Sports Injuries: Heat Illnesses

Heat illnesses occur when your young athlete is exposed to extremely high temperatures and humidity, and their body is unable to cool down. Types of heat illness can range in severity, from mild cramps to life-threatening heat stroke.

Heat Illness Prevention

Heat illnesses are 100% preventable. Make sure that your young athlete:

• Gets a pre-participation exam to identify their risk for heat illness
• Talks to their physician to see if any medications they take put them at a higher risk for heat illness
• Wears clothing that is lightweight, light-colored, and loose-fitting during activity in the heat
• Avoids sunburn
• Drinks plenty of fluids and stays hydrated throughout the day
• Gives their body time to adjust to the heat
• Avoids the heat during off-days or off-times

Other ways to protect young athletes include:

• Providing education for young athletes about heat illness
• Monitoring weight loss via weight charts, to record pre- and post-practice weight: If there is more than a 3% weight loss prior to the next exercise session, avoid activity in the heat
• Planning rest breaks ahead of time, and modifying the work to rest ratio based on the heat
• Providing a cooling station during activities in a high heat and high humidity environment

Is Your Young Athlete At Risk For Heat Illness?

• Dehydration

  During physical activity, the body sweats. Sweat then evaporates and cools the body. Drinking water replaces what is lost in sweat. Dehydration occurs when the body’s fluid in sweat loss exceeds fluid intake. This can cause chills, dizziness, headaches, dry mouth, thirst, dark colored urine, or overall weakness. Over time, dehydration increases the risk of heat illnesses such as heat cramps, heat syncope, or heat stroke.

  Fortunately, dehydration is preventable. Make sure that your young athlete:

  • Drinks water before, during, and after activity
  • Wears light-colored, loose-fitting clothing
  • Regularly has high-water content foods in their diet (e.g., watermelon, cucumbers, lettuce, tomatoes, oranges)
  • Avoids caffeinated beverages before and during activity, as those can increase fluid loss

• Heat Acclimatization

  Heat acclimatization is a series of changes that occur in response to heat stress in a controlled environment over 7 to 14 days. Heat acclimatization programs are crucial to minimizing the risk of exertional heat illness during the preseason practice period. The goal of acclimatization is to gradually increase your young athlete’s duration and intensity of physical activity and expose them to a warmer environment.

  Heat acclimatization provides several benefits. The biggest are minimizing exertional heat illness and improving athletic performance. Positive adaptations that occur in the body are reductions in heart rate, body temperature responses, and skin temperature responses. There are also increases in sweat rate, sweat onset, heart function, and overall ability to perform in the heat.

  Tips for heat acclimatization include:

  • Participating in one practice per day during the first 5 days
  • Gradually increasing in intensity over the first 5 days
  • Not practicing for more than 3 hours in one day
  • Not wearing full gear until day 6 of practice
  • Full-contact activities starting on day 6
  • Following double practice days with a single practice day or day of rest
  • Having your adolescent properly hydrate before, during, and after practice with clear fluids and electrolyte replacement drinks
  • Increasing the amount of sodium in your adolescent’s diet for the first several days of practice to make up for sweat salt loss
  • Not having your adolescent practice while sick
  • Providing available and accessible cooling methods
  • Making sure your adolescent takes frequent breaks during practice
  • Making sure your adolescent gets plenty of sleep

  For more information, read Beat the Heat: Dehydration and Heat Illnesses from the National Athletic Trainers’ Association.

• Heat Cramps

  Heat cramps are painful, involuntary muscle cramps, often occurring in the legs, arms, or abdomen. They typically occur during pre-season conditioning when the body is not properly conditioned and is more subject to fatigue.

  Heat cramps are often caused by dehydration or lack of adequate electrolytes in the diet. These cramps are a brief tightening or spasm of the muscle that is very painful and may occur during or after activity.

  In order to stop heat cramps, your young athlete should:

  • Stop the activity
  • Stretch and gently massage the affected muscle
  • Rehydrate with water or sports drinks that contain electrolytes and sodium
  • Use ice massage for persistent cramping
  • Seek shade or go indoors

  Your adolescent may return to play once they have rested and replaced the fluids and electrolytes lost from their sweating. They can typically return to practice or a game the same day, as long as they can perform sport-specific tasks (e.g., running, catching a ball) correctly and without pain.

• Heat Exhaustion

  Heat exhaustion is a condition with symptoms that include overall weakness, nausea, dizziness, and profuse sweating, resulting from physical exertion in a hot/humid environment. This can arise quickly or gradually and may or may not be preceded by heat cramps.

  It is important to recognize the signs and symptoms of heat exhaustion early. If it is not immediately recognized and treated it can progress to heat stroke. Symptoms of heat exhaustion may include:

  • Rapid, weak pulse
  • Dizziness
  • Faintness
  • Heavy sweating
  • Goosebumps in the heat
  • Low blood pressure upon standing
  • Nausea or vomiting
  • Muscle cramps
  • Fatigue or weakness
  • Headache
  • Thirst

  Have an emergency action plan for heat exhaustion and initiate treatment promptly:

  • Stop all activity, move the person to a cool, shaded area and remove any tight clothing
  • If the person is conscious, give them fluids
  • If the person’s core body temperature is above normal, begin cooling measures to help lower their body temperature
  • Seek immediate medical attention if their core body temperature is 104 degrees or higher
  • Heat exhaustion symptoms will often resolve within 2 to 3 hours
  • If the signs or symptoms begin to worsen or do not improve within one hour, transfer the patient to a medical facility for further diagnoses
  • Refer to a physician to evaluate the need for fluid/electrolyte replacement and further medical attention, especially if the person is experiencing nausea and vomiting

  Same-day return to activity is not recommended for athletes suffering from heat exhaustion. In severe cases, return to play should be delayed to make sure young athletes are symptom-free and fully hydrated. Physician clearance is recommended before allowing young athletes to return to play in order to rule out underlying conditions or illnesses that may predispose them to continued problems. If the underlying cause was lack of acclimatization and/or fitness level, this issue should be addressed before the athlete returns to full-intensity training.

