August 2012

Medical: How to Avoid Heat Exhaustion

Author: John P. Batson, MD, FACSM

Living in the Lowcountry, we are exposed to extreme heat and humidity. This year has been no exception, with heat indices over 100 degrees the norm during the last month. Football players, in particular, are at risk with the season starting in August and protective gear required for participation. Heat associated deaths are the third leading cause of exercise related deaths in young athletes. The recent death of a Lamar High School football player after a practice this year is thought to be related to heat illness.

Heat illness represents a spectrum of problems including cramps, passing out, exhaustion, and stroke. Important risk factors for heat illness include a history of previous heat illness and a lack of acclimatization (cardio-vascular adaptations related to heat training). Other risk factors include certain medical conditions (obesity, diabetes, sickle cell disease), current illness (fever, vomiting), and certain medications and supplements. The young or elderly are also at higher risk for heat illness due to immature and impaired regulatory mechanisms.

Preventing heat illness – Physicians should ask about medical conditions affected by the heat, previous heat related problems and fitness conditioning at preseason physicals.

- Parents should ensure young athletes maintain optimal year-round physical activity and nutrition habits.

- Athletic trainers present on the sideline are extremely valuable to monitor heat conditions and players’ hydration.

- Coaches can encourage healthy habits, as well as minimize the risk of heat illness with modifications in uniform wear and training schedules.

- Supplements, caffeinated sodas and energy drinks are discouraged.

- Light-colored clothing and clothing with SPF and wicking features is helpful.

- Water breaks should be scheduled at regular intervals during the practice. Salty snacks and sports drinks with electrolytes can help replenish lost sodium and chloride in sweat.

- When an athlete is suspected of suffering heat illness, he or she should be placed in the shade and encouraged to drink as much as possible. Excessive clothing can be removed to aid with sweating and evaporative cooling. If muscles such as the calf or hamstrings are cramping, they can be stretched and massaged. If the athlete feels lightheaded, he or she should lie down with legs elevated. For more serious conditions, EMS should be activated by dialing 9-1-1.

Living in the south, it is a challenge for all of us to beat the heat and keep our young athletes hydrated and healthy. It is important to keep in mind that sports related heat illness is entirely preventable by following some simple advice and common sense.

“Cool” tips for avoiding heat illness: – Thirst is a not a good indicator of hydration level. If you are thirsty, you are already dehydrated.

- Don’t pour that cold water on your head. It will do a lot more for you if you drink it!

- Monitor weight before and after a workout. For every pound of weight loss, you should consume a pint (16 ounces) of fluid prior to the next workout.

- If you are more “in shape,” you actually sweat more than the average couch potato does when exercising and thus must drink more to stay hydrated.

John P. Batson, MD, FACSM specializes in interventional spine care, adult and pediatric sport medicine and pain medicine. For more information, call Lowcountry Spine & Sport at (843) 208-2420 or visit online at

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