Greetings from the staff at the Utah Orthopaedics. Once again, I’d like to thank you all for making the Utah Orthopaedics the ‘go to’ clinic for all of your athletes’ sports medicine needs.
This newsletter will focus, on summer training, hydration, avoiding heat exhaustion and more importantly heat stroke. Heat exhaustion occurs when athletes train in hotter temperatures and are unable to maintain normal core body temperatures. This occurs most often in the summer months and athletes, particularly those who are under-hydrated, begin to increase their core temperatures into the 102-3 degree range. Symptoms include increased heart rate, increased breathing rate, disorientation, dizziness, lethargy or sense of being overly tired, thirsty, decrease in athletic ability and confusion. These athletes should be removed from the playing field at once, given fluids, cooled and allowed to recover fully before continuing sports. If symptoms persist medical attention is recommended because if untreated, heat exhaustion can lead to heat stroke.
Heat stroke is a life threatening condition in that the body’s core temperature can reach 108-110 degrees. Once body temperatures reach this level the risk of death may exceed 50%. Over the past 7 years 19 high school and college athletes have been reported to have died as a result of heat stroke. Interestingly, Kory Stringer of the Minnesota Vikings was the only professional football player to have died in the 80 year history of the NFL. His body temperature was said to have reached 110 degrees despite extensive resuscitative attempts.
Signs of heat stroke are similar to heat exhaustion, but are more severe. The athletes often are very confused, fall and do not respond to questions. Many people are trained to think that heat stroke is accompanied by a loss of sweating. This is not always true. Athletes with heat stroke may still be sweating. These athletes are in a dire situation and must be transferred to a hospital emergently.
Treatment consists of immediate cooling and that is done not in an ice bath, but with ice packs to both sides of the neck, armpits and groin. The athlete should be moved to a cool location. Fans placed at the foot and side to give multidirectional cooling is most effective. Of course, EMS should be contacted immediately.
The beauty of living in a relatively dry climate is that there is increase evaporation from the skin which helps keep us cool. Unfortunately, sometimes this is not enough and core temperatures increase to dangerously high levels.
None of us ever want our athletes to reach the stage of heat exhaustion or even heat stroke. So, how do you avoid it? Be aware of the current weather conditions and the athletes’ warning signs or symptoms. Pay close attention to your athletes, especially those who would never let on that they aren’t feeling well. Keep plenty of cold water available and encourage drinking. Sideline misters are helpful if you have them. Educate your athletes to keep properly hydrated.
How is this done? It can be difficult as every person’s fluid intake requirements are different. It is well known that a 2% loss of body weight will typically trigger the thirst response. It is also a pretty good rule of thumb that if you are thirsty you have lost at least 2% of your body weight and should have already been taking in fluids. Interestingly, a 3% loss of body weight will result in 5-10% loss in athletic performance. The easiest and most effective way to test your athletes for proper hydration is to weigh each athlete before and after practice. Those who have lost weight need to drink more during practice/games and those who maintained their pre-practice weight have taken in enough fluids.
The question may be asked are sports drinks better than water? The short answer is yes. Depending on the brand, they may help replenish the salts lost in sweat. Do they replace all of the lost salts? No. It would take a concentration of about 3 times that of salt water to accomplish that task. Most of our athletes would rather go thirsty than drink that. Nonetheless, if your athletes would rather drink sports drinks than water then use the sports drinks. After practice full-strength sports drink is also advisable. If practice is more than 1-2 hours long about 100 grams of carbohydrate will help replenish glycogen stores in the liver. Something like a banana, power bar or a bagel would do the trick.
What about the ‘recovery’ sports drinks? They are very good for endurance athletes and athletes who have participated in a difficult sustained strength training program. These drinks contain branched-chain amino acids, carbohydrates and electrolytes which are the building blocks of muscle tissue damaged in intense training. They are rapidly absorbed and are effective in reducing lactic acid and the muscle damage that may be caused by strenuous or prolonged exercise. We often recommend recovery drink within one hour after exercise or training session. Two to three hours later a meal with protein will also be beneficial in recovery from the day’s exercise.
I hope this newsletter is useful to you as a coach or trainer. Your athletes count on all of us for appropriate, proper and accurate advice. Please feel free to contact us at Utah Orthopaedics with any question you may have regarding training or injuries.
Also, know that I will make every effort to see your injured athlete either the day of injury or certainly by the next day. Just call our office (801 917-8000) and identify yourself or your athlete and either Dr. Rocco or myself will schedule you right in.
Have a great and healthy summer. See you on the sidelines this fall.
Dann C. Byck, MD