• Heat Stroke

  The prevention, recognition, and treatment of exertional heat stroke is key to an athlete’s safety. Of all of the heat-related illnesses, exertional heat stroke is the most severe. Your teen’s body temperature will rise to 104°F or higher, along with a variety of symptoms and central nervous system dysfunction. In sports, the risk of exertional heat stroke is increased in a high heat environment, but can also occur in normal or cooler environmental conditions.

  It is important to be able to recognize the signs and symptoms of exertional heat stroke to decrease the risk of long-term complications. Common symptoms of exertional heat stroke include:

  • Dizziness or disorientation
  • Irritability or other sudden mood changes
  • Unusual behavior
  • Seizures
  • Rectal temperature greater than 104°F (do not use alternative methods, such as oral, tympanic, axillary, or a forehead sticker — these devices are inaccurate when assessing an athlete who has been exercising in the heat)
  • Confusion or “dazed look”
  • Collapse or sluggish feeling
  • Change in personality
  • Aggression
  • Nausea or vomiting
  • Muscle cramps or loss of muscle function or balance
  • Loss of consciousness
  • Decreased performance
  • Weakness
  • Dry mouth or thirst
  • Rapid pulse, low blood pressure, or quick breathing

  Exertional heat stroke can cause organ failure, or even become life-threatening if it is not treated within an hour of onset. If your teen is displaying signs and symptoms of exertional heat stroke, it is important to cool their core temperature rapidly. The longer the body temperature remains high, the greater risk of these serious complications.

  • Always cool first and fast! The recommended method is immersion in a cold tub.
  • If a cold tub is unavailable, cool the athlete via tarping method, cold shower, or apply cold wet towels to their core.
  • After cooling has been initiated, it is important to call 9-1-1 and activate your emergency action plan.

  Following an exertional heat stroke episode, symptom duration is typically based on the severity of the incident. Once the athlete is symptom-free, and the physician clears them for physical activity, a specific return-to-play program should be initiated. The program is dependent upon the severity of the exertional heat stroke, and their general health, and should be closely monitored by a physician or athletic trainer.

  It is important to keep in mind that after a heat illness, a young athlete’s tolerance to heat decreases and is often a permanent side effect.

  Here is an example of an exertional heat stroke return-to-play program. Each step should be performed over several days to ensure a safe progression:

  Step 1: Start with easy-to-moderate exercise in a climate-controlled environment.

  Step 2: Move to strenuous exercise in a climate-controlled environment.

  Step 3: After that, try easy-to-moderate exercise in the heat.

  Step 4: If there are still no concerns, move to strenuous exercise in the heat.

  Step 5: If your young athlete’s sport includes equipment, then perform easy-to-moderate exercise in the heat.

  Step 6: Finally, they can move on to strenuous exercise in the heat with equipment on.

• Heat Syncope

  Heat syncope is fainting or dizziness as a result of the body overheating. This form of heat illness may be associated with some mental confusion.

  If your young athlete is experiencing heat syncope, they may have symptoms such as dizziness or lightheadedness, weakness, loss of consciousness, tunnel vision, pale or sweaty skin, and a decreased or weak pulse. Dehydration and lack of the body’s ability to adjust to heat are two factors that may contribute to heat syncope.

  Treatment involves stopping all activity and moving to a cool, shaded place to sit or lay down. Have your adolescent slowly drink water, clear juice, or a sports drink. Seek immediate medical attention for repeated episodes of fainting or if your adolescent has chest pain, seizures, or confusion.

  Same-day return to activity is not recommended and should be avoided. Have your young athlete gradually work back into physical activity after being evaluated by a physician.

For Coaches, Athletic Trainers, And School Administrators: Emergency Preparedness

With heat-related illnesses increasing in severity quickly, it is important to be 100% prepared by having the proper cooling equipment and an emergency action plan in place before the sports season starts. The information below will allow you to take the appropriate steps and have the proper equipment on-hand to treat any heat-related illnesses.

Equipment needed to effectively cool a young athlete:

• Tub (can be a kiddie pool or stock tank that can hold water and a person)
• Access to ice (ice machine or multiple coolers of ice)
• Access to a water supply (hose or multiple coolers of water)
• Tent for shade
• Towels
• Emergency phone or cell phone
• List of addresses and locations for practices and games
• Copy of emergency medical cards for each athlete (containing emergency contact information, allergies, and health conditions)

Heat Illness Resources

• National Athletic Trainers Association (NATA)
• Korey Stringer Institute (KSI)
• Gatorade Sports Science Institute
• American Academy of Orthopaedic Surgeons (AAOS)
• Centers for Disease Control and Prevention (CDC)
• Beat the Heat infographic
• Exertional Heat Stroke Prevention