TheAmerican College of Sports Medicine (ACSM) re-issued its call for major caution in preseason practice and training for high school players during hot summer days.
ACSM emphasizes high heat and humidity represent a significant danger for heat illnesses and heat stroke unless precautions are taken and guidelines are followed.
ACSM recommends fluid replacement and acclimatization to the heat, as well as practice uniform and other modifications in order to reduce the risk for heat exhaustion and exertional heat stroke in young football players.
Severe incidents from heat-related complications are notoriously problematic for young football players, particularly during preseason practices. The overwhelming majority of serious heat illnesses occur in the first four days of preseason football practice (especially on the first and second days), when players are not acclimatized to the heat, the intensity/duration of practice, or the uniform.
"The primary reasons for a football player to overheat on the field are intensity and duration of practice, the environment, and the uniform," said Michael F. Bergeron, Ph.D., FACSM. "There's also a variety of problems that a football player can have related to sweat losses and consequent fluid and electrolyte deficits. That can range from feeling a little 'off,' to not performing well, to heat cramps or heat exhaustion—or if it were unattended, even heat stroke. If a player's body temperature reaches a certain threshold and they no longer have the capacity to regulate temperature, it can run away from them and readily lead to death."
Among its recommendations, ACSM guidelines suggest high school football players and their parents be aware and understand the impact of HEAT:
1) Hydration
2) Environmental Conditions
3) Acclimatization
4) Treatment
Hydration
- Large sweat losses, insufficient water intake and consequent fluid deficits increase the risk of hyperthermia and heat injury. Players should begin practice well hydrated, well rested and well nourished, with a normal resting body temperature. Every practice should include regular water breaks designed to replace the majority of sweat loss at least every 30 to 45 minutes. Breaks should be more frequent as heat and humidity rise.
- Water should be chilled and easily accessible. Players should use shade whenever possible. Body weight measurements should be taken before and after practice to help determine the amount of fluid that needs to be replaced.For recovery, sports drinks have an advantage over water, as they replace electrolytes such as sodium (which is lost in sweat), as well as carbohydrates for energy.
"Young athletes are coming to practice dehydrated, they're getting more dehydrated as practice continues, and they're progressively even more dehydrated on each succeeding day of practice. Athletes need to pay more attention to hydration in earnest, and make a stronger effort to be more hydrated at the start of practice, to drink regularly during practice, and to recover sufficiently from each practice so they can start the next day adequately hydrated," said Bergeron.
Environmental Conditions
- The length of each practice session should not exceed three hours (including warm-up, conditioning, instruction, breaks, and cool-down) and should be modified appropriately, in accordance with the environmental conditions (heat, humidity, and exposure to direct sunlight) in order to effectively reduce the associated risks and improve the overall safety for young football athletes.
- Players should not use stimulants, including ephedrine and high-dose caffeine often found in dietary supplements or "energy" drinks.
Acclimatization
- When players report to camp, they generally are not as well conditioned and acclimatized as college players, which may contribute to earlier fatigue and greater risk of injury.
- The body needs up to 14 days of progressive activity in the heat to undergo the physiological changes that allow for safe and sufficient acclimatization (the first three to five days are the most critical).
- Players should practice in light-colored clothing, and wear shorts with helmets and shoulder pads only (not full equipment) or shorts only (with all protective equipment removed) for the first week of practice. Helmets should be removed whenever possible (during instruction).
Treatment (Monitoring/Emergency Readiness)
- Players should be closely monitored by the team support staff (including athletic trainers) for signs and symptoms of developing heat-related injury during practice.
- Any changes in player performance, personality, or well-being should be sufficient reason to stop practice immediately for that individual. Teams should use the "buddy" system, by assigning two players to help monitor each other.
- If exertional heat stroke is suspected, players should be stripped of equipment and immediately cooled in a tub of ice water until emergency personnel can assume care and evacuate the athlete to the nearest emergency facility.
Parents, players, and coaches should all be aware of the warning signs and symptoms of dehydration and heat illness:
- Thirst
- Irritability
- Headache and dizziness
- Muscle cramping and unusual fatigue
- Nausea and/or vomiting
- Hyperventilation
- Confusion and change in personality
Between 1995 and 2001, 21 high school football players died of heat stroke, and there have been other fatalities since this time. Two severe incidents, one resulting in death, occurred last season during preseason training in Oklahoma and Texas, respectively.
The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 20,000 international, national, and regional members are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.
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The published guidelines,Youth Football: Heat Stress and Injury Risk, are based on recommendations from a national panel of experts who examined hydration, environment, and other factors which cause players to overheat. The recommendations are designed for coaches, parents, and players to follow during preseason football practices.