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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

Randy Eichner:

Is a team physician for the University of Oklahoma. He can be reached at


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


90° – 105°Heat cramps or heat exhaustion possible
105° – 130°Heat cramps or heat exhaustion likely, Heatstroke possible
130° and upHeatstroke highly likely

Heat CrampsModerate sweating, cramping in arms, legs, abdomen

Ingesting large amounts water/sports drink, mild stretching, ice massage of muscle’s

Heat Exhaustion

Profuse sweating, temperature (103° and up), cool pale skin, rapid weak pulse, low BP, hyperventilation, dizziness, fatigue, nausea vomiting, headache with slight confusion, thirst.

Replacing fluids, move to shaded area, air-conditioning, remove excess clothing, elevate legs, ice packs to neck, armpit, groin, and behind knee

Proper acclimatization, proper hydration, rest, breaks, light-colored clothing, adjust practice sessions, sun block, avoid carbonated or caffeinated drinks

Heat Stroke

Red, hot, dry skin, temperature (105° and up), rapid pulse, high BP, rapid breathing, confusion, violent behavior, nausea, vomiting, headache, dilated pupils possible unconsciousness

Have someone CALL 911, move to shaded area, airconditioning, replace fluids if possible, remove excess clothing, ice packs/cold immersion

Hydration Guidelines
Before exercise:

-drink about 20 ounces of water/sports drink 2-3 hours before competition

-additionally drink about 10 ounces of water/sports drink about 20 minutes before competition

During exercise:

-general rule drink about 10 ounces every 20 minutes

-do not wait until thirsty; need to drink beyond thirst

After exercise:-drink about 20 ounces/ pound of weight loss

For more information visit these web sites:,, and


  • 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


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, 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”


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.

However, the magnitude of the force with which the projectile hits the chest wall is not the only factor that can result in SCD. When the impact occurs on the upswing of the T-Wave in the cardiac cycle, this will ultimately result in ventricular fibrillation, which can lead to death. A combination of the location (center of the ventricle), timing and force of the impact are the primary causes of this injury.

In sports, there have been several documented cases of commotio cordis that have resulted in SCD. Commotio cordis most commonly occurs in baseball and softball but can occur in other sports such as ice hockey, football, lacrosse, boxing and karate. It can occur at any age, but young children are more prone to this injury because their thoracic walls are weaker and pliable (not rigid). Approximately 40% of all documented cases of commotio cordis occur at home, school, or on the playground. The estimated incidence of SCD in high school athletes is 1 in 200,000 to 300,000, whereas the incidence in college-aged athletes is slightly higher, ranging from 1 in 65,000 to 69,000. However, with no national reporting or surveillance system, the true incidence of SCD in athletes is unknown. Although SCD is a rare but catastrophic event in young athletes, it is more common in an older population, with an estimated annual frequency of 1 in 1000 persons aged 35 years or older in the United States.


Sudden cardiac arrest (SCA) is the leading cause of death in young athletes. Also, the increasing presence of and timely access to automated external defibrillators (AEDs) at sporting events, as well as other public places (schools, airports, casinos, etc.) provides a means of early defibrillation and the potential for effective secondary prevention of sudden cardiac death. Therefore, an Inter-Association Task Force was sponsored by the National Athletic Trainers’ Association to develop consensus recommendations on emergency preparedness and management for SCA in athletes. (Click here to see the Task Force’s sudden cardiac arrest management flow chart)

Once an athlete is suspected of being in cardiac arrest, cardiopulmonary resuscitation (CPR) should be immediately administered by trained individuals. This should continue until the arrival of an automated external defibrillator (AED). It is important to note that CPR doesn’t save lives, it saves time. CPR is important, but the AED SAVES LIVES. An automated external defibrillator analyzes the heart’s rhythm and tells the user to deliver a shock if it is needed. AEDs are designed for people who are not medically trained to use easily and safely. Although this unit can be costly, there is no value on a human life. If the use of an AED is not initiated within a 2-minute window the athlete will probably not survive. The single greatest factor affecting survival after an out-of-hospital cardiac arrest is the time interval from arrest to defibrillation. Studies have shown that when defibrillation occurs within 1, 2, 4 and 6 minutes after commotio cordis, survival rates were 100%, 92%, 46% and 25%, respectively. AEDs are simple to use and people can be easily trained to use them.

Additional Information

For more information regarding the importance of AEDs, click here to read the Task Force’s complete set of recommendations for the management of sudden cardiac arrest.

Also, click here(opens in a new tab) for more information on how an AED can save your child’s life.


Children are dying because they are not protected. Athletes need to be trained to wear chest protectors routinely as they would head and face gear, groin cups, etc. One current method of prevention is the use of a chest protector. Listed below are a few choices to consider when purchasing your child’s next piece of chest protecting equipment.

General Protection

Rawlings BCP550 Youth Sternum Protector

Item #1162582

This is designed for batters and fielders. The protection piece is constructed of foam and plastic with a fabric cover, and has a hook and loop closure so it is easy to get into and out of.

Cost: $12.99 in a new tab)


It has a plastic outer surface with the center 50% thicker and has low-density foam inside. May not cover entire chest/heart area. Made specifically for ages 5-14.

Cost: $20


Rawlings 12P1 Youth Catcher’s Chest Protector

Item #504459

Especially designed for catchers 12 to 16 years old. Features a contour neck pad for coverage and comfort. Polyethylene sternum insert design provides additional protection.

