It’s an exciting time: you’re coming back from summer break, school is back in session, and the fall sports season is right around the corner! The weeks leading up to the first game, race, or match can be the most rigorous and intense periods of preparation experienced throughout the entire season. In normal conditions, the amount of physical activity performed during this part of the preseason is enough to leave any athlete fatigued, sore, and utterly exhausted. Unfortunately, these athletes aren’t operating under normal conditions. All of this grueling preparation is taking place during the hottest times of the year. 

According to the Arizona Department of Health Services, “Heat illness during practice or competition is a leading cause of death and disability among U.S. high school athletes.”1 Furthermore, the National Athletic Trainer’s Association states, “The first 2-3 weeks of preseason typically present the greatest risk of exertional heat illnesses (EHI), particularly in equipment-intensive sports.”2 Because of this, our team at Spooner Physical Therapy wants to help provide our coaches and parents with the knowledge, awareness, and tools needed to ensure our athletes are safe and healthy, especially during these crucial weeks leading up to the start of the season. 

 

Recognizing the signs and symptoms of heat illness 

Before we get into prevention and recovery, we must first highlight the different heat illnesses one can experience, and how you can identify them: 

Muscle Cramps – Involuntary, painful muscle contractions that are present during or after exercise. This can be caused from a variety of factors including dehydration, electrolyte imbalances, and fatigue. 

Heat Exhaustion – Symptoms can include heavy sweating, dizziness, muscle cramps, nausea, pale and clammy skin, weakness, poor muscle coordination, headache, or possible fainting. The individual will have an elevated core body temperature (below 103 degrees F), and will display an inability to continue with exercise.2,4 Beware of hot skin and red faces that do not show signs of relief with rest, shade and re-hydration. This is a possible sign of heat exhaustion, and should be treated as such. Often, younger athletes, who don’t typically sweat as much as more mature athletes, will present with bright red faces. This should be taken as a sign that intensity needs to decrease and recovery should be incorporated until relief is achieved.

Heat Stroke – Classified as having an internal body temperature of 104 degrees F or higher, as well as impaired functions of the central nervous system.2 Symptoms may include disorientation, hot and red skin (no sweating), confusion, irrational or unusual behavior, headache, or loss of consciousness.2,4 

 

I’m noticing the signals of heat illness, what should I do? 

Having an awareness of these different conditions is crucial in order for swift and proper action to take place. We’ll go over the primary treatment recommendations for each heat illness, as well as expectations for recovery. 

Muscle Cramps 

  • Stop exercising 
  • Hydrate with water and sodium-based fluids/foods 
  • Static stretch and/or ice massage the affected muscle(s) 
  • Recovery: should take a couple minutes to about an hour. 
    • If cramps continue to persist, seek out a medical professional to help identify any other underlying causes that may be contributing to these involuntary muscle contractions 

Heat Exhaustion 

  • Stop exercising 
  • Move to a cool or shaded area 
  • Remove or loosen excess clothing or equipment 
  • Cool off with water, fans, wet towel, ice bath, etc. 
  • Sip water 
  • Lay on back and elevate legs above heart 
  • Recovery: usually is resolved within 24-hours. Can take up to 3 days. Recommended to not return to play same-day. 
    • If symptoms worsen or have not improved within the first hour, seek medical attention immediately 

Heat Stroke 

  • Lower body temperature as soon as possible by cold application (cool cloths, water, fans, wet towel, ice bath, etc.) 
  • Move to a cool or shaded area 
  • Call emergency medical services immediately 
  • Continue cooling efforts until medical assistance arrives 
  • Recovery: dependent on severity and initial treatment. Return to play not advised until cleared by a physician. 

*Heat stroke is a medical emergency. Studies show that being able to reduce one’s body temperature within the first 30 minutes is the biggest factor contributing to a successful recovery.2 

 

Preventing heat illness 

It’s clear that heat illness is very serious and can have debilitating effects on the body; luckily, we have complete control in suppressing these conditions from the get-go. Let’s run through the key prevention measures that will protect our athletes from overheating in the first place. 

Heat Acclimation – As stated earlier, the first 2-3 weeks of preseason presents the greatest risk for heat illness.2 This is mainly because athletes have not had the proper time to adjust to the temperatures they’re performing in. So, how should you be acclimating your athletes to these workout conditions? The Arizona Interscholastic Association (AIA) lays out a 14-day protocol that coaches and parents should follow in an effort to minimize risk of heat illness when returning to sports in hot weather. 

