1. Chapter 6: Environmental Considerations
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Environmental stress can adversely impact performance and pose serious health threats
Areas of concern
Hyperthermia
Hypothermia
Altitude
Exposure to the sun
Lightening storms
Air pollution
Circadian dysrhythmia
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Hyperthermia
Athletic trainers require knowledge and information concerning temperature, humidity and weather to adequately make decisions regarding environmental dangers
Has caused a number of deaths over the years
Must manage heat stress appropriately and plan accordingly with coaching staffs
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Heat Stress
Extreme caution should be used when training in the heat (overexposure could result in heat illness)
It is preventable
Athletes that train under these extreme conditions are at risk
Physiologically the body will continue to function if body temperature is maintained
Body must be dissipate heat to maintain homeostasis
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The clinician must also consider that young athletes and the elderly are more susceptible to heat stress
The ability to dissipate heat may be limited due to the utilization of equipment and certain clothing
Head stress can also be a factor when competing in the cold if heat dissipation is limited and dehydration occurs
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Metabolic Heat Production
Normal metabolic function results in production of heat (will increase with intensity of exercise)
Conductive Heat Exchange
Physical contact with objects resulting in heat loss or gain
Convective Heat Exchange
Body heat can be lost or gained depending on circulation of medium
Radiant Heat Exchange
Comes from sunshine and will cause increase in temperature
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Evaporative Heat Loss
Sweat glands allow water transport to surface
Evaporation of water takes heat with it
When radiant heat and environment temperature are higher than body temperature, loss of heat through evaporation is key
Lose 1 quart of water per hour for up to 2 hours
Air must be relative water free for evaporation to occur
relative humidity of 65% impairs evaporation
relative humidity of 75% stops evaporation
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8. Preventing Heat Illness
Common sense and precaution
Consume fluids and stay cool
In conjunction with the NATA recommendations multiple factors should be strongly considered
Hydration
Should begin activity well hydrated
Involves hydrating during the 24 hours prior to activity
Urine should be a light yellow in color
Dark urine is an indication of dehydration
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Should consume fluid at regular intervals
17-20 fl oz of water or sports drink 2-3 hours prior to activity and an additional 7-10 fl oz minutes before exercise
Dehydration
Mild dehydration occurs when 2% of body weight is lost in fluid
Will impair cardiovascular and thermoregulatory responses
Signs & symptoms
Thirst, dizziness, dry mouth, irritability, excessive fatigue, and possible cramps
Must move individual to cool environment and begin rehydration
Return to normal weight and absence of symptoms
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Fluid and Electrolyte Replacement
Body requires 2.5L of water daily when engaged in minimal activity
Adult will typically lose ~1.5L per hour
1-2% drop in body weight (due to dehydration) results in thirst
If thirst is ignored, dehydration results in:
nausea, vomiting, fainting and increased risk for heat illness
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More likely to occur when exercising outdoors sweating heavily and engaging in strenuous exercise
Prevent through hydration, don’t ignore thirst, and don’t rely on it being your indicator
Generally only 50% of fluid is ever replaced and should therefore be replaced before, during and after exercise
Athletes should have unlimited access to water to prevent decrements in performance and hypohydration
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Using Sports Drinks
More effective than just replacing fluids with water
Flavoring results in increased desire to consume
Replaces fluids and electrolytes
Water alone can prematurely stop thirst response and initiate fluid removal by kidneys
Small amounts of sodium help in retention of water
Different drinks have different nutrient levels
Optimal CHO level is 14g per 8 ounces of water
More CHO results in slower absorption
Effective for both short term and endurance activities
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Figure 6-1
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Gradual Acclimatization
Most effective method of avoiding heat stress
Involves becoming accustomed to heat and exercising in heat
Early pre-season training and graded intensity changes are recommended with progressive exposure over 7-10 day period
80% of acclimatization can be achieved during first 5-6 days with 2 hour morning and afternoon practice sessions
Equipment restrictions may help athlete gradually acclimate
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Identifying Susceptible Individuals
Athletes with large muscle mass
