Heat Injury, ATC’s, and Athlete Responsibility

There is a lot of talk about dehydration and heat related illness with student athletes for good reason. The tragedy at University of Maryland demonstrates the importance of qualified and diligent athletic trainers. In NC, the school’s certified athletic trainer (ATC) is required to oversee the health of the all student athletes during any game or practice. They must be physically present at all football practices and games. Let’s talk about some of the things ATC’s do to prevent heat illness, how to recognize symptoms of heat illness, what you should do to avoid heat illness.

The most critical risk factor for heat illness is dehydration because when dehydrated the body loses the ability to cool itself. Drinking during play is only part of the answer. Your hydration level is highly dependent on what you did the day before. So, RECOVERY after practice or game is critical – see guidelines below.

If you don’t think this can happen to you and need some extra motivation then consider this….

Why does the ATC weigh me at the start of football season?

It’s about recognizing risk… Let’s take a quick look few different things the ATC does at the start of the season. The ATC is required to weigh each football player before and after practice to start the season. A player should not lose more than 1-2% of body weight and if they are unable to recover hydration loss by the next day then they are not allowed to play. The ATC also monitors the wet bulb temperature (combines temperature and humidity) and implements required rest breaks for cooling and hydrating. Have you ever wondered why players have to wear helmets without pads for two days followed by pads and helmets for two days prior to being allowed to play in a game? They need to acclimate to the heat plus all of the equipment to reduce the risk of heat illness. In other words, they need to get used to working out in the heat AND with equipment. Finally, we all want toughness in our athletes and I consider it essential for coaches to encourage that in his/her players. Furthermore, there are also some athletes that are reluctant to report problems because they do not want to be pulled from action. In these two situations, the ATC play a critical role in recognizing when an athlete is at risk and has the authority to intervene.

If you suspect you are dehydrated, get to a cooler/shady place, remove excess clothing/equipment, and rehydrate including sports drink. If symptoms are not rapidly improving, assume it has progressed to a dangerous level and immerse in a cold bath to cool body and call 911.

How to Stay Hydrated

Gatorade gives you a perfect balance of fluid, carbs (energy), and electrolytes (sodium and potassium). If you do not like Gatorade or prefer something natural, I like Skratch Labs (www.scratchlabs.com) which is also perfectly balanced. Skratch Labs also has a Rescue Hydration mix if you know you are very depleted or expect heavy sweating.

Myth: Coconut water is a better “sports drink”. Actually, it does not have enough sodium and has excessive potassium.

Myth: Pickle juice is a good replacement. Based on evidence, Pickle juice can help with cramping because of the acidity from acetic acid rather than replacing the needed electrolytes. People suffering from heartburn or hypertension may find this can do more harm than good.

Myth: All sports drinks are the same. Some contain 8% CHO (carbohydrate) which can cause stomach upset. Gatorade and Skratch are 6% CHO which is ideal.

Finally, Good nutrition is key. Athletes may need to increase their intake of saltier foods during training in hot/humid environments. If you eat a lot of processed foods, you likely get way more sodium than you need. Everyone is not the same. Some people are very heavy sweaters and some are salty sweaters. If you are getting headaches or feeling excessively fatigued after training, you may not have your rehydration under control. Watch the color of your urine – it should be sunrise yellow. If it is a heavier yellow or has a heavier smell, you are likely dehydrated.

Hydration Guidelines:

  1. DAY BEFORE: Hydrations starts the day before the event. Start each day well hydrated. Avoid consuming things like soda and coffee that deplete hydration levels and eat well.
  2. PRE-EVENT: To ensure proper pre-exercise hydration, you should drink 2 cups of water or sports drink 2-3 hours before exercise AND another cup 10 – 20 mins before exercise.
  3. DURING EVENT: 8-10 oz every 20 mins of play at regular intervals of combination of water and Gatorade. If the athlete is a heavy sweater, he/she may require more. A balance of water and Gatorade/Skratch will prevent stomach upset.
  4. RECOVERY: This is CRITICAL and as I mentioned above this is where people drop the ball! Rehydration requires water, Gatorade/Skratch (6% CHO), and food. Ideally the athlete weighs themselves and the weight is restored within six hours. This requires about 3 cups of fluid/pound lost. This is highly individual and makes recommendations very difficult. Eat within an hour, including protein and carbs.


When an athlete consumes more water than necessary and sodium becomes diluted in blood stream it can cause cerebral and/or pulmonary edema. This is called hyponatremia (low blood-sodium levels). It can cause confusion, coma, convulsions. Symptoms include headache, nausea/vomiting, swelling of hands/feet, lethargy/apathy, agitation. This may require transport to ER because it is difficult to increase electrolytes without fluids. You can’t just replace water without electrolytes!

As usual, INJURY PREVENTION = IMPROVED PERFORMANCE. Hydration is key to avoiding heat illness. Follow these guidelines, work with your athletic trainer, stay healthy and play your best.


Written by, 

Dr. Kristal Nelson PT, DPT, SCS

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