Jan 29, 2015When It’s Hot
As sports medicine professionals become more sophisticated about cooling down their athletes, a host of new products have emerged to help.
By R.J. Anderson
R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: [email protected].
For the majority of athletic trainers working with high school and college athletes, a priority for the fall preseason is preventing heat-related problems. With more research detailing the dangers of dehydration and heat illness, keeping athletes safe in the heat is at the top of everyone’s to-do list.
The good news is that there are more and more products being developed to assist athletic trainers’ efforts to beat the heat. From ways to cool athletes on the sidelines to monitoring their temperatures during practice, an industry has grown up around keeping athletes safe during hot weather exercise.
In this article, we talk to athletic trainers who are in the forefront when it comes to keeping their athletes cool and describe some of the newest products they are using. We also provide a comprehensive list of products that can help you tame heat stress.
ON THE FIELD
The first step to beating heat stress is keeping athletes cool during strenuous preseason August practices. At Virginia Tech, preseason practice sidelines are cooled the same way as during game days—with misters and fans placed in strategic locations where players typically spend breaks. The same goes for the University of Oklahoma where during preseason practices the game day sideline cooling system is set up under a tent.
“The players are encouraged to congregate in that area as they’re taking time out from activity to have a sports drink or water,” says Oklahoma Head Athletic Trainer Scott Anderson, ATC. “It’s usually open on one side and big enough to fit 25 of our players—typically our offensive and defensive linemen.”
In New Orleans, where late-summer/early-fall temperatures regularly hover in the 90s and the air is heavy with humidity, Tulane University is well practiced at taking the steps necessary to keep its student-athletes safe. The practice fields there include tents, fans, misters, and lots of ice.
“During preseason football camp, our practice field looks like a circus,” says Wendy Svoboda, ATC, Director of Athletic Training at Tulane. “We have three tents set up. Two have eight big mister fans around the tent, and a company in town donated a third tent with a portable air conditioning unit in it.
“We have at least two 10-minute breaks per two-hour session, and during those times we take the athletes into the closest tent,” she adds. “And in each tent we have cups of Gatorade and GatorLytes available.”
Svoboda and her staff also place towels soaked in ice water at different stations throughout the practice field and encourage players to utilize them. After practice, players are required to cool down in one of the 20 available 80-gallon ice water-filled rubber tubs that that sit outside the complex. But before getting into the tubs, each player picks up a couple electrolyte popsicles.
“They’ll pick up a couple of those popsicles and sit in an ice tub for five minutes, then go in and shower and get ready for their meetings,” says Svoboda, adding that the same strategy is used for all of the school’s outdoor fall teams. “The ice water immersion brings their body temperatures down, so they recover a little more quickly and feel better for the next practice session.”
Ice water immersion is also one of the favorite tactics of Mike Goforth, MS, ATC, Head Athletic Trainer at Virginia Tech. “We’ve got cold tubs in our facilities, and during two-a-days we put them outside under a tent or canopy and regularly fill them with big blocks of ice,” says Goforth. “We also have 16-by-16-foot pools with their own filtration systems that we encourage athletes to use after each practice.”
While large quantities of ice have been a mainstay on hot summer practice fields, some new technology has recently entered the picture as well. A new option is a product called CoreControl from Avacore, which cools the body by extracting heat from thermal portals in a player’s hand. A portable non-invasive device, CoreControl works by pumping cool water through a cone encased in a bubble-shaped vacuum that athletes reach into and grip with one of their hands. The water cools the blood in the palm, which then circulates to the core to decrease overall temperature. The process takes approximately five minutes. Schools using the CoreControl include the University of Miami and Stanford University, and a number of professional teams also use the device.
No matter what cooling devices are used, one of the keys to making proper use of them is ensuring there are breaks in practice intensity for the players. At Oklahoma, Anderson conducted a study that monitored athletes’ core temperature during different types of workouts and found that the numbers rose quickly during intense training. After just 10 minutes of working out, athletes’ temperatures climbed two to three degrees. When they took a break, their temperatures dipped, then spiked again when they resumed working out. Anderson says the intensity of the workout was a key factor in how high the temperatures rose.
“One of the lessons that we learned [through the study] is the importance of taking breaks and varying the pace during practice,” Anderson says. “We found that there’s an opportunity for a reduction in core temperature simply through slowing down periodically. As a result, we try to have functional team breaks throughout practice and use varied intensity to lower core temperatures.”
While it is important for athletic trainers to take proper precautions when equipping a facility, it is equally important to take similar steps when outfitting players. Today’s athletic trainers encourage players to wear base-layer pieces made of synthetic fibers that have wicking and thermal regulation qualities. These pieces do not absorb perspiration, instead wicking it to the outer layer of the clothing where it can evaporate quicker, which keeps the skin drier and cooler.
