Maximizing Player Performance
Avoiding the crunch of heat illness
by: Aaron S. Lee©
More from this issue
It has been more than a year since the death of Korey Stringer,
a 27-year-old, 6-foot-5, 335-pound All-Pro offensive lineman for
the NFL’s Minnesota Vikings. It has been more than a year
since the death of Eraste Autin, an 18-year-old, 6-foot-2, 250-pound
fullback from the University of Florida. And it has been more than
a year since the death of Travis Stowers, a 17-year-old high school
student and football player from Michigantown, Ind.
What do these three young athletes have in common besides football?
All three died of complications related to heat stroke. Three young men ... three
star football players ... three victims of an oppressing heat wave that swept
the nation in the summer of 2001.
Heat can affect everyone: professionals, collegians and high schoolers alike.
So that leaves just one question: what can be done to protect football players
from suffering the same fate as those three young men?
“Heat-related illnesses can be prevented,” Mike Ryan, head athletic
trainer for the NFL’s Jacksonville Jaguars. “But you need to have
a game plan for prevention.”
Football is not the only sport that has been rocked by tragic deaths associated
with heat-related illness. Baltimore Orioles pitching prospect Steve Bechler
was the most recent headline as the 23-year-old right-hander died of heatstroke
with a core body temperature that reached reported levels of 108 degrees in February
after a session of spring training in Fort Lauderdale.
It is reported that Bechler, took three Xenadrine, an over-the-counter drug whose
primary ingredient is ephedra. The 6-foot-2, 239-pound Bechler died less than
24 hours later.
Ephedra has been banned by the NCAA, the NFL and the International Olympic Committee,
but not yet by major league baseball, according to the recent Food and Drug Administration
report on ephedra.
“Awareness of the risk factors will play the biggest role in preventing
heat illness,” said Suzanne Steen, D.Sc., R.D., director of sports nutrition
for the University of Washington. “Once coaches and athletes are aware
of the signs, causes and treatments for heat-related illnesses, the sooner we
can eliminate tragedies such as these.”
The Signs ...
Athletes commonly encounter dehydration during training and competition as a
result of profuse sweating. Dehydration causes the body to heat up even faster
than normal. According to the National Athletic Trainers’ Association,
it is not uncommon to reach dehydration levels significant enough to place athletes
at risk of developing exertional heat illness in as little as an hour of exercise.
Athletes can reach this level even more rapidly if they begin the workout, practice
or competition dehydrated.
“There are several preventative measures that can be utilized to avoid
tragedies on the field,” said Ryan. “Education is the most important
factor. Coaches and athletes must be able to recognize the warning signs of dehydration,
such as dark yellow urine color, dizziness, cramps, headaches, fatigue and loss
of coordination.” (See Heat Illness: The Warning Signs)
While dehydration, heat exhaustion and heat stroke are all symptoms of heat-related
illnesses, they are not additive. Therefore, an athlete could experience heat
stroke without suffering from either heat exhaustion or dehydration.
“Coaches must think of hydration and heat illness prevention in the same
vein as playbooks and starting lineups,” said Ryan. “They must truly
get to know their players. By understanding which players are more prone to dehydration
and heat exhaustion or muscle cramps caused by low sodium levels, they can better
formulate a game plan to keep players out of danger and on the field.”
The Risk ...
Lack of acclimation to the heat is the No. 1 cause of heat-related illnesses
in football during two-a-days. Coaches must provide athletes time to get used
to the heat, even in moderate climates. Heat-related illnesses, including heat
stroke, have occurred when the ambient temperature was only 80 degrees with less
than 60 percent relative humidity.
According to Randy Eichner, M.D., professor of medicine at the University of
Oklahoma Medical Center and Team Internist for the Oklahoma Sooners, eight common
risk factors for heat intolerance in football are:
- Days 1 & 2 of two-a-days
- Temperatures above 80 degrees, relative humidity above 40 percent
- Unacclimatized athletes and availability of fluids
- Lack of proper fluid breaks
- Overweight, Out-of-shape athletes
- Warrior mentality among athletes
- Football uniforms
- Certain Supplements (such as ephedra) that may increase
the body’s production of heat
“Coaches need to relate hydration to not just health but also performance,” said
Steen. “If your top player is cramping then he is out of the game because
he is dehydrated. If it is fourth down with the game on the line and your best
player is not in the game because of dehydration then that is huge in terms of
your team potentially winning the game.
“I think for coaches it is important that they understand that this is
about life and death, and that it also has a huge impact on the ability of their
players to perform at the level that they are asking them to perform at. They
are giving them the plays, they are giving them the equipment, but they also
have to include nutrition and fluids because it is part of that package to help
them outwork the competition.”
The Solution ...
By understanding that heat illness is an issue that athletes especially need
to be aware of and that it can happen to anyone in a hot environment is the
first real step toward prevention.
Next, coaches must allow for acclimation to the heat. While some athletes
show up the first day of practice prepared and ready to go, many arrive after
a
long summer layoff from intense exercise and outdoor activity.
