Special Considerations in Athletes Chapter 25

Special Considerations in Athletics• Training staff needs to be aware of any medical

condition an athlete has so they can be prepared if an emergency should arise▫ Information could be found on physical and

should be on emergency medical cards• Environmental Considerations• Skin Conditions• Diabetes• Seizure Disorders• Insect Stings or Bites• Female Athlete Triad

Heat Stress•A condition that

occurs when the body cannot maintain homeostasis and the body temperature begins to rise (hyperthermia).▫The hypothalamus

of the brain is in control of regulating body temperature

Assessing the Risk • There are certain risks that increase the chance of

suffering from heat stress▫ Athletes need to be well hydrated, rested and in good

physical condition for temperature regulation work properly Poor condition causes the body to work harder, putting more

strain on the hypothalamus• The heat index combines temperature and humidity to

provide a reference point for various levels of risk associated with exercise under hot and humid conditions▫ The greater the head index, the more moisture in the air.

The body progressively loses its ability to adequately evaporate moisture

• These risks can cause potentially dangerous increases to core temperature

Athletic Activity Guidelines• Bright Yellow Zone

▫ CAUTION: Normal practice for athletes, closely monitor new or unconditioned athletes or all athletes during extreme exertion. Schedule mandatory rest / water breaks. (5 min water / rest break every 25 min)

• Gold Zone ▫ EXTREME CAUTION: New or unconditioned athletes should not

practice. Well conditioned athletes should have more frequent rest breaks and hydration as well as cautious monitoring for symptoms of heat illness. Schedule frequent mandatory rest / water breaks. (5 min water / rest break every 20 min) Have immersion pool on site for practice.

• Orange Zone▫ DANGER: All athletes must be under constant observation and

supervision. Remove pads and equipment. Schedule frequent mandatory rest / water breaks. (5 min water / rest break every 15 min) Have immersion pool on site for practice.

• Dark Red Zone▫ EXTREME DANGER: SUSPEND PRACTICE

General Care of Heat Illnesses• There are varying degrees of heat-illnesses but

even the milder ones can become life threatening if not properly treated or managed

• Methods of Treatment▫Reduce body temperature

Moving victim to cool location, removing unnecessary clothing, pouring cool water over extremities

▫Fanning the victim Increases air circulation and evaporation

▫ Immerse victim in cool water Extremities should be massaged to promote

circulation of cool blood

Avoiding Heat-related Illnesses• Keys to avoid heat-related illnesses

▫Prevention▫Addressing the environment▫Acclimatization ▫Proper Hydration

• Heat-related illness include▫Dehydration▫Sunburns▫Heat cramps▫Heat Syncope▫Heat Exhaustion▫Heat Stroke

Dehydration• Dehydration in athletics is usually

due to the increased demand for water during exercise, which can be lost by the body at a rate of 1 – 2 liters per hours during vigorous exercise.

• Symptoms are very subtle at first▫ Light yellow urine▫ Mild headache ▫ Fatigue▫ Reduced endurance and oxygen

uptake▫ Feelings of thirst

• Serious dehydration▫ Disorientation▫ Irritability▫ Rapid pulse▫ Complete exhaustion

Dehydration (cont’d)• There are 3 levels of dehydration

▫ Mild Mucous membranes drying out Normal Pulse Yellow Urine Mild Thirst

▫ Moderate Extremely dry mucous membranes Weak and rapid pulse Very dark urine (apple juice) Very thirsty feeling

▫ Severe Completely dry mucous membranes Disorientation Drowsiness No urine output Inability to form tears Beginning stages of shock

Rapid weak pulse, Rapid breathing pale skin

Treatment for Dehydration• The best treatment is prevention• Athlete’s recommendations

▫17 to 20 oz. 2 – 3 hours before activity

▫7 to 10 oz. after warm-up▫28-49 oz. every hour of play▫20 to 24 oz afterward for every

pound of body weight lost of sweat• Water vs. Sports Drinks

▫The use of sports drinks vs. water has been debated for a while

▫Sports drinks do contain carbohydrates and electrolytes that the body may need Especially endurance athletes

Sunburns• Caused by overexposure to UV light

from the sun▫ Can lead to premature aging and skin

cancer• Medical attention should be sought if

the burn is severe enough to cause blistering

• Treatment▫ Cold washcloth▫ Use of over-the-counter pain

medication▫ Petroleum or products containing

benzocaine should be avoided▫ Moisturizing lotion or aloe vera gel can

help relieve itching and provide moisture

• Prevention▫ Use of sunscreen on exposed skin

Sun Protection Factor (SPF) of 15 or greater

Heat Cramps• Heat cramps are very common and

should not be overlooked because they can be the first stage of heat illness▫ Caused by rapid water and

electrolyte loss through to perspiration

• Occur in various muscles▫ Calf (most common)▫ Quadriceps ▫ Hamstrings

• Abdominals• Treatment

▫ Slow passive stretching with ice▫ Immediate fluid and electrolyte

replacement

Heat Syncope• Occurs when the body tries

to cool itself through the dilation of blood vessels▫Also called fainting

• Symptoms▫Lightheadedness▫Dizziness▫Headache▫Nausea ▫Vomiting

• Treatment▫Drinking fluids ▫Stop activity

Heat Exhaustion• A condition of near-total body

collapse, where the athlete experiences difficulty dissipating the heat.

