Young athletes face seasonal issues of heat, deconditioning

Across America, steamy August days also herald the start of high school and middle school practices for football, cross-country, volleyball and other fall sports. With heat indexes breaking records, getting young athletes safely through the transition of increasingly demanding workouts and into the competitive season is paramount for coaches and athletic trainers. 

Two Seattle specialists in sports medicine and safety, Mike Dillon and Dr. Lauren Paladino, discuss injury prevention, athletic performance and the responsibilities that face team coaches, trainers and athletes. Paladino is a family medicine physician with UW Medicine and Dillon is a senior associate athletic director for health and performance for Husky Athletics at the University of Washington.

The Q&A below was edited for length and clarity.

Q: What are the major safety considerations for coaches and athletic trainers when young athletes start to practice for fall sports?

Dillon: The biggest concern is athletes, especially in high school and middle school, being in a deconditioned state over the summer and going into more coordinated physical activities and exertion. Any time you go through that transition, the body is at highest risk for soft-tissue injuries and other conditions that are much more serious. 

Paladino: For instance, rhabdomyolysis is when extreme overexertion breaks down muscle tissue and can lead to kidney failure. It’s common in any athlete who overuses their muscle when they aren’t conditioned or are dehydrated. Some athletes basically go from zero to 100 in terms of energy they’re expending. We focus on the importance of not doing that.

Q: Do team athletic trainers work with coaches to set up drills that will avoid those types of injuries? 

Dillon: Ultimately the athletic trainer is tasked with the overall health and well-being of the student athlete. They should have awareness to make sure the load-dosing (of training) is appropriate based on an athlete’s condition. 

A coach should have education and understanding about the risks that go along with their specific sport. But some coaches may be using older methods to train their teams, so it is up to the athletic trainers to step in when they feel like there is a health and safety risk for the student athletes. Doing that is not always easy at the high school level.

Q: How should coaches and athletic trainers consider players’ safety in the persistently higher temperatures we face?

Dillon: National standards are set forth in this consensus statement by the National Athletic Trainer Association, the American Medical Society for Sports Medicine and other orgs. They establish the green, yellow, red and black levels that indicate local safety for training outside (see graphic below). Every athletic trainer should find out what level they're at.

Paladino: In western Washington, we have relatively temperate climate. But on hot days when athletes put on equipment that doesn't allow them to disperse heat effectively, they can still go into heat illness, heat exhaustion or heat stroke. Athletic trainers have to be able to respond effectively. 

And even when the guideline says “safe,” athletic trainers should have access to cold water and towels that can be used to quickly cool down a player who shows signs of heat illness.

Q: What would you say about student athletes’ overall conditioning these days?

Dillon: I don’t think the average high school student athlete has been so active over the summer that they can tolerate two-a-days (two practices a day) on Day 1. That said, we certainly have seen an increase in sports specialization and year-round training, which tend to cause overuse injuries. If you have a football team of 40 or 50 students, a chunk of them during the summer have been in the weight room, doing 7-on-7 games, doing speed training. Their muscles and tendons may not be getting enough rest and recovery. 

But preseason training also can help protect athletes from transitional-period injuries where load is suddenly increased. For instance, if a cross-country runner shows up to practice on Day 1 without having run any miles, they're going to hurt themselves 100% of the time. If you want to be successful and lower your chance of injury during a short season, you have to build a base before you start running 25 or 30 miles a week.

Q: Are problems created by student athletes who don’t want to disclose an injury or show vulnerability?

Dillon: It is a problem. We're required by the NCAA to provide annual education for student athletes, and a lot of that has to do with the them being upfront with how they're feeling, if they are hurting or experiencing certain symptoms.

Paladino: At the high school level, I think athletic trainers spend a lot of time with those athletes. They learn the athlete's mannerisms and personality and can be faster to recognize when something’s wrong. That relationship is very helpful. 

Q: Let's talk about water-enhancement and -energizing products. Are they safe for young athletes?

Dillon: Just because something's on a store shelf doesn't make it safe. The “pre-workout” energy powders, something people take before they go to the gym, have become popular for young people. These typically have a stimulant like caffeine — sometimes at hazardous levels, depending on the individual’s size and age. These products’ claims can be outlandish compared to what they actually do.

Products that say they help with hydration have a higher level of sodium in them, and these are often used on the sidelines. There are electrolyte beverages or powders designed to replace the sodium and potassium and carbohydrates that your body loses during high-intensity activity. You need sodium and potassium to generate a muscle contraction, so if you’re doing long intensive exercise like soccer, it’s important to replace that fluid within that workout. If your activity is short-duration, you probably don’t need these products. 

Overall, hydration is important, but some people just don’t like to drink water. So if a flavoring agent can get an athlete to drink water, that’s great. 

Q: What about the colorful tape that lots of athletes seem to use now? How important are these products to athletic performance and injury prevention?

Paladino: Typically kinesio tape is used with an existing overuse injury or mild muscle strain. It helps protect during training or competition, so you don't exacerbate an injury. If you watched the Olympics, those athletes were using tape to manage injuries they already had. 

Dillon: For injury prevention and athletic performance, zero importance. In high school, I think a lot of student athletes use it because it looks cool. But for injury management, kinesio tape or a similar product in the hands of the right provider, with the right application, can be extremely effective. 

Q: What’s one piece of guidance that you’d give a young athletic trainer?

Dillon: Prepare for emergency situations. Review, update and rehearse your emergency action plans with anyone who will be on hand during events. Many of these emergencies happen in situations where the athletic trainer is not there. I think coaches are actually the population that needs to hear this most.

Paladino: In high school, it can even help to include the superintendent or the principal in this planning.

For details about UW Medicine, please visit http://uwmedicine.org/about.