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Keyword: hydration

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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Guest Post by:

Lindsey Clarke, MS, ATC, CMT
Athletic Trainer;  Massage Therapist Charleston Battery
MUSC Sports Medicine

It’s that time of year again…no, not yard work or taxes, but time for the 38th annual Cooper River Bridge Run.  People from all over the world flock to this event to enjoy the beautiful views of Charleston, participate in a world class distance running event, and spend the better part of the day with 40,000 of their closest friends.  There is A LOT going on for this race…many uncontrollable variables that just make shake the most seasoned runner.  Paying attention to your nutrition is the one variable that day you will have complete control of.  Running a race takes preparation, strength, and energy, and how you approach your pre-race eating plan can affect all three. Throughout training, your diet plays a significant role in helping you perform and recover. In the weeks leading up to the race and immediately before the event, a correctly balanced pre-race nutrition plan will contribute towards your best performance.  If you are a professional, world class runner, or just decided to get in on the action and signed up last week, here are a few tips on giving yourself everything your body needs to have a successful and enjoyable race.

WEEK PRIOR: Moderate quantities of carbohydrate-rich foods will fill your glycogen stores throughout the week leading up to the race. Depending on the length of your race, shoot for about 3-5 grams of carbohydrates per pound of body weight per day, with foods like oatmeal, potatoes, carrots, and other vegetables. For example, a 150-pound adult would need at least 450 grams of carbohydrates per day. Many runners focus so much on getting enough carbohydrates that they don't pay enough attention to their protein consumption. Protein is used for some energy, but mostly in repair of tissue damaged during training. Again, depending on your training/length of race, you should consume .5 to .75 grams of protein per pound of body weight.  Good sources of protein are fish, lean meat, poultry, beans, nuts, whole grains, egg whites, low-fat milk, low-fat cheese and some vegetables.  Being a long distance race, you’ll want to aim for the higher amount of carbohydrate and protein per pound body weight.  This is the time to experiment with discovering which foods work best for you, and which foods you want to avoid…experimenting on race day is never a good idea!

DAY BEFORE: Many beginning runners hear that “carbo-loading” before a race is a good idea and mistakenly overindulge on enormous portions of carbohydrate-rich foods. Gone are the days of indulging in stacks of pancakes or sitting down to an all-you-can-eat pasta bowl.  Instead, continue eating as you have in the week leading up to the race, increasing your intake of up to 5.5 grams of carbohydrates per pound of body weight; a 150-pound adult would need up to 825 grams of carbohydrates. Foods with a moderate to high glycemic index are your best choices before a race. Eat foods like whole-wheat pastas, which contain 40 to 50 grams of carbohydrates per dry cup serving, and vegetables.

MORNING OF:   As a 10K(6.2m), this race is considered a long distance race.  For longer races, your body will require more fuel.  With an 8am start, a more substantial meal is warranted approximately 2 hours prior to start, so set that alarm just a little extra early.  In addition to your meal, it is good practice to have a light snack 1 hour prior to the race. While it may be tempting to run into the Duncan Donuts on Coleman Avenue while waiting for your heat’s start time, bring a granola bar, energy chews, GU, etc. as a option for more sustained energy release and a lower possibility for GI distress.

In making food choices, it’s always best to stick with what you know works. No one wants any surprises waiting in cue or during your run!  A well-rounded diet of lean meats, legumes, dairy, fruits, and vegetables is a great way to set your self up for success come race day. Some foods to include in race preparation are:

*Whole grain pastas, brown rice     *Lean proteins; salmon, chicken

*Fresh fruit          *Fruit/Vegetable juice                   *Oatmeal

*Bagels                  *Yoghurt drizzled with honey       *Toast with nut butter

Some foods to avoid in race preparation are:

*Cruciferous vegetables; broccoli, cauliflower     *Sugar-free items/artificial sweeteners

*Bran; cereals, muffins     *Caffeine(unless you regularly consume)

*Fried foods     *fatty meats/high fat cheeses     *alcohol

Another extremely important and often forgotten about component of pre-race preparation is proper hydration practices. Many runners underestimate how much fluid they actually lose during their runs and don't drink enough while they're running as well as post workout/race. The result? Dehydration. This is detrimental to performance and dangerous for your health. In the days leading up to your race, you’ll know you’re properly hydrated if you void a fairly large volume of pale urine at least six times a day. On the day of, drink 8-16oz. of water one to two hours before the race, and then another 4-8oz just before. Consumption will vary depending on the length of your race.