• Symptoms▫ Skin is cool, moist and pale▫ Generalized weakness▫ Dizziness▫ Nausea▫ Rapid breathing▫ Pulse▫ May progress to heat stroke if not

treated• Treatment

▫ Moving the athlete to the shade▫ Immediate fluid replacement▫ Cooling the body▫ Use ice towels if necessary

Heat Stroke• The most severe heat-related condition, where the

body’s heat regulation breaks down• Symptoms

▫Dry, hot skin▫Strong, rapid pulse▫Possible mental confusion▫Unconsciousness

• Treatment▫Move the athlete to shade▫Cool immediately by removing unnecessary clothing▫ Icing with towels with ice packs in axilla and groin

areas▫Misting and fanning the skin

• Heatstroke is a medical emergency and requires immediate transport to an emergency room by EMS

Cold Stress• There are 5 ways that the body loses heat

▫Respiration▫Evaporation▫Conduction▫Radiation▫Convection

• Contributing factors▫Cold temperatures▫High or cold winds▫Dampness▫Cold water

• The body has to work harder to maintain its temperature

Evaporation

•Rids the body of heat with every expiration

Respiration•Evaporation of

perspiration and other moisture from skin causes body to lose heat

Conduction

•When the body is in direct contact with a cooler object. Heat from the body flows to the cooler object▫Ex. Sitting on cool ground or

standing/swimming in cool water

Radiation

•Transfer of head by infrared rays. ▫Just as the body gains head from infrared

rays of the sun, it can lose heat by infrared rays to a cooler environment.

Convection

•Occurs when heat near the body’s surface is removed by moving air▫Wind, cool breeze

Wind Chill• Describes the rate of heat loss on the human body

resulting from the combined effects of low temperature and wind▫Wind-chill temperature is a measure of relative

discomfort due to combined cold and wind Developed in 1941 and revised in 2001 to make use of

advances in science and technology• The factors of wind chill

▫Amount of clothing▫Other protection worn▫Age▫Health▫Body characteristics

• Wind-chill temperatures near or below 0 degrees F indicate a risk of frostbite to expose flesh

Hypothermia• When heat from the body is lost (from being in a

cold environment) faster than it can be replaced• Symptoms

▫Begin when body temp drops to 95▫Shivering▫Stomping feet▫As body temp continues to drop

Slurred speech Lack of coordination Memory loss

▫Unconsciousness after body temp reaches 85▫Death may occur around 78

Hypothermia (cont’d)

•People who have experienced trauma often go into shock and begin to shiver▫Warming sign for hypothermia

Physical or mental trauma limits body’s capability to regulate its own temperature

•As a core body temperature decreases, severe hypothermia sets in

Frostbite•When skin tissues and blood vessels are

damaged from exposure to temperatures below 32 degrees F▫Commonly affects toes, fingers, earlobes,

chin, cheeks, and nose

3 Stages of Frostbite• Stage 1 – Frostnip

▫ pins-and-needles sensation▫ skin turns very white and soft

• Stage 2 - Superficial frostbite▫ May show blistering▫ Skin is numb, waxy, and frozen▫ Ice crystal form in the skin

• Stage 3 – Deep Frostbite▫ Freezing of blood vessels, muscles,

tendons, nerves, and bone.▫ Can lead to permanent damage,

blood clots, gangrene▫ No feeling in the affected area▫ Usually no blistering▫ Serious infection and loss of limb is

frequent▫ Medical attention is needed as soon

as possible

Treatment of Frostbite•Emergency care should be provided. If it is

not possible to immediately transport to a hospital, the following steps will help▫Bring the individual indoors as soon as possible▫Apply warm towels or immerse the area in

circulating lukewarm water or 20 minutes. Leave any blisters

▫Do not use hot water or hold the affected area near fire

▫Offer warm fluids to the athlete, but never alcohol, which causes the blood to cool quickly

▫Keep the affected areas raised.

