Rising Temperatures Signal Need for Safety Precautions on the Field

About 45 minutes into tennis practice at Nashoba Regional High School on a warm May afternoon, Lindsay Kallander felt ill and went to lie down in the sun. The next thing she knew, a policeman was standing over her and an ambulance was waiting to take her to the hospital.

“I was short of breath, freezing on the inside and hot on the outside,” said Kallander, a senior from Bolton. “I seriously thought I was going die.”

The diagnosis was dehydration and heat exhaustion, complicated by an infected navel piercing that had weakened Kallander's immune system but primarily attributable to the fact that she had essentially gone the entire day without eating or drinking. And although Kallander says she normally drinks at least two bottles of water per day, the experience has taught her that even that may not be enough to prevent heat-related illness in athletes who practice or play outdoors in high temperatures.

“Most people think you should drink until you're not thirsty any more, but you really need to drink more than that,” she said.

It's a lesson that Amy Beckman, the athletic trainer for Nashoba Regional, can't emphasize enough. Beckman, who is also a physical therapy aid at South County Physical Therapy in Auburn, says she sees a handful of heat-related cases every spring and that the risks increase as summer progresses and temperatures and humidity levels rise. Most of the cases Beckman sees are on the mild end of the spectrum of heat illness, which includes dehydration, heat cramps, heat exhaustion, and heat stroke.

And as if the environmental factors weren't daunting enough, poor hydration habits can make athletes their own worst enemies when it comes to exercising in the heat. Research suggests that many people have so little concept of their own hydration status that they may actually be dehydrated even before exercising. This is especially common in children who either forget to drink water or choose instead to slake their thirst with caffeinated soda, which can accelerate dehydration. Advising young athletes to pay attention to the color of their urine (the darker the color, the more dehydrated the body) can improve awareness, but studies also suggest that even athletes who know they are dehydrated often still fail to drink enough fluids without reminders from a coach or parent.

The best way to prevent heat-related illness, Beckman said, is to avoid scheduling games or practices during the hottest part of the day (between 10 a.m. and 4 p.m.). That, however, is much easier said than done, particularly given the number of local sports organizations competing for field time.

“It's incredibly hard to schedule,” she said.

Beckman encourages coaches to have their athletes take frequent breaks and make sure that water is readily available during those breaks; not wanting to wait in line for water is one of the reasons for inadequate hydration cited by athletes in some studies. Some fun but effective ways for athletes to beat the heat include dousing themselves with cold water or covering their heads with cool, wet towels, she said.

Coaches and parents should also familiarize themselves with the symptoms of heat illness and methods of treatment, Beckman said. (Guidelines provided by the National Athletic Trainers Association are listed in the accompanying table.) It's important to note that even well-hydrated athletes can still be vulnerable to heat illness, and that in rare cases excessive fluid consumption by athletes can lead to a serious condition called hyponatremia, whose symptoms can mimic those of heat exhaustion and heat stroke but often occurs following exercise rather than during exercise.

And athletes shouldn't assume that spending the summer in an air-conditioned gym will save them from heat exposure come fall. Beckman says she sees about a dozen cases of heat illness every fall in football players, many of whom have been inactive over the summer and therefore haven't become acclimatized to exercising outside in the heat.

“At every fall pre-season meeting, it's definitely something I mention,” she said.