Heat Illness and Hydration Tips

Jason Price, MS, CSCS, ATC, LAT, CPT, USAW Club Coach

With August nearly half over most High School and College Athletes either back into or on their way to pre-season practice.  Where most athletes go into the season prepared from a summer long of training they often find themselves getting into trouble with conditions of August Two a Days with decreased performance or far worse.  Most athletes prepare for the season working out in hot conditions and this gives them a false sense of security when approaching preseason practice.  They feel they are acclimatized to the conditions but facts are facts.  Most athletes may train at the most 2 hours a day and if they go everyday that is impressive.  Most are taking days of in between training sessions.  Now look at the facts of the preseason.  Multiple hours of multiple training sessions a day, increased stress of fighting to make the team or earn a position, and practices strung together for days at a time.  That is a recipe for disaster for an athlete if they do not take the right approach into the preseason.  Heat Illness is the one of the only injuries that is 100% preventable.  All it takes is awareness, it is that simple.  Awareness from the coaching staff, athletic trainer and athlete, and all it takes is one of those people to be ignorant to the dangers of training in heat to cause a potentially tragic situation.  In the book “Junction Boys” about the preseason camp run by Paul Bryant at Texas A&M does a great job describing how heat illness can ravage a team because of ignorance towards it. 

First, let’s discuss heat illness and what can happen from it.  There are three heat related conditions of primary concern for Coaches, athletic trainers, and athletes.  In order by how dangerous the condition is they are Exercise-Associated Muscle Cramps, Heat Exhaustion and Heat Stroke.  Again these three conditions are 100% preventable.  Symptoms of the three conditions can overlap and often one condition will move on to the more serious condition.  So, athletes who start having exercise-associated cramps will often put themselves into a condition of heat exhaustion and even heat stroke.  Failure to treat these conditions can cause serious dehydration and the complications that come with that and even possible death!  Now, I am not saying athletes should not train in the heat.  Most Athletes have no choice and all it takes is being aware of the dangers and how to keep yourself protected. 

So, how can you tell if someone is suffering from heat illness?  They will present with signs of thirst, fatigue, lethargy, flushed skin, headache, and visual disturbances.  Anyone showing signs of heat illness should be treated as a medical emergency and if the proper treatment given then they are in a potential life threatening situations.  Again, Heat Illness is 100% preventable and when someone shows signs of heat illness if they are treated appropriately they have an excellent prognosis for full recovery. 

The table below outlines how you can differentiate between heat exhaustion and heat stroke.  Heat stroke is by far a more serious condition and is potentially life threatening and the individual should be transported to the nearest medical facility for treatment.

Who is at risk of heat injury?  Healthy, individuals, Children, Elderly, Excessive muscle mass, Obese, Low Body fat, Poorly Acclimatized or conditioned, previous history of heat illness, Dehydrated, Sleep deprived or those with acute illnesses (flu, allergies, colds, etc).  So this is a good portion of individuals.  So how can you prevent the risk of heat related conditions?  First and for most stay hydrated.  Hydration is key.  If you wait until you are thirsty to drink then it is too late and you are highly at risk.  If you wait till practice to hydrate then you are highly at risk.  So, here is the best strategy to fight heat illness:

• Drink 8-12 8oz of fluid at least 24 hours prior to an event in heat
• Drink at least 16oz of fluid 2 hours prior to exercise and again 20 min before exercise
• Have fluid available during training and practices (unlimited water breaks should be given if an athlete says then need water let them get it)
• When exercising for more than an hour drink at least 5-10 oz of fluid every 15-20 minutes. 
• Drink cool fluids containing less than 8% carbohydrate
• Use individual water bottles to monitor fluid consumption
• Check Urine color for hydration status  (See Urine color gauge)
• Take weights prior to and after practice to measure loss of fluid in the body
• Replenish lost fluid with at least 24 oz of fluid for every pound of body weight lost due to exercise
• Avoid Caffeine, alcohol, and carbonated beverages
• Allow 10-14 days to get acclimatized
• Reduce intensity of prolonged exercise

*By Fluid I am inferring water or a watered down sports drink. Fruit Juices, energy drinks, and other beverages are not good fluids to hydrate with.

So with this knowledge of heat illness and a strategy on how to prevent it you are prepared for taking on the heat as you prepare for the fall sports season. 

Reference:

Anderson, Marcia; Hall, Susan; Martin, Malissa. Foundations of Athletic Training. New York: Lippincott Williams & Wilkens. 2005.