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Keyword: hydration

By Stephanie Davey, MEd, ATC, PES
Athletic Trainer
MUSC Health Sports Medicine
www.MUSCHealth.org/Sports

The middle of July means that high school football is just a couple of weeks away. In South Carolina, most of our high schools start around July 27th. If your son is planning to play football and go through preseason, there are a few things they need to focus on off the field in order to be safe and productive on the field.

Hopefully, your son has already been working on his conditioning. This will go a long way to him being able to acclimate to the South Carolina heat. South Carolina High School League mandates an acclimatization practice plans that all high schools must follow. If you have questions about that plan you can find it on the South Carolina High School League website

Hydration is always the first thing that comes to mind when we think of preseason football. Your son must be hydrated prior to reporting to practice each day. There is no way to catch up if they are already dehydrated when they arrive. Two ways to tell if they are hydrated is monitoring the color and volume of their urine and making sure they weigh in and out of practices. Their urine should be a light yellow color and high in volume before they go to bed each night. Secondly, they should be weighing in prior to practice and out after practice. They can do this at home or with their athletic trainer. For every pound that they lost during practice, they need to drink 20-24 oz of fluid. If they do not regain the weight they’ve lost during the previous practice, they may need to be held out of practice until they’ve rehydrated. To rehydrate, they should consume water and a sports drink. Soda and beverages with a high caffeine content should be avoided. Energy drinks should not be consumed at all.

The next thing to focus on is proper nutrition. The body is just like a car, the better fuel you put in it the better it performs. Your son needs quality food that is high in nutrition volume with a good balance of carbohydrates, proteins, and fats. Your son needs 40 – 50 kcals/kg of body weight. They should consume 4-8g/kg of carbohydrates and 2-3 g/kg of proteins.  Foods to focus on are lean meats, eggs, nut butters, protein shakes, pastas, and fruits and vegetables. Fruit and vegetables with a high water content can also help to hydrate. Your son needs to eat prior to practice, even if it is an early morning practice. It shouldn’t be a big heavy meal, but they need to have some source of energy before practice.

The last thing to focus on is sleep. The National Institute of Health recommends that high school athletes get an average of 9-10 hours of sleep each night.  Proper sleeping habits with allow your son’s body the time it needs to recover after each practice.  It allows him to stay focused and think clearly during practice. Better recovery and better focus leads to better performance.

Taking these steps will go a long way towards protecting your son during preseason football, ensuring that he has a fun, productive and safe football season.

By Brittney Lang MS, ATC
Athletic Trainer
MUSC Health Sports Medicine
www.MUSCHealth.org/sports

Summer workouts for athletes have started and with temperatures and humidity rising daily as we get closer to summer we have to be aware of making sure our athletes are properly hydrated. Athletes should have access to water during any weights and conditioning sessions and given breaks during sessions as needed. It is also necessary to educate athletes on the importance of hydrating well before and after physical activity to maintain good health.

An athlete needs to be properly hydrated if they want to be able to perform at their highest level. Physical activity, heat, and humidity increase the amount of fluid your body needs to stay hydrated.  Below are recommendations for how much fluid one should be drinking to maintain adequate levels.

Everyday
Drink adequate fluids. Roughly 1 ml for every calorie consumed. For example, if you eat 4000 calories, drink 4000 ml of fluids (4 L).

2 to 3 hours before training/competition
7 oz of fluid

Immediately prior to training/competition
6 to 12 oz of fluid

Every 15 to 20 minutes during training/competition
6 to 12 oz of fluid

Exercise longer than one hour
Be sure to include a carbohydrate source in the form of solid, gel or sports drinks. Consume roughly 30 to 60 grams of carbohydrate per hour. 600 to 1200 ml of a sports drink will fulfill this need.

After exercise 
16 to 24 oz for every pound lost from the training session or competition.

It is good practice to do a pre and post workout weight check to make sure the athlete has been consuming enough during the workout; and to see if they have lost any weight and determine how much extra they may have to replenish.

Staying well hydrated will help decrease the risk of heat illnesses such as muscle cramps, heat exhaustion and heat stroke by helping with body temperature regulation and cooling efficiently.

Dehydration

The body loses fluid through the skin as sweat, through the lungs while breathing, and through urination. When the body loses more fluids than is being taken in to replace what is lost we have dehydration. There are some common signs and symptoms of dehydration to look out for during training:

  • Headache
  • Nausea
  • Dizziness
  • Thirst
  • Fatigue
  • Muscle cramping
  • Low output of urine/dark coloration

If an athlete is experiencing any of these symptoms, they should stop what they are doing and drink fluids. An athlete should not completely rely on their thirst mechanism to tell them to drink. If the athlete feels thirsty, it is too late. The body has begun to feel the effects from dehydration and their performance will suffer along with their body. One should not wait that long.

