Jan 29, 2015
Feeling The Heat

by Kenny Berkowitz

Earlier this year, the NATA released new guidelines for heat acclimatization, with major recommendations for the number, duration, and types of practices that should be held during the first two weeks of preseason training. But across the country, many schools are ignoring those suggestions and continuing to put their student-athletes at risk for muscle cramps, heat stroke, and even death.
Football players are particularly at risk for dehydration, and a survey of 50 area school districts conducted by The Dallas Morning News found that most football programs failed to follow either the recommendations of the NATA or those of Texas’s University Interscholastic League (UIL). To determine a minimal amount of care, the newspaper asked four questions:
• Will you continue to use two-a-day practices?
• What do you use to determine if it’s too hot to practice?
• Do you weigh your athletes before and after practices?
• Do you have an ice bath (cooling tank) on the sideline during practice?

Of the 42 districts that responded, 37 continue to hold two-a-days, which the NATA recommends delaying until the sixth day of practice. Rather than using a sling psychrometer, as suggested by the NATA and UIL, 21 districts rely on the heat index, using charts that can vary as widely as 10 degrees from one district to another. Eighteen failed to weigh all their athletes before and after practices, and 25 aren’t equipped with ice baths in case of emergency.

Coming after a year in which 18 high school student-athletes died from heat-related causes, including six from heat stroke, that’s bad news, says David Csillan, MS, ATC, LAT, Head Athletic Trainer at Ewing (N.J.) High School, who co-chaired the NATA task force that wrote the guidelines.

“[Heat-related deaths are] preventable,” he says. “I’ve had coaches say to me from all parts of the country that we have thousands of athletes practicing every day, and if we have one guy go down, that’s not a bad percentage. One is not a bad percentage until it’s your son or daughter.”

Craig Voll, ATC, PT, Assistant Athletic Trainer/Physical Therapist at Purdue University and president of the Indiana Athletic Trainers Association, agrees.

“Heat-related death is 100 percent preventable,” he told the Lafayette-West Lafayette Journal & Courier. “These are the best practices for limiting the effects that heat has on our athletes.”

In the Dallas Independent School District, all schools and stadiums have been equipped with ice baths since 2005, when the district made them mandatory. But four years later, Head Athletic Trainer Phil Francis, MEd, ATC, LAT, CSLP, still finds himself trying to persuade other districts to take the necessary precautions.

“[Ice baths] have to be on the sideline,” he told the Dallas Morning News. “Some schools say they have the same equipment ready in the locker room, but that’s the wrong answer. And anyone who uses towels or fans is completely uninformed.”

For many districts, budget woes are at the heart of failing to comply with the recommendations. But some solutions cost little or no money to implement. The Mesquite (Texas) Independent School District uses plastic kiddie pools for its ice baths, and at Pine Ridge (Fla.) High School, Head Athletic Trainer Perry Revlett, MA, ATC, LAT, packs three to four bottles of cold water for every student-athlete.

The National Federation of State High School Associations (NFHS) has issued its own guidelines for hydrating before, during, and after practices, and recommends providing sports drinks at any practice longer than 50 minutes. And according to researchers at the University of Connecticut who studied youth football and soccer campers, athletes often become significantly dehydrated without even realizing it.

“Most of the campers thought they were doing a pretty good job of staying hydrated during the day,” researchers told the New York Times. “Obviously, there’s a gap between their knowledge and their actual behavior.”

When covering summer practices, what should athletic trainers look for? Heat cramps, with muscle spasms in the calves and lower extremities, are often related to an imbalance in water and electrolytes, which can be remedied by replenishing lost fluids. Heat exhaustion, which manifests as profuse sweating accompanied by dizziness, elevated body temperature, and rapid pulse, needs to be quickly treated with fluids and a cooling bath. Heat stroke, where athletes may lose consciousness as their body’s thermoregulatory system stops functioning, requires immediate medical attention.

Although state associations continue to pass their own regulations, including new heat policies in Ohio and Tennessee, there are still no nationwide standards, and most decisions continue to be made at the local level. However you and your school choose to tackle the issue, creating guidelines for heat acclimatization is a must, and the simplest way is to follow the best practices recommended by the NATA:

• Athletic trainers must be on site before, during, and after all practices.

• During the first five days of practice, athletes should participate in no more than one practice per day, and total practice time should not exceed three hours a day, including warm-up, stretching, cool-down, and conditioning and weight-room activities.

• If a practice is interrupted by heat or weather, it should not recommence until conditions are safe.

• If a walk-through is held during the first five days, a three-hour recovery period should be inserted between the practice and walk-through.

• Helmets should be the only protective equipment permitted during the first two days of heat acclimatization. From the third to the fifth day, shoulder pads can be added, and on the sixth day all protective equipment may be worn and full contact begin.

• From the sixth day through the 14th day, double-practice days should be followed by a single-practice day.

• On a double-practice day, neither practice should exceed three hours, and student-athletes should not participate in more than five total hours of practice, including warm-up, stretching, cool-down, walkthrough, conditioning and weight-room activities.

Even without an established national standard for heat acclimatization, the legal implications for not following a cohesive set of guidelines like those of the NATA are clear. “In the unfortunate event that an athlete goes down,” says Csillan, “an attorney is going to pick these guidelines up and ask why the school district didn’t follow them.”


For more T&C stories about heat acclimatization, go to:

Cooler Heads Will Prevail

Facing The Heat

High School Heat Tips

Hot But Not Bothered

Salt In Their Sweat

When It’s Hot

Kenny Berkowitz is an Assistant Editor at Training & Conditioning. He can be reached at [email protected]

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