Cost: $29.99

Rawlings AFCPY Girls’ Fast Pitch Catcher’s Chest Protector

Item #1383545

Designed for mobility and easy adjustability. The 14-inch body length is constructed with closed-cell foam for tough protection and it includes added shoulder coverage.

Cost: $29.99

Rawlings Coolflo Junior Catcher’s Chest Protector

Item #2802851

Features a junior 15-in body length as well as the exclusive Dynamic Fit System™ that provides greater flex and fit. Perforated foam with Pro Dri Plus® back harness wicks away moisture and heat, while the “Memory Foam” conforms to the body and drastically reduces ball rebound.

Cost: $69.99 in a new tab)

Adams Batters Vest

Search: bv-1530

For youth aged baseball and softball players. Constructed with nylon material and equipped with plastic fiber inserts surrounded by foam padding. One size fits all. Unit aids in the protection of the frontal chest and rib cage regions of the player.

Cost: $60 in a new tab)


Intrepid Adult Lacrosse Goalie Chest Protector

Search Code: intcpm

Features a form fitting design for increased flexibility. Comes equipped with hard plastic layered over dual-density foam in the upper left quadrant (where the heart sits in the chest wall).

Available in small, medium and large sizes.

Cost: $47-$49

To ensure that your child is participating in a safe and healthy environment, here are some ideal goals for your community to reach:

  • Mandatory use of chest protectors by athletes in all sports at risk
  • Mandatory presence of CPR certified coaches/athletic trainers
  • All schools and sports facilities should be equipped with AEDs
  • An AED is to be available during all competitions with trained sports personnel available

For more information, contact Jeremy Erkel, ATC at


Mouth Guards can prevent serious injuries such as concussions, fractured jaws and teeth, severe cuts to the cheek and tongue (often requiring surgery for repair), and traumatic damage to the roots and bone that hold teeth in place. The mouthpiece acts as a shock absorber and can help prevent or minimize the injury.

All mouth guards are not created equal. Depending upon the design and materials used, mouthpieces will vary in protection, ease of maintenance and longevity.

  • Custom-Made: Formed from a cast model of your teeth, these custom-made guards aredesigned to cover all the teeth and make contact with a greater area of the wearer’s mouth. These mouth guards can cushion falls and blows to the chin. Custom-made Mouth guards also provide extra thickness and elasticity for the best protection against concussions. They may be slightly more expensive than commercially produced mouthpieces, but they offer the best possible fit and protection. These mouthpieces are specifically shaped in palate to improve breathing and speech with proper alignment of the jaw.
  • Mouth-Formed:Mouth-formed or “boil and bite” mouthpieces also shouldbe fitted by your dentist. These guards are generally made of acrylic gel or thermoplastic materials shaped to fit the contours of your teeth. If you or your child wear braces or fixed dental appliances, it is essential that your mouth-formed guard be custom-fitted by your dentist. Stock mouth guards are not designed to properly fit. The boil-and-bite mouth guards offer very little thickness to protect the teeth. As they wear down with use, it’s almost like no plastic at all.

Mouth guards are required in sports such as football, but custom-fitted models can cost about $100. Most high school athletes use a self-adapted mouth guard that is softened in boiling water and then self-fitted around the teeth. Custom mouth guards, because of their exact fit, reduce the chances of concussions and tooth damage much more than so-called “boil-and-bite” mouth guards that athletes fit for themselves.

Sports Dentistry facts offered by the National Youth Sports foundation for safety:

  • More than 5 millionteeth are knocked out each year, many during sports activities.
  • An athlete is60 times more likely to sustain damage to the teeth when not wearinga protective mouth guard.
  • The cost to replacea tooth and the follow-up dental treatment is about $5,000.

Advice from the American Dental Association:

  • A properly fittedmouth guard reduces the chances of sustaining a concussion from a blowto the jaw.
  • It is estimatedthat face guards and mouth guards prevent approximately 200,000 injurieseach year in college and high school football.

Pro Mouthguards is recommended for custom-made mouth guards and the cost is anywhere from $40 to $60. For more information about this product or to order Pro mouthguards you can go on-line at If you have any questions, please call us anytime.

Protective Eye wear Mandated for Women’s Lacrosse in 2005


Lacrosse Women’s Division Board of Governors has voted to amend the rules of women’s lacrosse to highly recommend the use of protective eye wear meeting current ASTM lacrosse standards for 2004 and to mandate its use beginning in 2005.

The purpose of this rule is to acknowledge that while women’s lacrosse is a comparatively safe sport, the use of protective eye wear will prevent the rare but catastrophic eye injury. After exhaustive discussion and information-gathering, as well as comprehensive review of the available medical literature and a recommendation by the US Lacrosse Sports Science and Safety Committee, the Board has decided that the use of protective eye wear will minimize the risk of catastrophic eye injury at all levels.

Because of concerns about product availability and other timing issues, the Board highly recommends that all players wear ASTM-approved protective eye wear for 2004 but will not mandate its use until Jan. 1, 2005. The following products have been tested and meet current ASTM eye wear standards (able to withstand an impact of 60 miles per hour for adult play (high school and older) and 45 miles per hour for youth play) for lacrosse:

  • CascadeIRIS (wire)
  • Halo/BangerzHS-3000 (polycarbonate)HS-5500 (polycarbonate)
  • HS-OTG (polycarbonate)
  • LeaderSport USAField Sport (Rx, polycarbonate)
  • Lax Vision (polycarbonate)
  • LibertyOptical/RecSpecs USAMX10 (Rx, polycarbonate)
  • ShamrockLacrosseOptic Pro (polycarbonate)
  • Over The Glasses (polycarbonate)

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