 14-day Heat Acclimation Protocol:3 

 Days 1-5 

  • Athletes should not practice more than once a day. 
  • Practices should be no more than 3 hours (including stretching, weightlifting, cool-down, etc.) 
  • Walk-throughs are permitted in addition to practice. Walk-throughs should not exceed 1 hour in duration and should include a 3-hour rest period in between practice and walkthrough. 
  • In sports with helmets and pads, only helmets should be worn days 1-3. During days 4-6, only helmets and shoulder pads should be used. 

 Days 6-14 

  • Athletes are allowed to practice twice a day. 
  • Neither practice should exceed 3 hours. 
  • Athletes should not practice more than 5 hours a day (includes stretching, weightlifting, cool-down, etc.) 
  • Practices should be separated by at least 3 hours of continuous rest in a cool environment. 
  • Double-practice days must be followed by a single practice or a rest day. 
  • Single practice days can also include a walk-through. Similar to Days 1-5, the walk-through should not exceed 1 hour, and a 3-hour rest period should separate the practice and walk-through. 
  • Starting on Day 7, all protective equipment can be worn, and full contact can begin. 

Hydration – Its no secret that proper hydration is a crucial component to an athlete’s health and success. This statement couldn’t be truer of athletes performing in hot weather conditions. Staying hydrated reduces exercise heart rate, fatigue, and core body temperature whilst improving performance and cognitive functioning.2 For parents and coaches, promote continuous fluid consumption before, during, and after practice. Replenishing drinks and snacks should always be available for athletes during the entire duration of these hot weather practices.  

Exercise Intensity – Be wary of implementing too many high-intensity exercises or drills, especially before the heat acclimation process has been completed. High-intensity workouts cause a rapid rise in body temperature, which puts athletes at greater risk of overwhelming their thermoregulation systems.2 As a defense mechanism, their bodies will begin to perform at slower paces in an attempt to reduce the amount of work it needs to do. This causes a couple different problems. Firstly, coaches may see this as a lack of effort, and continue to re-run the drill until performed to satisfaction. Secondly, the athlete may be participating in a game or match, and will ignore their body’s signals to slow down and continue over-exhausting themselves. 

Frequent and Quality Rest Breaks – Rests should be taken every 15-20 minutes. Athletes should have unlimited access to water and electrolyte drinks. Rest should take place in a cooler and shaded area. Helmets should be removed, and no physical activity should be performed during the rest period. 

Other Risk Factors – There are various influences that should be taken into consideration when assessing the safety of your athletes when it comes to exercising in hot weather: 

  • Athletic Gear – Athletic wear can prevent the heat the body produces from releasing into the environment. It also keeps sweat from evaporating into the air and cooling the body properly. This is especially true with helmets, as a significant amount of heat is dissipated through the head.  
  • Poor Conditioning – Athletes with lower aerobic capacities are not able to withstand higher levels of heat stress as those with higher aerobic capacities.2 Intense bouts of aerobic exercises should be used cautiously when performed outside, especially early in the preseason when athletes are still getting into shape. 
  • Increased Body Mass – Athletes with higher body masses produce more heat and are less efficient at dissipating body heat. Because of this, they are at higher risk for heat illnesses. 
  • Illness – Athletes that are currently or were recently ill should proceed with caution, as their bodies are in a compromised state, which puts them at higher risk for heat illness. 

 

Beat the Heat Cheat Sheet

(Printable cheat sheet for coaches and parents of athletes to refer to in the hot summer months – click the image above to download)

 

Nothing is more important than the health and safety of our athletes. The team at Spooner Physical Therapy is here to help however we can to ensure our athletes are receiving the best care possible. With the hot weather and the preseason upon us, we hope you find this guide informative and useful so our athletes can stay safe, continue to improve their game, and have fun in the sun! 

If you or your athletes have any questions or needs, Spooner Physical Therapy is here to help! Schedule an appointment or complimentary movement screen with one of our therapists here.  

  

References:

  1. AZDHS: Epidemiology & Disease Control – Heat Safety. (n.d.). Retrieved from Arizona Department of Health Services: www.azdhs.gov/preparedness/epidemiology-disease-control/extreme-weather/heat-safety/index.php#heat-schools. 
  2. Casa, D. J., DeMartini, J. K., Bergeron, M. F., Csillan, D., Eichner, E. R., Lopez, R. M., . . . Yeargin, S. W. (2015). Exertional Heat Illnesses. National Athletic Trainers’ Association Position Statement, 986-1000.  
  3. “Health: Heat: AIA Online.” Arizona Interscholastic Association, aiaonline.org/health/heat. 
  4. Warning Signs and Symptoms of Heat-Related Illness. (2017, Sept. 1). Retrieved from Centers for Disease Control and Prevention: www.cdc.gov/disasters/extremeheat/warning.html.