Coaches should slowly increase practice intensity and duration over the first
two weeks of training. According to Larry Kenney, Ph.D., professor of physiology
and kinesiology at Noll Physiological Research Center at Penn State University,
most cases of heat illness occur in the first three days of training.
“Coaches need to make athletes aware that water quenches thirst, but it
is not necessarily the best hydrator,” said Kenney. “Sports drinks,
like Gatorade, provide fluids and fuel. The electrolytes, sodium and potassium
provided by sports drinks help replenish critical minerals lost during heavy
sweating. Sodium is also crucial in stimulating voluntary thirst and it promotes
hydration. The carbohydrates found in sports drinks fuel muscles which is something
water simply can’t duplicate.”
Unlike water, which stimulates kidneys to turn on urine production, sports
drinks containing sodium allow the body to maintain fluid retention for better
cooling
efficiency.
Athletes cannot rely on thirst to gauge dehydration, once they feel thirsty
they are already somewhat dehydrated. Coaches should recommend their athletes
take
fluid breaks on a regular schedule to replace what they have lost in sweat.
Players should weigh themselves before and after exercise to determine their
losses (16
oz. = 1 pound) and then drink anywhere from 7-10 ounces every 10-20 minutes
during exercise to meet their needs.
Another key factor to remember in the prevention of heat-related illnesses
is that football gear is for protection and not for regulating body temperature.
According to Jackie Berning, Ph.D., R.D., nutrition consultant to the Denver
Broncos and assistant professor at the University of Colorado at Colorado
Springs, it is not uncommon for players to lose anywhere between 5-15 pounds
during
a
game or workout, especially during the dreaded two-a-day practices held in
August.
Berning adds that even the helmet, which is a football player’s most essential
protective equipment, substantially reduces the body’s ability to release
heat, thus increasing body temperature and the risk of heat illness.
Therefore, perhaps one element in reducing the risk of heat-related illness
is the choice of attire during the hottest times of the day/year. By wearing
fewer
clothes and frequently removing helmets during breaks, the athlete allows
his body a better opportunity to cool itself during hot weather. Also, by
increasing
the frequency and length of breaks, an athlete will increase his odds of
remaining hydrated and cool.
Scheduling practice or exercises for early morning or late evening, when
the weather is coolest, can also be an extra safety precaution.
If Something Does Happen...
Should an athlete become overheated and show signs of heat exhaustion or – even
worse – heat stroke, a coach must remember the critical “Golden Hour.”
“‘The Golden Hour’ is the initial hour after someone suffers
an exertional heat stroke,” said Doug Casa, Ph.D., ATC, director of athletic
training education at the University of Connecticut, “if you use this hour
wisely and are able to rapidly cool the athlete then you will minimize the likelihood
of organ damage, which is the primary reason why someone would die following
an exertional heat stroke. Maximizing cooling efforts in the first hour via immersion
in cold water maximizes survival rates.”
The NATA recommends that coaches continually educate themselves and their
athletes on the effects of dehydration on physical performance. Coaches must
also teach
athletes how to monitor their own hydration status. They must also convince
athletes to participate in their own hydration protocols based on sweat rate,
drinking
preference and personal responses to different fluid quantities.
Finally, coaches must teach their athletes that being thirsty, dehydrated
or fatigued are not a sign of weakness and will not be frowned upon. Athletes
must be aware that no starting job will ever be lost due to common sense
and
safety.
The only thing that can be lost from not properly taking the necessary steps
to avoid heat-related illness is life.
Heat Illness:
The Warning Signs
Dehydration
Symptoms:
- Thirst
- Fatigue
- Irritability
- Loss of performance
- Muscle cramps
- Nausea
- Vomiting
Treatment:
- Hydrate! Sports drinks work best. Both the fluid and carbohydrates can
prevent fatigue and the sodium may help prevent muscle cramps.
- Stop activity immediately and massage cramped
muscles, if necessary.
Heat Exhaustion
Symptoms:
- Dizziness
- Rapid pulse
- Headache
- Heat flushes
- Weakness
- Nausea
- Vomiting
Treatment:
- Replace fluids immediately. Rehydration is critical. Rest in cool, shaded
area until all symptoms have passed.
- If dizziness continues, lie down with your legs elevated
to promote circulation and seek appropriate medical attention.
Heat Stroke
Symptoms:
- Confused or disoriented
- Irrational behavior
- Drowsiness
- High body temperature
- Nausea
- Combative or belligerent
- Conscious but unresponsive
Treatment:
- Immediately cool the athlete by immersion in a tub of ice
water and seek immediate medical treatment. Heat Stroke is
an emergency that calls for
fast cooling with ice baths or any other available means.
NOTE: The above symptoms of dehydration, heat exhaustion
and heat stroke are not additive, which means an athlete
could experience
heat
stroke in the absence
of other symptoms. Seek immediate medical assistance at
the first signs of serious or unusual symptoms. Also note
that some of
these symptoms
can be
associated with hyponatremia, a serious condition which
also requires immediate medical
attention. – Gatorade Sports Science Institute
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