Overweight athletes (due to increased metabolic rate)
Death from heat stroke increase 4:1 as body weight increases
Women are physiologically more efficient with regard body temp. regulation
Others that are susceptible include, those with poor fitness, history of heat illness, or febrile condition, the young and the elderly
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Uniform Selection
Base on temperature and humidity
Dress for the weather and temperature
Avoid rubberized suits
Weight Records
Keep track of before and after measures for first two weeks
If increase in temperature and humidity occurs during the season, weights should again be recorded
A >2% loss of BW could be a health threat and should be removed from practice until normal weight is achieved
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Monitoring Heat Index
Heat, sunshine and humidity must be monitored closely
Wet bulb globe temperature index (WBGT) provides objective measure for determining precautions concerning participation in hot
WGBT incorporates different thermometer readings
Dry bulb (standard mercury temperature)
Wet bulb (thermometer with wet gauze that is swung around in air)
Black bulb (black casing that measures radiant heat)
Formula yields WBGT index
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DBT and WBT can be measured with psychrometer (combines both thermometers)
Wet bulb will be lower due to evaporation of water
Drier air = greater depression of wet bulb temperature due to evaporation
Ventilation is provided by whirling thermometer (sling psychrometer) or suction fan (aspiration psychrometer)
Newer models utilize digital sensors
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Figure 6-2
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Heat Illnesses
Heat rash (prickly heat)
Benign condition associated with red, raised rash, combined with prickling with sweat
Result of continuously wet un-evaporated sweat
Continually toweling the body will prevent
Generally localized to areas covered with clothing
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Heat Syncope (heat collapse)
Associated with rapid fatigue and overexposure, standing in heat for long periods of time
Caused by peripheral vasodilation, or pooling of blood in extremities resulting in dizziness and fainting
Treat by placing athlete in cool environment, consuming fluids and laying down
Heat Cramps
Painful muscle spasms (calf, abdominal) due to excessive water loss and electrolyte imbalance
Occurs in individual in good shape that overexert themselves
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Profuse sweating results in loss of water and electrolytes (sodium, potassium, magnesium, and calcium)
Prevent by consuming extra fluids and maintaining electrolyte balance
Treat with fluid ingestion, light stretching with ice massage
Return to play unlikely due to continued cramping
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Exertional Heat Exhaustion
Result of inadequate fluid replacement
Unable to sustain adequate cardiac output
Will exhibit signs of profuse sweating, pale skin, mildly elevated temperature, dizziness, nausea, vomiting or diarrhea, hyperventilation, persistent muscle cramps, and loss of coordination
May develop heat cramps or become faint/dizzy
Core temperature will be <104o
Performance may decrease
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Immediate treatment includes fluid ingestion (intravenous replacement, ultimately), place in cool environment, remove excess clothing
Must continue to monitor vital signs
Return to play – must be fully hydrated and be cleared by a physician
If not appropriately treated it could progress to exertional heat stroke
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Exertional Heatstroke
Serious life-threatening condition, with unknown specific cause
Characterized by sudden onset - sudden collapse, LOC, CNS dysfunction, flushed hot skin, minimal sweating, shallow breathing, strong rapid pulse, and core temperature of > 104o F
Breakdown of thermoregulatory mechanism
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Drastic measures must be taken to cool athlete
Strip clothing
Sponge with cool water
Do not immerse in water
Transport to hospital immediately
Cool first, transport second
Athlete should avoid exercise for a minimum of one week and gradually return to full practice
Must be asymptomatic and cleared by physician
Death may result if not treated appropriately
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Malignant hyperthermia
Muscle disorder causing hypersensitivity to anesthesia and heat
Similar S&S to heatstroke - muscle biopsy is needed to detect
Athlete will complain of muscle pain after exercise
Temperature will remain elevated minutes following exercise
Athlete with condition should be disqualified from competition in hot, humid environments
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Acute Exertional Rhabdomyolysis
Sudden catabolic destruction and degeneration of skeletal muscle (myoglobin and enzyme leakage into vascular system)
Occurs during intense exercise in heat and humidity resulting in:
gradual muscle weakness, swelling, pain, dark urine, renal dysfunction
severe case = sudden collapse, renal failure and death
Associated with individuals that have sickle cell trait
