete might say they feel strong and energetic in their training but the data tell a different story. In the case of Agnes, her toughness and her desire not to let down her team, the university, and even the country (the U.S. had granted Agnes asylum under very difficult circumstances when she was still in high school) cued Ramos to be on guard for signs that her pain was even more severe or constant than she communicated. Athletes seldom deliberately mislead their coaches, but even when they don’t, their self-reports can’t always be relied on in isolation in the search for solutions to weird problems.

Ask if you’re actually using what you know.
Coaches should also question whether they are making proper use of their own knowledge in situations like Agnes’s. It’s easy for coaches to take their knowledge for granted, assuming, for example, that because they know a lot about training, no athlete of theirs could possibly be overtrained. When a problem an athlete’s experiencing remains unresolved, coaches must consider the possibility that something they already know but aren’t using might help. In a sense, Ramos was doing this when she realized she was assuming that, because Agnes looked very strong in the core, she must be strong, which might not actually be true. Sure enough, testing revealed that the strength Agnes demonstrated in the gym did not fully translate to her running, a discovery that led to changes resulting in greater functional core strength.

Assess the athlete’s mindset, coax them toward a hopeful outlook.
As you can well imagine, the experience Agnes went through with her tumors was extremely traumatic, and I haven’t even told you the half of it. There’s much more to the story, including unsuccessful surgeries and a typically Kafkaesque struggle with America’s health insurance system. Ramos was at Agnes’s side through all of it, doing everything she could not only to get her healthy again but also to keep her spirits up and give her hope for a good future. At one of her lowest moments, as Agnes lay in a hospital bed, Ramos vowed to her, “I will put you on the podium at Conference.”

The “Conference” she was referring to was the Mountain West Conference Indoor Track and Field Championships, which took place seven weeks after Agnes was cleared to resume running. At that meet, Agnes ran the 800 meters, and she made the podium, finishing second in 2:08.31, a new national record for Sierra Leone.

Figuring It Out
It was during the seven weeks between Agnes’s first post-surgery run and her fulfillment of her coach’s promise that Ramos really showed what it means to coach the exception. She is a running coach after all, and although she had a vital role to play with respect to Agnes’s medical situation, it was indeed a medical situation, hence largely outside her purview. There exists no codified set of rules for training athletes in Agnes’s precise circumstances, so instead of looking up the perfect formula in a book and applying it wholesale, Ramos created it on the fly.

Among they decisions the coach made were basing all of Agnes’s runs on time rather than distance, having her do key workouts apart from the team so she would become demoralized by comparisons, explaining her training strategy to Agnes so she would buy in to it, and building her confidence by putting her into the B heat of a meet preceding the conference championship, which she won.

This has turned into a rather lengthy blog post, so let me get to the key point I want to make: All athletes are exceptions to some degree, and every situation is unique, at least nominally. Coaches therefore should bring the same mindset to coaching athletes facing common challenges as they do to coaching athletes facing novel or mysterious problems. This requires that coaches be taught how to operate as creative problem solvers rather than as competent practitioners of rote procedures.

Toward the end of her tumor ordeal, when things were looking a little brighter, Agnes (for whom English is her fourth language) said to Ramos one day, “Coach, why are you so extra?” I love that line. If you want to be the kind of coach who is perceived as “extra” by your athletes, then learn to coach the exception! To learn more about our coaching certification, follow this link. We hope to inspire, teach, and build a community of coaches of all kinds.