LENGTH OF RACE:

ONE HOUR OR LESS
Three to six ounces every 15 to 20 minutes. Water is usually fine. For a tougher runs over 30 minutes, consider a sports drink to replace electrolytes and glycogen.

ONE TO FOUR HOURS
Three to six ounces every 15 to 20 minutes. A sports drink with carbohydrates and electrolytes will replenish sodium.

OVER FOUR HOURS
Three to six ounces of sports drink every 15 minutes, after which use thirst as your main guide (drinking more if you're thirsty and less if you're not).

POSTRUN
Replace fluids, drinking enough so you have to use the bathroom within 60 to 90 minutes after your run(approximately 8-24oz).

Whether you cruised effortlessly across or stumbled through and promptly found a nice patch of grass to flop down on in Marion Square, you’ve finally made it across the finish line!  So what comes next? Post race practices are very important in regards to recovery. Replacing fluids lost and replenishing glycogen stores are crucial and the window of opportunity is small.  It is best to consume a recovery ‘meal’ within the first 30 minutes after completion of the run. The optimum ratio is 3:1 carbohydrates to protein.  Depending on your preference, this meal can take the form of nutrition bars, recovery sports drinks, or even chocolate milk.   There are numerous sponsors that provide fantastic goodies such as yoghurt, peanut butter crackers, bananas, oranges, and more for all runners, so there is certainly no excuse in consuming your post-race snack and replenishing fluids lost.  For longer runs, you should also take in a full meal within 2 hours of completing your race that contains lean proteins, carbohydrates, and maybe even a post-race treat…you deserve it!  This attention to detail in your meals leading up to your race will definitely take a bit of planning, but getting the proper nutrition for pre and post race will not only help your performance and recovery, but will make the experience over all much more enjoyable and successful!

Guest Post by:
Bobby Weisenberger, ATC, PES
Head Athletic Trainer Charleston Battery
MUSC Sports Medicine

Practice Days

7:30am: Arrive at stadium about a half an hour before the players show up. Sidelines are prepped for the day’s practice. This consists of filling ice coolers and water bottles.

8:00am: First round of players show up at injury clinic for treatment and rehabilitation. This ranges from electric stimulation, ultrasound, and or hot/cold treatments.

8:30am: All non-injured players arrive for taping, stretching and mandatory weigh-ins.

9:00am: Warm-ups begin. I speak with the coaching staff about injured players’ status. Coach is advised who’s in or out of training. Training sessions typically last 1 ½ hours and during that time, I will be doing on-field rehabilitation with players who are close to returning to full play while keeping a close eye on the field, looking for and taking care of any new injuries that occur. In addition, I refill water bottles. HYDRATION, HYDRATION, HYDRATION. In the summertime heat and humidity where heat indexes easily reach 115, this cannot be stressed enough.

10:30am: As training wraps up I return to the training room where another round of treatments is performed on injured players. Recovery exercises and whirlpool treatments are also coordinated.

11:30am: When all of the players weigh out and leave for the day I will work on injury reports, and fill out treatment notes on injured players. I prepare and send out a daily injury report to our team physicians, team physical therapist, and coaching staff so that everyone is made aware of player’s statuses on a daily basis.

12:30pm: Leave for the day! Though, the job never ends. Players have my mobile number and are encouraged to call me for any medical concerns they may have. I coordinate their medical appointments and ancillary services throughout the MUSC network.

Game Days

4:30pm: Arrive at Blackbaud Stadium, to set up the home and visiting locker rooms as well as both sides of the field with injury ice and water.

5:30pm: Injured players arrive. I work with them and our team physical therapist doing treatments and rehabilitations.

6:00pm: Players who are on the roster for the night’s game will arrive at and I will tape and assist with any types of warm-up exercises/treatments they may need.

7:30pm Kickoff! During the game I will keep a close eye on the game and take care of any injuries that may occur. After the game, I will work with our team physician to access and provide treatment for any injuries that have occurred during the game.

10:30pm: Goodnight!

 

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