Should be referred to a physician immediately
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Exertional Hyponatremia
Fluid/electrolyte disorder resulting in abnormally low concentration of sodium in blood
Caused by ingesting too much fluid before, during and after exercise
May be result of too little sodium in diet or to much ingested fluids over a period of prolonged exercise
Athletes that ingest large quantities of water and sweat over several hours are at risk (marathon, triathlon)
Preventable – must maintain balance
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Signs and Symptoms
Progressively worsening headache, nausea, vomiting
Swelling of hands and feet, lethargy, apathy or agitation
Low blood sodium
Could compromise CNS and create a life-threatening situation
If levels can not be determined on-site, measures to rehydrate should be delayed and the athlete should be transported to a medical facility
Delivery of sodium, diuretics, or intravenous solutions may be necessary
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31. Guidelines for Athletes Who Intentionally Lose Weight
Predispose themselves to heat related injuries and could create life-threatening situations
Weight loss should not be accomplished through dehydration
Gradual process over weeks and months and should be a result of body fat lost
NCAA and high school federations have established guidelines for weight loss in wrestling
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Hypothermia
Cold weather vs. nature of particular sport
Most activity allows for adequate heat production (increased metabolism) and dissipation, allowing for sufficient functioning
Impact on warm-up and “down time”
Temperature in conjunction with wind chill and dampness or wetness can increase chances of hypothermia
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65% of body heat is lost through radiation (head and neck 50%)
20% through evaporation
2/3 through skin and 1/3 through respiration
Problems arise when heat lost exceeds heat production via metabolism
Results in impairment of neuromuscular function
Drop in core stimulates shivering but stops after temp. drops below 85-90oF
Death is imminent when temp falls below oF.
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Prevention
Apparel geared for weather to provide semitropical microclimate for body and prevent chilling
Waterproof and windproof fabrics that allow passage of heat and sweat and allow movement
Layers and adjusting them are key to maintaining body temperature (during period of (in)activity)
Be aware of inadequate clothing, improper warm-up and chill factor can lead to injury, frostbite, chilblains, and/or minor respiratory problems
Be aware of hydration levels as well to enhance blood volume and heat maintenance
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Common Cold Injuries
Localized cooling can result in tissue damage
Formation of ice crystals between cells, destroys cells, disrupts blood flow, clotting may occur
Frost nip
Involves, ears, nose, chin, fingers, and toes
Occurs with high wind and/or severe cold
Skin appears firm with cold painless areas that may peel and blister (24-72 hours)
Treat with firm pressure, blowing warm air or hands in armpits (if fingers involved)
Do not rub
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Frostbite
Chilblains result from prolonged exposure causing redness and swelling, tingling pain in toes and fingers
Due to poor peripheral circulation
Superficial Frostbite involves only skin and subcutaneous tissue
Appears pale, hard, cold and waxy
When re-warming the area will feel numb, then sting and burn
It may blister and be painful for several weeks
Deep Frostbite indicates frozen skin requiring hospitalization
Rapid re-warming is necessary ( oF)
Tissue will become blotchy red, swollen, painful and may become gangrenous
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Figure 6-3
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Altitude
Most events do not occur at extreme heights
As height increases, maximum oxygen uptake decreases resulting in a decrease in performance
Body compensates through tachycardia and hyperventilation
Responses are a result of having fewer red blood cells than necessary to adequately capture available oxygen
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Adaptations
Increased height = reduced barometric pressure resulting in decreased partial pressure of oxygen = less saturation of red blood cells
Individual adaptations dependent on whether an the person is a native, resident or visitor
Native has larger chest capacity, more alveoli, capillaries and red blood cells
Resident makes partial adaptations (increased mitochondria and hemoglobin, glycogen conservation)
Visitor responds with increased breathing, heart action, hemoglobin, blood alkalinity, myoglobin and changes in blood flow and enzyme activity
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Other uncertainties with regards to training and competition
Time to adjust (2-3 weeks vs. 3 days)
Short adjustment allows acid-base balance to recover but does not allow significant changes in blood volume and maximum cardiac output
Altitude Illnesses
Acute Mountain Sickness
1 out of 3 will experience when making the jump feet.
