Tips to help avoid heat related issues

Athletes practicing and competing in hot and humid environments have a higher chance of experiencing Exertional Heat Injury (EHI). Fortunately, heat injuries are typically preventable by taking the proper and necessary steps.

EHI usually happen in high temperatures and humidity (Temperatures above 90°F and humidity above 30%). Additional risk factors include direct sun or heat, limited air movement, poor physical condition, unacclimatized, medications or supplements and poor or inadequate diet/nutrition.

Heat Illness Definitions:

  • Exertional Heat Cramps (EHC): Intense pain and prolonged involuntary contractions of working muscles during an intense or prolonged bout of exercise.  This is often brought on by in football usually by excessive electrolyte losses, neuromuscular fatigue, or any such combination of these factors. In other words, losing too much salt, muscles overworked (maybe due to inadequate conditioning) or a combination of the two.
  • Exertional Heat Syncope(EHS): Syncope means passing out. Brought on when the body sends too much blood to the skin to try to give off heat and not enough left over to go to the brain. This can be complicated by dehydration (not enough volume in the blood stream) and pooling of blood in the legs during prolonged standing (like on the sidelines during the game). The athlete can pass out or just feel dizzy like he/she might pass out.
  • Exertional Heat Exhaustion(EHE): An inability to continue physical activity. The following factors: profuse sweating resulting excessive water and/or sodium loss, or muscular fatigue. Sound familiar?  Basically, the temperature in the body gets to hot and the brain just puts on the brakes. The athlete will stop. Not necessarily pass out.
  • Exertional Heat Stroke (EHS): EMERGENCY! Call 911! Put the athlete on ice! The technical definition states the athlete must have an elevated core (rectal) temperature of 40°C (104°F) due to the failure of the thermoregulatory system to control body temperature with signs of central nervous system(brain) and end organ damage(kidneys and others).  The athlete may start acting erratically, talking inappropriately, dizzy all the way up to coma and death.
  • Exertional hyponatremia: More water on board than sodium (salt). Dilution of sodium levels in the bloodstream due to excessive fluid intake. Signs and symptoms altered mental status, disorientation, headache, nausea/vomiting.

(Information from The Journal of Athletic Training, Cooper et al, 2006)

The best way to avoid heat related-issues is to acclimate your athletes properly and educate as well as provide sufficient amount of “breaks” for the athletes to re-hydrate. Breaks should be at least 5 minutes long and athletes are strongly encouraged to drink water or electrolyte enhanced beverages at this point. If available, water should be present and accessible throughout each practice session.

Recommendations for the 14-Day Heat – Acclimatization Period for High School

  • Days one through five of the heat-acclimatization period consist of the first five days of formal practice. During this time, athletes may not participate in more than one practice per day.
  • If a practice is interrupted by inclement weather or heat restrictions, the practice should recommence once conditions are deemed safe. Total practice time should not exceed three hours in any one day.
  • A one-hour maximum walk-through is permitted during days 1–5 of the heat-acclimatization period. However, a three-hour recovery period should be inserted between the practice and walk-through (or vice versa).
  • During days 1–2 of the heat-acclimatization period, in sports requiring helmets or shoulder pads, a helmet should be the only protective equipment permitted (goalies, as in the case of field hockey and related sports, should not wear full protective gear or perform activities that would require protective equipment). During days 3–5, only helmets and shoulder pads should be worn. Beginning on day 6, all protective equipment may be worn and full contact may begin.
    1. Football only: On days 3–5, contact with blocking sleds and tackling dummies may be initiated.
    2. Full-contact sports: 100 percent live contact drills should begin no earlier than day 6.
  • Beginning no earlier than day 6 and continuing through day 14, double-practice days must be followed by a single-practice day. On single-practice days, one walk-through is permitted, separated from the practice by at least three hours of continuous rest. When a double- practice day is followed by a rest day, another double-practice day is permitted after the rest day.
  • On a double-practice day, neither practice should exceed three hours in duration, and student-athletes should not participate in more than fvie total hours of practice. Warm-up, stretching, cool-down, walk- through, conditioning, and weight-room activities are included as part of the practice time. The two practices should be separated by at least three continuous hours in a cool environment.
  • Because the risk of exertional heat illnesses during the preseason heat-acclimatization period is high, we strongly recommend that an athletic trainer be on site before, during, and after all practices.

(Information from The Journal of Athletic Training, Casa et al, 2009)

Recommendations for Acclimatization for Ages 13 and Under

  • 8–10 acclimatization episodes with 30–45 min of conditioning are recommended, at a rate of one per day or one every other day.
  • No one practice session should last more than 2 h (including warm-up, conditioning, instruction, breaks and cool-down).
  • Preseason practices are limited to one session per day and 10 h total in a week (including within-session breaks).
  • First week (up to 10 h total) — Shorts, shirts, and helmet only, with an emphasis on heat acclimatization and basic skills.
  • Second week (up to 10 h total) — First 6 h in helmet and shoulder pads, and the remaining 4 h in full pads, without live contact (limited contact with blocking dummies and sleds permitted after total of 14 h of practice—weeks 1 and 2 combined).
  • Third week (up to 10 h total) — Full pads with live contact permitted.
  • No more than six consecutive days of practice.
  • Regular season practices — Up to 6 h a week, with no practice session lasting longer than 2 h (including warm-up and conditioning, instruction, breaks, and cool down.

(Information from the American College of Sports Medicine Youth Football: Heat Stress and Injury Risk position stand 2005)

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