Herniated Disk

Heat Illnesses

Female Athletic Triad

Burners/Stingers

Commotio Cordis

Mouth Guards

Protective Eye wear Mandated for Women’s Lacrosse in 2005

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Heat Illness: Keeping Athletes from Falling Into Danger Zones

Formula For Disaster

Heat illness is an ever-present risk when athletes are engaged in high-intensity exercise. This is particularly true in an overweight, out-of –shape, unacclimatized and dehydrated player wearing a dark-colored uniform. There are, however, a variety of steps that certified athletic trainers and coaches can take to increase the safety of exercise in hot temperatures and diminish the risk of dehydration and associated heat-related injuries.

Keep Them Cool

The cooler they stay the harder they can play. Frequent breaks to allow athletes to drink and cool down should be part of any successful program designed to keep athletes from overheating. Practice duration and intensity should be reduced and the frequency and duration of rest breaks should be increased on particularly hot days. Having players sit in cold water tubs right after practice provides another opportunity for rest and recovery.

Hydration Is Key

An important step in preventing heat illness is to stay properly hydrated. That means both the right amount and the right kind of fluid need to be available to players at all times. Research consistently shows that drinking an optimally formulated sports drink before, during and after practice and games helps athletes stay better hydrated than water alone. Water has no electrolytes to promote fluid retention and no carbohydrates to fuel the brain and muscles. In addition, athletes who drink only water have been shown to have poor voluntary fluid intake and increased urine production.

Gear Up For The Heat

High temperatures and humidity can quickly overwhelm even well hydrated and acclimated athletes. A few days of moderate physical activity lasting from 60 to 90 minutes will provide some initial acclimatization to the heat (greater blood volume, better sweat response, improved drinking), a critical step in reducing the risk of heat illness.

Focus On High-Risk Athletes

Larger athletes, especially those who are unfit, overweight and not acclimatized to the heat, are high-risk candidates for heatstroke. Even when they are properly hydrated, physically fit and acclimatized, some athletes can heat up faster than they cool down. An important safety measure is to make sure that athletes’ temperatures and body weights are at their normal levels before practice, especially if they experienced symptoms of heat illness the previous day.

Train Them, Don’t Strain Them

Athletes cannot be expected to perform high-intensity exercise until they are sufficiently acclimated to the heat. Most athletes will begin to show improved heat acclimation within four to five days, with 10 to 14 days needed for most physiological adaptations to occur. For at least the first three days of camp, workout intensity and duration should be increased gradually.

Keep An Eye On Over-Motivated Athletes

Pride can play a huge factor in heat-related injuries. Many athletes are determined to succeed no matter the cost and fail to alert ATCs or coaches when they develop heatstroke symptoms. Symptoms include headache, dizziness, weakness, nausea or vomiting, belligerence, confusion or irrational behavior.

Monitor Medications

Some prescription, over-the-counter and recreational drugs can adversely influence heat production (by increasing metabolism) and heat loss (by decreasing sweating and/or skin blood flow). Instruct players to advise a certified athletic trainer or doctor about all the medications they are taking.

Behavioral Risk Factors

Athletes who have recently been ill (with the common cold or flu, especially when accompanied by vomiting or diarrhea), are not sleeping well or who consume a lot of alcohol are at increased risk of heat illness.

Cooling Cues

Players who are at high risk of heat illness may respond well to pre-cooling before practice and games. Research shows that 15 to 30 minutes in a cold bath will slightly reduce resting core temperature, increasing the safety buffer for heat problems. Using cold towels or splashing cold water on the face, head and neck are no substitute for adequate hydration and minimal clothing during exercise in the heat. The psychological relief associated with a splash of cold water has no effect on core temperature. In emergency situations, cool first and transport second. Immersing a heat-stricken player in a tub of ice water is the best way to cool fast. Cellular damage from overheating occurs quickly, so every effort must be made for immediate cooling.

Robert Murray is the director of the Gatorade Sports Science Institute. He can be reached at bob_murray@quakeroats.com. Randy Eichner is a team physician for the University of Oklahoma. He can be reached at ereichner@aol.com. Reprinted with permission from NATA News, June 2002.

Heat Illnesses

by Chris Klekker, Riverview High School Athletic Trainer

Heat-related illness has been a major concern for athletes participating in outdoor activities for years. Hot, humid conditions are one of the leading factors in dealing with environmental distress in athletes. On the other hand, athletes participating in gymnasiums that are poorly ventilated and not air-conditioned can also be vulnerable to heat illness. The major forms of heat illness are heat cramps, heat exhaustion and heat stroke. All of these are 100% preventable.

Risk Factors:

Environmental - air temperature combined with humidity, breeze, and radiant heat can hinder heat dissipation. Increased humidity (>60%) will drastically reduce heat dissipation mechanism.

Clothing - dark clothing plus sports equipment will enhance the likelihood of heat stress.

Age - younger athlete’s bodies tend to be less efficient in regulating body heat and acclimatization to the heat.

Hydration Status - If an athlete is already in a dehydrated state prior to competition, this will increase his/her chances of heat stress during the game.

High Body Fat - Increased body fat = increased difficulty in heat dissipation

Poor Fitness Level - substandard conditioning and acclimatization increase risks of heat illness.