Over hydration

While dehydration is more common in athletes, there is a very real possibility of over hydration. This is when the athlete intakes more water than the body has released i.e through sweat. This can lead to low sodium levels also known as hyponatremia and cause very severe health problems if the athlete does not seek the necessary help right away. Drinking some sport drinks during longer or intense workout sessions can help with keeping sodium levels up and eliminate the possibility of hyponatremia during training.

Hydration is one of the most important things an athlete can do to maintain mental and physical performance. Educating the athlete on proper hydration techniques is the best way for them to stay healthy.

With the start of October comes the start of wrestling conditioning before the official season starts. The conditioning helps to get the wrestler ready for the season as well and is a time for an athlete to start cutting weight safely, if needed, to determine a healthy weight class for competition. High school wrestling programs should have a weight management program that includes urine testing with a specific gravity test that does not exceed 1.025, a body fat assessment no lower than 7 percent for males or 12 percent for females, and a monitored weekly weight loss program that does not allow for more than 1.5 percent per week of the alpha weight. Before competing, all wrestlers must go through a weight assessment to determine an alpha weight to include hydration and skin fold testing. The alpha weight will be used to help determine possible weight class as well as used for any weight loss during the season.

The alpha weight, hydration assessment, and skin fold testing are to be tested all at the same time and required to be completed no later than two weeks prior to the district certification deadline, this includes any appeals. This is all prior to the start of any competition with another school for any of the athletes.

A trained assessor will perform the testing protocols on each wrestler and will record results on the proper weight certification forms. There are three parts that are tested:

  1. Hydration Assessment: This is a pass/fail urine test based on the specific gravity levels of less than or equal to 1.025. If greater than 1.025, the test is a failure and can be re-assessed after a 24-hour wait period. Specific gravity determines how hydrated the athlete is at the time of test. This urine test can be judged using a color chart, but to get a better or more accurate reading, the use of a dipstick or specific gravity refractometer or other hydration testing methods is acceptable. If the hydration assessment is passed, the athlete will then weigh in to determine the alpha weight right then with no exercise or delays between the tests. 
  2. Alpha Weight Determination: The wrestler weighs in on a certified scale and that weight is the athlete’s alpha weight for the year. The alpha weight is the weight used to calculate a descent calendar using the 1.5 percent loss per week rule. After the weigh in is performed the athlete will move on to the skin fold testing.
  3. Skin Fold Measurements: Using the proper testing calipers, the skin fold measurements are performed on the bare skin. Each site is tested three times and each measurement recorded accurately. This is to allow an average overall percentage to be determined. Skin fold sites that are tested are the abdominal, tricep, and subscapular areas for males and tricep and subscapular areas for females. All testing is performed on the right side of the body.

Once all testing has finished and all the data collected, it’s then recorded properly in a computer system that will determine a minimum weight class at which the athlete can compete. The weight class is determined by a predicted body weight at 7 percent for males and 12 percent for females including a 2 percent variance made by the system. If the predicted weight including variance is a specific weight class, then that is the athlete’s minimum weight class. But if the athlete's weight is in between weight classes, the higher weight class is determined as the minimum weight class. If the athlete already has a body fat percentage below the allowed 7 percent or 12 percent, then their alpha weight including 2 percent variance is used to determine minimum weight class.

Although there is not much to be done for the testing and protocols, these are very important steps that must be done for the safety of the athlete. Making sure all testing protocols are done properly and accurately is key and can play a big part in the athlete’s season.

Guest post by:
T. Ryan Littlejohn, ATC
Athletic Trainer
MUSC Health Sports Medicine

It seems simple, but do you drink enough fluids before exercising? Proper hydration is one of the top preventive actions for heat related illnesses. According to CDC recommendations, when exercising you should drink 24 ounces of fluids two hours before activity and at least 16 ounces of fluid 15 minutes beforehand. I am not referring to soft drinks or alcohol, but water. When trying to rehydrate make sure to add a sport drink or some type of electrolyte fluid to add nutrients safely during your recovery. Checking your urine is also important. It should be clear; a person who is well hydrated should have the urge to go to the bathroom every two to four hours. It also seems obvious, but ingesting alcohol is a bad idea because it will cause dehydration, so avoid it completely.