A number of companies that produce these garments have emerged in the last few years, with some making padded, sport-specific models. And there are usually many options, such as compression-style or loose fitting.
New technology is also turning clothing into cooling units. At Virginia Tech, several players (typically offensive and defensive linemen and athletes with a history of cramping) wear a product called the Cool Shirt under their pads during games. During breaks in the action, players wearing the one-pound Cool Shirt, which is also popular among firefighters and race car drivers, hook up to a sideline unit that pumps 50-degree water through tubing in the shirt. The water circulates over the athletes’ upper torso and reduces their body temperature.
“We also use Chill Factor Performance cooling hoods,” says Goforth. “They’re basically thermal hoods that we freeze, and then the players put them on in between series.” Both products are designed to cool athletes and reduce perspiration, which helps control the loss of electrolytes and ultimately reduces athletes’ risk of dehydration and cramping.
Much of the difficulty of preventing heat stress is knowing who is in danger before the outward signs are apparent. Some athletic trainers now monitor their athletes more closely to know which players may face the most danger and when.
At Tulane, Svoboda compiles information on each athlete’s risk for heat illness that is carefully reviewed by the athletic trainers on site. “We type up a card that details which guys have a history of heat illness,” says Svoboda. “If an incoming freshman says on his physical that he’s had a problem in the past, we put a little star by his name and keep a close eye on him. We’ll be a little quicker to pull him out of practice and bring him inside if he shows symptoms. And the doctors might be a little more proactive with IV treatments and similar measures.”
Goforth keeps similar records at Virginia Tech. “Since the same kids tend to cramp over and over, we have cramping history documented on each player’s sideline card,” he says. “And we have anybody who gets an IV fill out a questionnaire, and then we track them a little closer.”
Virginia Tech also has every incoming football players undergo blood screening. “We’re looking at things like sickle traits and kidney function measurements,” says Goforth. “Those tests can be an indicator of people who are more susceptible to problems associated with heat illness. We’ll definitely pay a little more attention to anybody that tests positive in any of those areas and possibly do some additional testing.”
Monitoring athletes while they are practicing and playing is another a piece of the puzzle. Many athletic trainers are beginning to measure their athletes’ core temperatures to know who may be having problems, and there are some interesting new products on the market to help with this task.
Instead of using basic thermometers, athletic trainers are turning to portable units, like the DataTherm from RG Medical Diagnostics, which not only reads core temperatures, but records, compares, and displays them against previous readings. Using temperature sensor probes that can be placed under the arm or in the rectum, the DataTherm features user-defined high and low temperature alarms, which alert athletic trainers when an athlete is in a danger zone.
Similarly, QuesTemp monitors from Quest Technologies allow athletic trainers to obtain core temperature and heart rate readings while providing alerts and history profiles for athletes. The QuesTemp III is a data-logging personal heat stress monitor that monitors both body temperature and heart rate through an elastic sensor belt that is worn around the chest. The sensors transmit the data to a portable, watertight monitor that stores the data and can be clipped to an athlete’s belt.
One of the most innovative products in this area is a digestible pill that allows athletic trainers to monitor an athlete’s core temperature while he is on the field. The pills emit radio signals to a sideline monitor that displays the player’s core body temperature. Oklahoma is one school using the product. “We’re pretty proactive about using the pill to monitor athletes who might have several risk factors based on history, physical stature, or conditioning status,” says Anderson.
HQ Inc.’s Core Body Temperature Monitoring System includes an ingestible pill-based product. Using an ambulatory data recorder and a heart rate chest transmitter, the system is designed to deliver time-correlated core body temperature readings from the temperature pill, which lasts for 24 to 36 hours upon entering an athlete’s system.
Another product, the VitalSense from Mini Mitter Co., contains similar features and uses ingestible temperature pills to record core-body temperatures. The VitalSense also records skin temperatures by using hypoallergenic, adhesive dermal patches. Both sensor types are disposable, but designed for multi-day use. And both use low-power radio frequency transmissions to communicate with the monitor.
Monitoring can also include testing hydration levels, which is a key part of Goforth’s plan. Virginia Tech mandates that each football player weigh himself before and after every practice. Those weights are entered into a spreadsheet that tracks their weight loss and calculates their hydration needs. “We also have urine charts in the bathrooms that compare urine colors and list their corresponding dehydration levels,” says Goforth.
Each year, most athletic trainers update their clinical equipment and medical kits in order to improve how they treat and rehab student-athletes. And they should take the same steps toward improving their management of heat stress.
