Maximizing Player Performance

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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