Special Edition News Tips - Fall Sports

Athletic alert: Watch for signs of heat illness

DALLAS – Aug. 2, 2012 – As temperatures rise and more people spend time outdoors, physicians at UT Southwestern Medical Center remind athletes of all skill levels to stay hydrated and watch for signs of possible heat illness.

Dr. Robert Dimeff
Dr. Robert Dimeff, director of primary care sports medicine at UT Southwestern and Children’s Medical Center

“You may feel light headed or dizziness, dry mouth, nausea, headaches, muscle twitching or weakness, all possible signs that you’re overheating,” says Dr. Robert Dimeff, director of primary care sports medicine at UT Southwestern and Children’s Medical Center. “More serious symptoms may involve severe muscle cramps, loss of balance, confusion, disorientation, trouble breathing, and fainting episodes.”

The American Orthopaedic Society for Sports Medicine recommends drinking fluids such as water or sports drinks before you exercise, and continuing with small amounts of these liquids during and after exercise or exertion. Water is adequate for activities lasting an hour or less, otherwise drinks containing carbohydrates, sodium and potassium are better at replacing fluids lost fluids in extended workouts.

If you notice signs of overheating, stop your activities, get into shade and drink some fluids. For cramps, massage the area. For heat exhaustion – a serious form of temperature-related distress – use towels or hoses to cool off the affected person. If symptoms persist, seek medical attention quickly.

Avoid staph with a game plan for good hygiene

Participation in school athletics should start with a program for personal hygiene to help avoid staph infections and the more severe methicillin-resistant Staphylococcus aureus (known as MRSA) bacteria.

Football players and wrestlers should be particularly wary. Studies by the Texas State Department of Health have found that the staph infection rate among football players was 16 times the national average.

Signs of infections include reddening of the skin, swelling or pus around sores, abrasions, or cuts. The sores may be mistaken for spider or bug bites as well.

“Have your athlete check in the mirror for any unusual red spots or lesions, particularly those that don’t seem to be healing, and don’t be afraid to alert the coaches to any issues so it doesn’t spread to others,” says Dr. Robert Dimeff, director of primary care sports medicine at UT Southwestern Medical Center and Children’s Medical Center.

If the skin is injured, wash the wound immediately with soap and warm water, then dry off the wound and ensure it is properly bandaged.

To help avoid and reduce the potential for infection:

  • Keep hands clean by washing thoroughly with soap and water or antibacterial hand sanitizer.
  • Avoid sharing towels, deodorant, razors or other items that touch bare skin.
  • Put a clean towel on the bench when weight training or using other shared equipment.

Pay attention to concussion signs

If your high school athlete is heading out to the practice field this month, UT Southwestern Medical Center sports medicine doctors urge parents to take time to review the latest guidelines about concussions.

Look over the equipment and make sure it fits properly, particularly the helmet. Make sure your athlete knows how to wear it properly and does so even in practice.

“Parents, coaches and student athletes should know what symptoms to pay attention to,” notes Dr. Robert Dimeff, director of primary care sports medicine at UT Southwestern and Children’s Medical Center. “The signs and symptoms can come immediately after the impact or even days later.”

Athletes need to let a parent, coach or other adult know if they are feeling signs such as headache or “pressure” in their head, nausea or vomiting, balance problems or dizziness, blurry vision, sensitivity to light or noise, drowsiness or fatigue, and concentration problems or confusion, Dr. Dimeff says.

Parents should note mood or behavioral changes, including athletes appearing stunned, dazed or confused about homework, particularly work that was not difficult before an injury.

“Those symptoms justify a doctor’s visit so a concussion isn’t overlooked,” Dr. Dimeff adds.

Get a thorough physical before getting physical

School athletes heading back to the fields and courts are often required to get only a cursory participation medical review. But more thorough examinations may be appropriate, particularly for advanced athletes and for those who have suffered injuries during previous seasons.

Dr. Robert Dimeff, director of primary care sports medicine at UT Southwestern Medical Center, says a full history and exam can help detect problems early, help avoid inflaming old injuries and establish critical baseline information in case of concussions or other injuries.

Consider the following screening and baseline tests:

  • A routine musculoskeletal screening exam to evaluate injuries that may not have fully resolved from previous seasons or that occurred during the summer, such as an ankle sprain or shoulder instability.
  • Baseline computerized neuropsychological testing programs, such as ImPACT, HeadMinder or CogSport, for athletes participating in contact sports like football, soccer or hockey or for those who may have had a previous concussion, may aid in treating concussion assessment and management.
  • Vision screenings to identify the need for corrective or protective lenses.

It’s important to review weight, nutrition, supplements and off-season training with your physician and mention any new medical diseases, medications or surgeries since last year to determine if there are special requirements. Make sure immunizations are up to date, including tetanus.

In addition to the standard gear, consider new custom bilaminate mouth guards to protect teeth during contact and projectile sports.

“Be sure to pay attention to any new signs of cardiopulmonary disease and tell your doctor about them,” Dr. Dimeff says.

Chest pain, pressure or tightness, shortness of breath, palpitations, fainting or near fainting, wheezing or coughing during or after exercise may suggest heart or lung disease that may require further evaluation and treatment, he said. Also tell your doctor about any family history, such as family members with early cardiac disease, Marfan syndrome or sudden cardiac death, particularly in relatives younger than 50.

Don’t ignore warning signs of overuse

Be aware that overuse injuries can arise over time as you progress through training and exercise regimes. They can result from improper form; pushing too hard after an injury to return to pre-injury levels; imbalances between strength and flexibility; as well as old injuries, poor body alignment, unfit sports equipment, including shoes, or difficult terrain.

