Sports Medicine Corner

Dr. Don Kirkendall



I had my topic picked out, then the temperatures in the Eastern U.S. skyrocketed.

So while this won’t appear until after this heat spell has (hopefully) run its course, one can never read about the challenge of heat too often, especially with August team training camps just around the corner.

Let’s get some basics first. Heat illness runs along a spectrum. Some start with heat cramps as the first stage of heat illness. Not sure that is true because one can get the more serious issues without ever experiencing cramps (spoken from experience on that one). More serious are heat exhaustion and heat stroke (a true medical emergency).

Heat exhaustion can be due to the depletion of water (leading to excessive thirst, weakness, or even loss of consciousness) or salt (nausea, dizziness, or cramping). Heat exhaustion can cause (beyond those just mentioned) confusion, dark urine (lemonade color-good; tea colored-very bad), fainting, headache, pale skin, excessive sweating, or a rapid heart rate.

Provide affected players plenty of fluids (NO caffeine or alcohol), remove unnecessary clothing, find a cool shower or sponge bath, get them out of the heat (use fans, A/C). Those who’ve experienced this are more likely to experience it again.

Heat stroke is serious. Call 911. Symptoms include throbbing headache, lack of sweating, hot red and possibly dry skin, disorientation, staggering, seizures, unconsciousness. The 9

This article is Premium, please Log in or Subscribe to view full content![show_to accesslevel=’Subscriber’]11 operator will probably give some first aid suggestions. They’ll probably suggest getting the player into A/C. Fan the player with cool air. They may suggest putting ice packs on blood vessel rich areas of the body like the armpits, groin, neck, back.

Depending on the 911 response time, it might be better to go directly to an ER. People can die from heat stroke so don’t mess around. If in doubt, call 911 or get them to an ER. So what if you’re wrong?

Heat illness is preventable by practicing some common sense behavioral changes to an exercise regimen.

A simple concept to start. Sweating is not heat loss. Evaporation of sweat is heat loss. This is what keeps the core body temp from climbing too high. Any barrier to evaporation is not good.

Train earlier or later in the day, closer to sunrise/sunset.

One suggestion I read was to exercise at a time when one’s shadow is twice as long as one’s height. It may be humid then, but the lower temps and reduced sun exposure help reduce the heat load.

The 90F line. When the air temp is 90F, the air temp is higher than the skin temp so from here and higher is the chance of gaining rather than losing heat.

Drink, drink, drink to keep hydrated, and not just during training. The urine should be close to the color of diluted lemonade. Drink 8-12oz about 15min before exercise – that’s about 3-4 mouthfuls – then the same every 15-20 minutes during a workout. A mist tent may feel good, but drinking is more efficient and beneficial.

Don’t force water down every player. Provide the opportunity to drink every 15-20 minutes and let them drink to their thirst.

Weigh in and out of training, if possible. Multiply the difference in pounds by 1.5. This is the number of pints one needs to drink to replenish what’s been lost. It’ll take a number of hours to get it all down.

Don’t force large volumes of fluid before players leave the field. Let them drink to quench thirst in the hours post exercise.

It’s not just the temp. Heat load adds in humidity and sun exposure. 70% of the perceived heat load is due to the humidity and 20% is due to the sun exposure. TV/Radio weather reports use the Heat Index, which is just the air temperature and humidity.

Wikipedia’s heat index page shows a good table. Bottom line? Any air temp over 90F, regardless of the humidity, is dangerous. Adding humidity makes it worse – 90F+70%=105F index; 94F+55%=106F; 100F+40%=109F.

Higher the heat index, exercise should be shorter and easier. Heat index 80F-90F=shorter/easier workout; 90F-103F=shorter/easier workouts early or late in the day; over 104F=train indoors or just cancel – a good test of your phone tree/text ap.

Clothing. It’s hard to find cotton exercise gear anymore as the synthetic fabrics have taken over. These help the sweat evaporate. It’s actually better to wear some form of moisture management fabric than it is to go shirtless.

Yes, they can be expensive, but one can find really good buys at Target, Penney’s and WalMart on the same type of materials used by Nike, Adidas, Under Armour, etc.

Drink choices. There are a number of sports drinks. I suggest both a commercial sports drink and water be available and let players choose according to taste and thirst. NO caffeine (in most dark sodas) or carbonation (feel full too quickly) or alcohol (a post game beer by adults-mostly males-is almost a religion, but really has no place during recovery).

Hopefully, players have been out in the summer’s heat doing some activity before fall training begins in August. It takes the body a week or two of daily exercise to get adjusted to the heat.

Players who have not been exposed to the heat are at a far greater risk for a heat illness. They need to be brought along more slowly than the player who has been out playing pick-up or running in preparation for when training camp begins.

Remember the Beijing Olympics men’s final? Bet you were surprised to see a fluid break in each half.

Contingencies were in place for last month’s Confederation Cup, too. If FIFA thinks it’s a good idea, then so should your home league.

Lobby the league to require a couple minutes in each half for a water break through the month of September. Don’t leave it to the ref’s discretion. Mandate it.

A couple other non-sport items: Never leave kids or pets in a car. A sunny 70F day can raise a car temp to over 90F in minutes. Kids and the elderly don’t sweat enough to evaporate sufficient sweat to keep the body cool.

Think about spectators, not just the players. And make sure older adults are using their A/C.

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