Heat stress and injury among young athletes can be prevented

August 18, 2005

Progressively increasing practice time and intensity and ensuring that football players are replacing lost fluids during training are two ways to significantly reduce the risk of heat stress and injury during preseason practice, a recent expert panel convened by the American College of Sports Medicine found.

Coaches also should allow enough recovery between practices and gradually introduce parts of the uniform, experts say.

Most high school and younger players are already fighting a losing battle when they show up to practice, says Dr. Michael F. Bergeron, panel co-chair and assistant professor of physical therapy at the Medical College of Georgia. The panel's full statement and recommendations are published in the August issue of Medicine & Science in Sports & Exercise.

"What we've found is that most players typically begin practice dehydrated - pretty significantly dehydrated," Dr. Bergeron says. "Young players generally just don't drink enough, especially following extensive exercise or training in the heat."

Surprisingly, though, hydration isn't the most important aspect of preventing heat-related injuries. Players are often simply not acclimated to the environment, the intensity of practice and the uniform, he says.

"What coaches and staff need to recognize and appreciate is that the athletes are not coming into the preseason as well-conditioned as they might hope," Dr. Bergeron says. "High school kids are going to be less fit and not only are they not accustomed to the physical exertion that workouts require, they're not really acclimatized to the heat and working out in that environment, especially while wearing a uniform and protective gear."

To help protect ill-prepared players, coaches should introduce a training schedule that progresses slowly - waiting until week two to introduce twice-daily conditioning and training sessions, experts say. They also should realize that adding a heavy uniform adds to the heat and strain players are already experiencing when weather conditions are unbearable. That can significantly add to the risk of heat injury.

"Most heat-related injuries and deaths occur within the first four days of practice, particularly on days one and two," Dr. Bergeron says. "The primary factors for driving body temperature during practice and clinical risk related to overheating are the environment and the intensity/duration of the workouts and the uniform."

During the first week of practice, protective equipment should be introduced in stages, starting with the helmet, progressing to shoulder pads and helmet and, finally, to the full uniform, the authors write.

Other suggestions include requiring a preseason exam to determine what medications and dietary supplements athletes are using and to rule out undiagnosed heart problems and other genetic risk factors. Also, twice-daily practice sessions, once introduced, should be staggered throughout the week to allow for at least a one-day break between multiple-session days.

And even if the temperature outside hasn't reached the boiling point, players and coaches should still take precautions.

"What we are beginning to appreciate more and more is that it doesn't have to be unbearably hot to have problems," Dr. Bergeron says. "The focus of this is prevention."

Medical College of Georgia at Augusta University

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