Illness - any athlete with fever or illness (causing vomiting, diarrhea) is at an increased risk of heat stress

Medications - medications that act as a diuretic or stimulant will enhance the chances of heat illness

Note: Exposure to full sunshine can increase Heat Index values by up to 15<°F

For more information visit these web sites: nata.org, nfhs.org, and gatorade.com

References:

Casa, D. Et al. National Athletic Trainer’s Association Position Statement: Fluid Replacement for Athletes. Journal of Athletic Training. 35(2):212-224, 2000

Zinder, S.M. and Shultz, S.J. Heat-Related Issues. National Federation of State High School Associations Resource Department. 34-39, 2001

FEMALE ATHLETIC TRIAD

It is widely recognized that regular physical activity has a positive impact on health. Physically active individuals have a decreased incidence of heart disease, high blood pressure, cancer, obesity, and many other health problems. With increased funding and availability for sport in recent years, more and more girls and women are regularly taking part in physical activity and sports. While the benefits are many, adolescent females and young adult women who participate regularly in sports are at risk of being effected by the female athletic triad.

The first component of the female athletic triad is menstrual irregularity. While menstrual cycles can vary from person to person, the average woman has a menstrual period every 28 days. In young women who exercise vigorously and don’t have adequate caloric activity this frequency may decrease. Less than 9 menstrual cycles per year is associated with decreased hormonal levels in females. This increases a woman’s risk for injury.

The second component of the female athletic triad is decreased bone mineral density. If the young athlete has a decreased level of the hormone estrogen, her bones may lose calcium and become weaker. This decreased strength in her bones may make the female athlete more susceptible to injury and fracture.

The third component of the triad is disordered eating. In our culture where physical appearance and thinness are stressed, it is easy for athletes to feel pressured to lose weight. An unhealthy diet leads to many medical complications including fluid imbalance, infertility, osteoporosis, altered thermal regulation, and even death.

While women and girls should be encouraged to be physically active in all phases of their lives, we should also be aware of warning signs for the female athletic triad. Weight loss, decreased food intake, or a disruption in regular menstrual cycles should prompt further evaluation by a health care professional.

If you have any additional questions with regards to the female athlete, please feel free to call a physical therapist at East Suburban Sports Medicine Center.

Erin B. Williams, PT

BURNERS/STINGERS

Burners, otherwise known as stingers, are injuries to the brachial plexus that cause a loss of neurologic function in the affected arm. These injuries are most common to football. The mechanism of injury is usually the head forced into lateral flexion and the shoulder is depressed away from the head and neck. This cause of traction on the brachial plexus can cause various degrees of damage. The athlete will notice a sharp burning shoulder pain that often radiates down the arm into the hand. The athlete will sometimes try to "shake off" the injury to restore feeling to the affected upper extremity. Weakness may be present at the time of injury and the athlete may leave the field supporting the injured extremity. The weakness is usually transitory and may resolve within a few minutes. In some instances, the weakness may not develop until hours or days after the injury. There is no neck pain or significant restriction in neck mobility usually associated with a true burner. In the presence of neck pain, a more serious injury to the cervical spine should be evaluated.

Injuries to the brachial plexus are classified according to severity:

Grade 1 (neurapraxias) injuries are the most common brachial plexus injuries, which represent a minor compression or contusion to the peripheral nerve with transitory loss of motor and sensory function that last from a few minutes to 4 weeks. Full recovery can be expected.

Grade 2 (Axonotmesis) injuries are when the nerve fiber is partially transected, and motor and sensory dysfunction is complete at the time of the injury. A complete recovery can be expected within 2 to 3 months.

Grade 3 injuries are rare and are a complete severing of the nerve fibers. Individuals that suffer this injury may exhibit motor and sensory loss at 1-year post injury without clinical improvement.

Treatment of grades 1 and 2 injuries involves removing the athlete from participation as long as symptoms or weakness to manual muscle testing persist. Return to play in this condition can result in further irreparable damage to the brachial plexus resulting in permanent disability. The athlete should be placed on a neck and shoulder muscle-strengthening program as soon as tolerated. Return to contact sport is based on the athlete regaining strength and endurance of the shoulder muscles to normal as compared to the uninjured side. The athlete should have no sensory dysfunction. When returning to football, the use of a neck roll or cowboy collar to prevent lateral flexion of the neck and wearing built up shoulder pads may reduce the incidence or recurrent burners.

Any Grade 2 or 3 injuries should receive further evaluation by an orthopedic surgeon or neurologist. A safe return to athletic competition may be achieved with the proper treatment and management of these injuries.

If you have any additional questions with regards to burners/stingers, please feel free to call a physical therapist at East Suburban Sports Medicine Center.

Brian Bernasconi, ATC

"Health Alert for Community Athletes!"

"Commotio Cordis: Concussion of the Heart"

BACKGROUND
Commotio Cordis is caused by a blunt force trauma to the chest, usually from a ball or other projectile traveling at speeds from 30 to 50 mph. This concussive force to the heart results in a ventricular arrhythmia (irregular heartbeat), and is the cause of approximately 20% of sudden cardiac deaths (SCD) in young athletes.