“With so many potential pitfalls, it can be difficult to know when to step it up to the next level,” says Dr. Robert Dimeff, director of primary care sports medicine at UT Southwestern Medical Center and Children’s Medical Center.

Among the common signs of overuse are recurrent stiffness or pain, often in the shoulders, legs or elbows; favoring one arm or leg over the other; or a drop in performance. Initially symptoms occur only during activity. But as the condition progresses, the pain will worsen after exercise and eventually interfere with your ability to exercise.

A generally recognized rule of thumb for increasing the exercise regimes is called the 10 percent rule: Don’t increase your training or activities more than 10 percent per week. Runners and walkers, for example, shouldn’t increase the distance or pace more than 10 percent. If you’re using weights, limit the increased weight to 10 percent or less.

“It’s important to give your body time to properly adjust,” Dr. Dimeff says.

A sports medicine specialist can help you identify and address specific pitfalls, such as flat feet, intestinal problems or previous injuries, before you start your routine, as well as help address and treat new issues should they occur.

Athletes, asthma, and heat

Rising temperatures, poor air quality conditions and outdoor sports can create a near-perfect trifecta for increased attacks for athletes with asthma.

Triggers including heat, humidity and air quality can exacerbate inflammation of the airways making them even more swollen. Before the fall sports season begins, asthma sufferers need to ensure their asthma is well-controlled.

Dr. Rebecca Gruchalla, chief of allergy and immunology at UT Southwestern Medical Center, recommends contacting a pediatrician, internist or asthma specialist for individuals with moderate to severe disease to craft a plan to ensure that asthma is properly controlled. At the appointment, be prepared to answer questions about the frequency of symptoms, albuterol use and night-time awakenings due to asthma.

School nurses and coaches should pay close attention to athletes with asthma and the athletes should ease into practice to see how well they tolerate exercising in the heat, Dr. Gruchalla adds. Signs and symptoms of an asthma attack include shortness of breath, fatigue, chest tightness, cough and wheezing.

Athletes need to take extra caution on extremely hot days and when air pollution is worse than normal, as these conditions exacerbate the effects of asthma.

Stay hydrated during summer workouts

Lona Sandon
Lona Sandon, assistant professor of clinical nutrition at UT Southwestern Medical Center

Dehydration happens when you lose fluid rapidly through sweat and don’t replace it by drinking enough. Signs of dehydration include sluggishness, dizziness, fatigue, nausea, high body temperature, and poor coordination.

People begin to feel the effects of dehydration with just 1-2 percent of weight loss from fluid loss in sweat, according to Lona Sandon, assistant professor of clinical nutrition at UT Southwestern Medical Center. For a 150 pound person, that is just 3 pounds of fluid loss during exercise. Heavy sweaters and those exercising outdoors during the summer months can easily lose this much or more in just one hour of exercise.

To stay hydrated follow these simple guidelines.

Drink plenty of fluids throughout the day and with meals. This will help assure you are hydrated before you begin exercise. The American Dietetic Association (ADA) and American College of Sports Medicine (ACSM) recommend drinking 2 ½ to 3 cups of fluid 2-3 hours before exercise and 1 ½ cups 1 hour before exercise.

Plan to drink fluids during exercise. If you are exercising for more than an hour in the heat you will need to drink 8 ounces or more every 15 minutes depending on how much you sweat. A good rule of thumb is to take 8 full gulps to get about 8 ounces every 15 minutes. Carry water or a sports drink with you in a bottle or back pack. Know where the water fountains are in parks and on trails. A sports drink will help you stay hydrated better than plain water. The sweet taste will help you to drink more, ensuring better hydration, and the small amount of added sodium will help you absorb fluid into the blood stream faster.

Replace fluid losses immediately after exercise. If possible, check your weight after exercise. For every one pound of weight lost, drink 2-3 cups of fluids. Low-fat milk, 100 percent fruit juice, smoothies, or sports drinks are all good options for replacing lost fluid. Milk may be the best choice. Research shows that the protein and naturally occurring electrolytes (sodium and potassium) found in milk, actually helps replace fluid losses better than other fluids.

Strengthening core, leg muscles reduces risk of ACL tears

First comes the pop, then comes the pain. For those who play or watch sports, the sound and sight of a torn anterior cruciate ligament (ACL) is a too-common experience.

It’s crucial heading into fall sports for athletes to take proper prevention steps to reduce their chances of suffering what’s often a season-ending knee injury, notes sports medicine specialist Dr. Katherine Coyner, sports medicine specialist and orthopaedic surgeon at UT Southwestern Medical Center.

Specializing in a single sport, which can emphasize one set of muscles over another, also can lead to ACL injuries.

“All of these muscles we used playing on the playground or playing all sorts of sports no longer develop as completely, creating muscle imbalances,” Dr. Coyner said. “People become one-muscle dominant at the expense of other muscles, and that can apply too much force on the knee.”

Dr. Coyner and other sports medicine experts recommend exercise training programs such as 11+, developed by soccer’s international governing body, FIFA. The 20-minute warm-up program is designed for use before practices and games. It concentrates on strengthening core and leg muscles though running, jumping and balance exercises to create a more well-rounded athlete.

“These injury prevention programs require no additional equipment and can be incorporated into game-day strategies,” Dr. Coyner said. “Using proper techniques when running and jumping can go a long way toward reducing ACL tears.”

Learn more about UT Southwestern’s sports medicine services at www.utsouthwestern.edu/patientcare/medicalservices/ortho/sports/conditions.html.

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Media Contact: Russell Rian
214-648-3404
russell.rian@utsouthwestern.edu

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