Diabetes

•A disorder in which the body does not produce or properly use insulin▫Hormone that causes body cells to absorb

sugar from the body for use within the cell•2 types of Diabetes

▫Type I: Insulin dependant Affects 10-15% of people with this disorder

▫Type II: Non-insulin dependant Affects 85-90% of people with this disorder

Types of Diabetes• Type I

▫ Results from the body’s failure to produce any insulin First appears in childhood to young

adults Insulin is normally produced by beta

cells within the pancreas▫ Management

Possible through frequent monitoring of blood sugar levels

Insulin injections May require the use of a pump

• Type II▫ Can usually be controlled with diet

and exercise▫ Body still produces insulin but in

insufficient amounts or poorly functioning

Diabetic Emergencies• Insulin reaction

▫ Happens when there is way too much insulin in the body, rapidly reducing the sugar level in the blood causing brain cells to suffer

▫ Causes Taking too much medication Failing to eat Heavy exercise Emotional factors

▫ Symptoms Fast breathing and pulse Dizziness Weakness Change in level of consciousness Vision difficulties

▫ Sweating Headache

Numb hands or feet Hunger

▫ Treatment Giving the athlete sugar if conscious

Diabetic Coma• Occurs when the sugar levels are too high and too little

insulin in the blood• Causes

▫ Eating too much sugar▫ Not taking prescribed meds▫ Stress ▫ Infection

• Symptoms▫ Drowsiness▫ Confusion▫ Deep and fast breathing▫ Thirst▫ Dehydration▫ Fever▫ Change in the level of consciousness▫ Peculiar, sweet-or-fruity smelling breath

• Monitor carefully and seek professional help

Seizure Disorders• Seizures are caused by disruption of normal brain

activity• Epilepsy is a condition in which seizures occur

regularly▫No clear cause

• Other causes▫ Infection▫High fever▫Brain tumors▫Drugs▫Strokes▫Bleeding in the brain▫Trauma to the brain▫Low blood glucose, sodium, or calcium

Types of Epileptic Seizures

• Simple partial seizure▫When jerking beings in one area of the body, arm,

leg, or face▫Victims may hear things that are not there, or feel

unexplained fear, sadness, anger or joy▫No first aid is necessary, unless the seizure becomes

convulsive• Generalized tonic-clonic seizure

▫Also called grand mal seizure▫Characterized by sudden cry, falling, and rigidity

Followed by muscles jerks, shallow breathing, or temporarily suspended breathing, bluish skin, and possible loss of bladder or bowel control

After a couple of minutes, normal breathing resumes, though there may be confusion and/or fatigue

Managing “grand mal” seizures• Look for medical

identification• Protect the victim from

nearby hazards• Loosed ties or shirt collars• Protect the head from injury• Turn the victim on side,

unless injury exists▫To keep airway clear

• If there are multiple seizures, or if they last more than 5 minutes, call 911

Insect Bites and Stings• Severity and duration of the reaction can vary from person to

person▫ If multiple stings are received or if allergic reactions occur, the

situation can be life threatening• Local Reaction

▫ Characterized by pain, swelling, redness, itching, and a whelp surrounding the wound

• Systemic Reaction▫ If it occurs, happens within a few minutes of a sting▫ May include

Skin flushing Itchy rash Chest wheezing Nausea Vomiting Abdominal pains Palpitations Faintness Falling blood pressure death

Treatment for Insect Bites/Stings

• Notifying a companion in cases assistance is necessary

• Immediately removing the sting apparatus by scraping it out of the skin

• Applying ice to reduce the pain and swelling

• Seeking medical assistance if a serious reaction is suspected

• For systemic reaction ▫ Epinephrine by injection is the only

effective, immediate treatment Epipen is an automatically injecting syringe,

designed to inject a premeasured, single dose of epinephrine. Its administered if the front part of the leg

through the clothing.▫ Effects will last 15-20 minutes▫ EMS must be activated

Female Athlete Triad• Involves a combination of 3 conditions

▫ Disordered Eating conditions such as anorexia and bulimia that

result in malnutrition When muscles that lack sufficient and proper fuel,

performance is impaired▫ Amenorrhea

The loss of menstrual periods A certain % of body fat in females is necessary for

proper functioning of the menstrual cycle IF the body fat % gets too low, hormonal balance

and the menstrual cycle are affected ▫ Osteoporosis

The loss of bone, most commonly among women after menopause, whose menstrual cycle also stops functioning

Amenorrhea can lead to osteoporosis in female athletes just like it can in postmenopausal women

Stress fractures become more common and repair is slow.

Warning signs of Female Athlete Triad • Frequent or unexplained injuries,

stress fractures• Excessive or compulsive exercise• Change in performance

▫Loss of endurance, speed and/or strength

• Impaired concentration• Absent or irregular menstrual

periods• Restrictive eating masked as a

“performance-enhancing” meal plan• Use of weight loss products or

supplements

Prevention of Female Athlete Triad• Choosing an activity that complements an individuals

natural body strengths.• Realizing health is more important that competitive

success.• Avoiding frequent weigh-ins, weight comments and

punitive consequences for weight gain.• Appreciating a healthy, active body. Optimal weight for

health and performance is different for everyone.• Realizing that the thinnest athletes are not necessarily

the fastest or the strongest.• Thinking of fuel as the ultimate performance enhancer.• Not starving the bones. Part of the fuel mix should

include several servings of good calcium sources.• Being a role model with words and actions. Take a

positive attitude about fueling and enjoying foods.