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Ask Dr. Rick – August 2010

August 13, 2010

Heat-Related Syndromes

It is August in St. Louis and we have gone through another hot St. Louis summer. One of the most pressing problems that a parent, coach or sideline physician will deal with is dehydration and heat-related syndromes. Dehydration can occur in any temperature, but is seen most commonly as football starts up, two-a-day practices commence and the athletes that may not be in top physical condition take the football field. This occurs at every level. This occurs in the National Football League, in Division I college football and in high school football.

Dehydration is essentially a loss of body water caused by decreased intake, increased losses by evaporation in sweating or a combination of both. Prolonged dehydration leads to many ill effects and creates tissue dysfunction, potential hemodynamic collapse and loss of intravascular volume. In English, this means that one’s water supply and intravascular supply are depleted. When these are depleted, there is decreased blood supply to the skin, decreased blood supply to the muscles and decreased blood supply to the organs. When an athlete is at the extreme level of dehydration, the athlete will no longer sweat, core body temperature increases and performance diminishes. At a larger level, the athlete can die. So, how do we identify heat-related syndromes? The clinical symptom is thirst. When two-a-day football practices start, water breaks are a necessity and need to be frequent. When an athlete is thirsty, he needs to stop and drink water as well as electrolyte fluids. Other symptoms include orthostasis or dizziness, an inability to go to the bathroom or to void, reduced skin turgor or dryness in the skin. As this process worsens, the athlete will experience lethargy, a rapid heart rate, rapid breathing and with 12-15 percent of dehydration, the athlete will experience hemodynamic collapse. Hemodynamic collapse is essentially the athlete passing out, vital signs being affected and the potential for death.

So, how do we prevent dehydration? Here are important steps to follow:

  1. Frequent water breaks.
  2. Electrolyte balance replacement. We do not recommend salt loading, and we do not recommend salt tablets.
  3. Weighing the athlete before and after practice to determine the insensible water losses.
  4. Sitting in a cool place immediately if dizziness, nausea or very rapid breathing occurs.

In short, this can be a medical emergency. If there is any question about an athlete undergoing significant heat disease, the athlete should be immediately transported to an emergency room. Although this process is 100 percent preventable, every year, a number of athletes will die due to heat-related diseases and this occurs again at every level. Hydrate the night before practice, during practice and after practice.

Ask Dr. Rick


“Dr. Rick, I am a high school football player and have had significant
cramping during my sophomore and junior years. The cramping gets
worse as the season progresses, and salt tablets and energy drinks
have not helped. Could you please help me?”
– Jalan R., Columbia, Illinois

Jalan: First of all, thank you very much for your question. We have chosen your question because today’s topic was about high school football and heat illness. One of the affects of electrolyte imbalance is clearly cramping. Cramping can be due to dehydration or due to sodium potassium imbalance. Cramping can be related to tightness in a muscle due to overuse, rest and then an attempt to overload the muscle. The first thing that you need to do is weigh yourself before and after practice. Then make sure you are getting enough fluid replacement. You also need to make sure that your fluid replacement has electrolytes as well as minerals so that during your rehydration process you are replenishing all of the needed nutrients. If this does not resolve your cramping, you need to see your physician and blood work needs to be done to measure your sodium and potassium to determine if there are some deficiencies. Lastly, if this
does not prove to be helpful, an analysis of your urine, as well as sweat will lead to the answer and determine exactly what needs to be done to resolve your cramping. This is a great question, and good luck. Please email us if you have any further questions.


““Dr. Rick, my dad and I have been arguing for two and a half weeks
about the benefits of stretching. Can you please clear this up?!”
– Patrick M., Chesterfield, Missouri

Patrick: Thank you very much for your question. For the first 10 years of my practice, I preached to patients that stretching was imperative. It was my opinion that stretching 15 to 20 minutes prior to football practice, hockey practice, track practice, etc. would decrease injuries, improve performance, pretension the muscle and decrease stress in the athlete’s tendons, muscles and soft tissues. Unfortunately, your dad and I were wrong and you are correct. Stretching has been shown to have very little benefit injury-wise and also very little benefit in improving performance. Studies have been done that have looked at this very carefully and the benefits of stretching are very short-lived. It is my opinion over the last 7 to 10 years that a short period of time to stretch does help warm up the athlete and may improve the beginning components of practice, but in terms of injury prevention and performance enhancement, stretching appears to have very little benefit. This is one instance where logic has proved to be incorrect and true science has essentially dismissed the
myth that stretching has great benefits.

This medical tip for August is again, hydrate, hydrate, hydrate!

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