By doing an annual review of the products his program uses, Goforth is able to stay up on the latest innovations. He’s not afraid to try something out of the ordinary, but, “as with anything we do, we’ll really try to address it from an athletic performance standpoint,” says Goforth.
The marriage of science and sports is the catalyst behind the innovative products of today, and for athletic trainers like Goforth it is an area providing even more promise. “I’m really excited by all the research that’s being done,” he says. “It’s going to tell us a lot about athletes and the effects of heat on their bodies. And hopefully that will enable us to protect them better.”
Sidebar: The Right Atmosphere
Along with using the instruments and devices on the market that help reduce the risks of heat stress, athletic trainers also preach the importance of developing a team atmosphere that values lowering the risks. Scott Anderson, ATC, Head Athletic Trainer at the University of Oklahoma, begins that process in the first preseason meeting he has with the school’s athletes and coaches.
“We consider education a primary tool,” he says. “We teach them risk factors and give points of awareness. They can be as simple as an athlete reporting that they’re having trouble or an athlete observing behavioral risk factors in a teammate and bringing it to our attention. It also means the coaches communicating with us if a player is making mental mistakes or is confused. We want everybody aware of the risk factors for heat stress so we can intervene early and deal with small problems instead of large ones.”
Wendy Svoboda, ATC, Director of Athletic Training at Tulane University, also teaches her athletes to be watchdogs. “We’re trying to create an atmosphere where the student-athletes look after each other,” she says. “We preach: ‘Look out for your teammates. If he’s missing his assignment a couple times in a row, there could be something seriously wrong with him and you should let us know.’ And our guys are good about that—they take care of each other.”
At Virginia Tech, the athletic department has a written policy for dealing with heat stress, which is included in a preseason book distributed by the football coaching staff to the players. “I also get 30 minutes during the first preseason meeting to talk about it,” says Mike Goforth, MS, ATC, Head Athletic Trainer. “Then our strength coach discusses the topic for 30 minutes from a performance point of view, and so does our nutritionist.”
Athletic trainers should also work closely with coaches when the heat index is high. “If the weather is bad, we’ll go up to the coaches and say, ‘It looks pretty bad today. We need a few more breaks, or maybe we shouldn’t go full-gear,'” says Svoboda. “And the coaches are always very cooperative when we tell them what the dangers are.
“We don’t call off practice or anything that drastic,” she adds. “In fact, if we followed all the guidelines that are out there for heat index, we would never practice since we are constantly in the danger zone. But knowing that we’re in the danger zone makes us a little more proactive in trying to prevent problems.”
Anderson does the same at Oklahoma. “When the heat index is high, we certainly raise everyone’s level of awareness,” he says. “And that level of awareness can dictate any number of things, depending on how the practice is structured. We’re confident in our ability to work through extreme conditions, but we want to pass on an understanding that there needs to be some accommodations in intensity when conditions warrant it.”
Sidebar: THINKING ABOUT DRINKING
Most coaches and athletes now understand the importance of hydration. At Virginia Tech, Head Athletic Trainer Mike Goforth, MS, ATC, takes that basic understanding to a higher level.
“The biggest thing is to create a mindset and preach the benefits of proper hydration from the performance standpoint versus a medical standpoint,” says Goforth. “For instance, we know from the research that a one-to-two-percent loss in body weight will reduce your performance, and at three to five percent you run the risk of experiencing some type of heat stress.
“Well, athletes tend not to care about that three to five percent statistic because they think they’re invincible,” he continues. “But, if you explain to them that the initial one to two percent loss can lead to a dramatic drop in their performance, which could mean that the person behind them could take their position, they tend to listen and start taking hydration seriously.”
While step one is convincing the athletes to consume more fluid, step two is providing the opportunities to reach their hydration goals. “We don’t have water breaks,” says Goforth, “because we always have water and Gatorade available. During every drill there’s an athletic trainer standing by with a six pack of water and a six pack of Gatorade, pushing fluids.”
Hokie football players are also not allowed to attend meetings unless they bring fluids with them. “We know from the research that if we wait for athletes to tell us that they’re thirsty, it’s too late,” adds Goforth.
Once the season starts, Virginia Tech’s coaches and athletic trainers continue to preach the message of proper hydration as they prepare the players for competition. For example, the night before a game, each player is given a gallon bottle of sports drink and encouraged to drink that full gallon before game time.
And selling the Virginia Tech coaching staff on the merits of hydration isn’t difficult, as the results speak for themselves. “Traditionally, when we’ve gone to hot places to play, like Texas A&M or Miami, we haven’t had any cramping problems,” says Goforth. “Our kids look good in the fourth quarter, and our coaches recognize that proper hydration is one of the factors. We’re looking for any edge that we can get, and we feel that our hydration program is one of our bigger assets.”