Heat and Sports Injuries
L. Michael Waters, Jr., DO
St. Vincent’s Primary Care-Branan Field
Adjunct Clinical Professor PCOM-GA
Disclosures
 Absolutely no conflicts to
disclose!
 I have 2 sons, they are both
in this picture and involved
with sports
 I coach both of their teams
in youth soccer
 I am a team physician at a
high school level for the
past 6 years
Heat Illnesses in FL
 In the state of FL, we are
aware of the heat to the
point that one of our sports
teams is named after it.
 FL is one of the hottest
states, and is projected to
have the top 13 cities with
an increase in number of
days with heat index
greater than 104 over the
next 34 years
Risk Factors For Heat
Illness
 Anyone with a current or recent fever may be at increased risk
 High humidity (greater than 60%) makes sweat evaporation very
difficult.
 Dark clothing absorbs heat
 Full body clothing, heavy pads, and helmets make cooling more
difficult.
 Direct exposure to the sun with no available shade can increase
your core body temperature.
 Children adjust to heat more slowly than adults
 Not having enough fluids, will lead to not being able to effectively
cool through sweat and evaporation.
Risk Factors For Heat
Illness
 Athletes with high body fat have greater difficulty cooling
themselves.
 Diuretics and stimulants may increase risk.
 Exercising in the heat, and the athlete not being in good
physical condition.
 Sickle cell trait or disease increases the risk for heat illness.
This is especially true if good hydration and electrolytes are
not maintained. (Ryan Clark, Steelers safety)
 Factors that can affect your pre-activity hydration status
include inadequate rehydration after a previous exercise
session, alcohol consumption, rapid weight loss regimes (i.e.
wrestling), and fever, vomiting, or diarrhea.
Mild Heat Injury
 Heat Cramps
 Heat cramps are painful cramps in the stomach, arm, and
leg muscles. These cramps are caused by not replacing salt
and fluids during intense, prolonged exercise in the heat.
 Treatment for Heat Cramps




Stop exercise activity
Gently stretch affected muscles
Drink cool water or an electrolyte solution (low in sugar)
For severe symptoms, treat as heat exhaustion (see below)
Moderate Heat Injury

Heat Syncope




Weakness, fatigue, and fainting are the chief symptoms of heat syncope. They
are typically brought on by exercising hard in the heat. Too much salt and
water are lost through perspiration, and are not replaced.
Often occurs during the first 5 days of adjusting to a new activity. It also can
occur in people taking diuretic medicines or those with pre-existing heat illness.
Young athletes returning to play after time off for injury are also at greater risk
for heat syncope.
Without treatment, heat syncope can put you at risk for heat stroke.
Heat Exhaustion (Water depletion)


Heat exhaustion is brought on by heavy sweating and results in extreme weight
loss. As heat exhaustion sets in, perspiration decreases, and skin and body
temperatures rise. Core body temperature typically rises to 104 degrees F.
Additional signs of heat exhaustion include excessive thirst, weakness,
headache, and sometimes unconsciousness.
My Youth Soccer Team
My U7 team played 4 games in one day to win their season tournament, but by the last
game several players sat out due to exhaustion and headaches. They played for more
time that day than the players do in the World Cup games.
Moderate Heat Injury

Heat Exhaustion (Salt depletion)




Common signs of heat exhaustion due to salt depletion are nausea and vomiting,
frequent muscle cramps, and dizziness. Core body temperature is typically up to 104
degrees F.
You are at risk for this type of heat exhaustion when you do not sufficiently replace
normal body salts and minerals. This can sometimes happen during prolonged
exercise if water alone is used to replenish fluids. Body minerals, such as those in
sports drinks, must also be replaced.
Electrolyte fluid drinks are an effective way to prevent this type of heat exhaustion.
Treatment for Heat Syncope and Heat Exhaustion





Move the person to a cool, shaded area
Remove tight clothing
Give fluids, if the athlete is conscious
Apply active cooling measures, such as a fan or ice towels, if the core temperature is
elevated
Refer to a physician to assess the needs of fluid/electrolyte replacement and further
medical attention, especially if nausea and vomiting are present
Severe Heat Injury

Heat Stroke





Heat stroke is the most severe form of heat injury. When suffering from heat stroke,
your body cannot cool itself. This is an acute medical emergency.
Heat stroke is medically defined as core body temperature greater than 104 degrees
F. Organ system failure can result from this high of a body temperature.
Nausea, seizures, and confusion or disorientation often occur with heat stroke.
Unconsciousness and coma are possible.
Heat stroke may occur with no preceding signs of heat injury. It can also occur as a
progression from heat syncope and heat exhaustion. Again, this is a medical
emergency.
Treatment of Heat Stroke






Call 911 immediately for emergency services
Monitor core body temperature and lower it as quickly as possible
Decrease core body temperature through immersion in an ice bath
Remove as much clothing as possible
Apply ice packs to the armpits, groin, and neck areas
Continue cooling efforts until an emergency crew arrives
Being on the sidelines

Know who has any injuries prior
to the game

Know who the coach is

Make sure the team has proper
hydration

Introduce yourself to other team
and their physician if they have
one

Introduce yourself to the EMTs

Watch the players, not just the
game

Try to not wear your team’s colors
In a Pickle?

An old home recipe for stopping
cramps is pickle juice

A 2009 study in the Journal of Athletic
training showed no evidence of
electrolyte replacement from pickle
juice to help with muscle cramps

Isolated muscle contraction with EMG
stimulation to decrease confounding
factors

Therefore the recommendation is not
to use pickle juice as the sodium in it
might be too concentrated to use
properly

This study was further supported in
2015 study
Musculoskeletal Injuries

The seven most common sports
injuries are:

Ankle sprain.

Groin pull.

Hamstring strain.

Shin splints.

Knee injury: ACL tear.

Knee injury: Patellofemoral syndrome
— injury resulting from the repetitive
movement of your kneecap against
your thigh bone.

Tennis elbow (epicondylitis)

Can evaluate on the field



Take your time, no rush
Might need to call for stretcher
Can help athlete up and off field

Send to Emergency Department

Have athlete follow up with their
primary care physician
Osteopathic Treatment
 Can be done on the sidelines
 On cart to remove players there is a flat portion that
can be used as a table
 Most teams have a massage / OMT table
 The ground/grass it typically not to hard and can be
utilized
 When comfortable with diagnosis and differentials
 All techniques can be utilized
A safe rule
 If in doubt, sit them out
 This could literally save a life (second-impact, heat
stroke)
 Treat the athletes as though they were related to
you
 Make sure you advise that they follow up with their
own doctors and not you (avoids conflict)
Thank-you
References
 J Athl Train. 2009 Sep-Oct; 44(5): 454–461.
 doi: 10.4085/1062-6050-44.5.454
 http://orthoinfo.aaos.org/topic.cfm?topic=a00319