Prevention is the most effective treatment for heat related illnesses. Here are a few suggestions:

  1. Proper training for the heat with gradual increase in intensity level over 7 to14 days
  2. Fluid replacement/hydration
  3. Appropriate clothing – light colored, loose fitting, one layer
  4. Monitor intensity of activity during high heat hours
  5. Early recognition – have an athletic trainer on site during all practices and events

When an athlete is overheated, steps should be taken to ensure that the athlete is cooled properly. Exertional heat stroke is defined as the athlete having a rectal temperature above 104 degrees. A cold water immersion tub is extremely important to use in order to cool the body immediately. If at all possible, use a rectal thermometer to get an accurate temperature, as an oral temperature may give false readings. According to the Korey Stringer Institute, research suggests if a person is cooled within 10 min of collapse and is properly cooled below 104 degrees, they will have a 100 percent survival rate. There are also many other steps to be taken like removing clothing and helmets to release the heat from the body. Emergency medical services should always be called in the event of a heat illness, but make sure steps are taken to cool the body before EMS arrives. Hopefully this information will help you as you enjoy exercising in the Lowcountry. As a rule of thumb, when it doubt call 911.

Resources:

WebMD - Heat Related Illnesses Prevention

Korey Stringer Institute

Stop Sports Injuries

Guest Post by:

Alec DeCastro, MD
Assistant Professor, MUSC Department of Family Medicine
Chief, Primary Care Sports Medicine

The summer is in full swing here in the Lowcountry!  July and August are on average the hottest months out of the year, and this is also the time of year that football players return to summer camp and conditioning.  As the temperatures continue to rise, it is important for all athletes to recognize the symptoms of heat illness while exercising in the summer sun. Even if you’re not planning on playing football or running outside, athletes must be smart before embarking on a summer workout. 

Heat illness is a spectrum that ranges from heat cramps, heat exhaustion, to heat stroke.  These conditions can occur suddenly due the risks of exercising in the heat.  Signs and symptoms can sometimes be mild, but it is important to recognize them early in order to prevent injury.  These include:

  • Dizziness
  • Fainting
  • Fatigue
  • Muscle cramps
  • Profuse sweating
  • Rapid pulse
  • Nausea
  • Pale skin

Certain risk factors can predispose you for sustaining a heat illness or injury.  Medical Conditions such as: heart disease, lung illnesses, kidney problems, obesity, high blood pressure, diabetes, pregnancy.  Exercise may improve these conditions, but always take the heat in account and consult your doctor or a sports medicine physician for specific advice.  Medications such as diuretics (water pills) or antihistamines may be dehydrating and should be avoided if it is too hot outside.   Infants up to the age of 4 or older adults > 65 should also use caution.

Heat illness may be easily prevented by some common sense precautions.  It is important to drink plenty of water prior to and during exercise in the heat.  Always limit caffeine and alcohol intake.  Also, dress cool with loose clothes that allow sweat to evaporate easily.  Don’t forget to wear sunscreen!

Another way to prevent heat illness is to be aware of the weather conditions.  A heat index is a better indicator than just the temperature alone.  At about a 60% humidity, our sweat stops evaporating and therefore our body doesn’t cool as easily.   A more accurate measure of humidity may be obtained by a Wet Bulb Globe thermometer (WBGT).  A simple chart for WBGT, which is used by the military, can guide sports teams on how to run summer practices and conditioning drills in this extreme heat.

Wet Bulb Globe Thermometer

If you or someone sustains a heat illness, get them out of the heat right away and bring them to an air conditioned building or the shade.  Let them rest and elevate their legs and feet.  Let them drink cool water

Another serious condition that may develop in the heat is called Rhabdomyolysis (Rhabdo).  Exertional rhabdo happens when there is damage to muscle caused by excessive unaccustomed exercise, especially in the extreme heat.  When muscle tissue works so hard, the fibers break down, causing an enzyme called CK to be released into the bloodstream.  In these cases, a lot of stress is placed on the kidney leading to kidney damage or even kidney failure.  The risk of rhabdo is markedly increased while exercising in hot, humid environments.  This condition is more common in football, and especially high intensity workouts such as cross-fit.  For example, in 2011, thirteen University of Iowa football players were hospitalized with rhabdo after a very intense workout.  Symptoms of rhabdo may be extreme muscle pain and soreness, or dark urine (brown, cola-colored).  In order to prevent rhabdo, athletes must hydrate before, during, and after workouts.  Make sure you don’t push yourself too hard until you get hurt.  If you have any of the symptoms, see a sports medicine doctor right away.

The most serious form of all the illnesses is heat stroke.  This a true medical emergency and happens when the body temperature reaches at least 104F.  Signs of heat stroke are:

  • Confusion
  • Lack of sweating (red, hot, dry skin)
  • Headache
  • Loss of consciousness

Heat stroke can damage the brain and other internal organs, so attempt to them cool right away with ice packs and call 911!  You may save a life!

With this in mind, exercise, get healthy, and enjoy the outdoors.  Please contact us at MUSC Sports Medicine for specific advice about you and exercising.

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