Experience headache, nausea, vomiting, sleep disturbance, and dypsnea
Caused by brain disruption associated with sodium potassium imbalance resulting in fluid retention and cellular pressure changes
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Altitude Pulmonary Edema
Occurs at ,000 feet.
Lungs accumulate fluid in alveolar walls forming pulmonary edema
Signs and symptoms: dypsnea, cough, headache, weakness and occasionally unconsciousness.
Treat by moving athlete to lower altitude and providing oxygen
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High Altitude Cerebral Edema (HACE)
Usually occurs in conjunction with other life threatening conditions that can lead to coma or death
Occurs in ~1% of people adjusting to altitudes above 9,000 feet
Result of increased cerebral edema due to increased cerebral blood flow which is caused by increased permeability of cerebral endothelium when exposed to hypoxia
The increased cerebral blood flow results in increased intracranial pressure
Signs & symptoms
Severe, persistent headache which may precede mental dysfunction, neurologic abnormalities
Decent to lower altitudes may save those with HACE
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Sickle Cell Trait Reaction
8-10% of African Americans have sickle cell trait
In most the trait is benign
Abnormality in red blood cell hemoglobin structure
When hemoglobin is deoxygenated, cells clump together causing blood cell to develop sickle shape making it easy to destroy
Causes enlarged spleen and could rupture at high altitudes
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Overexposure to Sun
Precautions must be taken to protect athletes, coaches, athletic trainers and support staff
Long Term Effects on Skin
Premature aging and skin cancer due to ultraviolet exposure
Premature aging is characterized by dryness, cracking and inelasticity of the skin
Skin cancer is the most common malignant tumor found in humans
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Damage to DNA is suspected as the cause of cancer
Major types include basal cell carcinoma, squamous cell carcinoma and malignant melanoma
Rate of cure is 95% with early detection
Fair skinned individuals are more susceptible to these maladies
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Using Sunscreen
Can help prevent damaging effects of UV radiation
Sunscreen effectiveness is expressed as SPF (sun protection factor)
Indicates how many times longer an individual can be exposed to the sun with vs. without sunscreen before skin turns red.
Greater the susceptibility the higher the SPF should be used
Should be worn by athletes, coaches and athletic trainers who are outside a considerable amount, and/or have fair complexion, light hair, blue eyes or skin that burns easily
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Individuals with dark complexion should also apply
60-80% of sun exposure occurs before the age of 20
Sunscreen use is at its highest March - November but should be used year round (particularly between the hours of 10am-4pm)
It should be applied minutes before exposure and re-applied after exposure to water, excess sweating, rubbing skin with clothing or a towel
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Lightening Safety
#2 cause of death by weather phenomena
NATA has established position statement due to number of athletes and coaches potentially exposed to lightening scenarios
Emergency action plans must be set for this type of event
Involving chain of command, monitoring of weather service, decision making regarding removal and return to field
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In the event of a storm, shelter indoors should be obtained
Other guidelines
Avoid large trees, flag/light poles, standing water, telephones, pools, showers, and metal objects (bleachers, equipment, umbrellas)
Last resorts find car, ravine, ditch or valley for safety
If hair stands up on hand you are in imminent danger and should get down on the ground but not flat as that increases surface area
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Additional Guidelines
Lightening is generally accompanied by thunder (except 20-40% of the time due to atmospheric disturbances)
Flash-to-bang methods estimates distance away for the storm
From time lightening is sighted to the clap of thunder count, divide by 5 to calculate the number of mile away
Count of 30 indicates inherent danger
Count of 15 seconds everyone should leave the field
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NATA and National Weather Service recommend returning to the field 30 minutes following the last clap of thunder or lightening strike
Major misconception is that lightening that is seen striking is coming down
In actuality it is the return stroke of the lightening going back up after it has already hit the ground
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Lightening detector
Hand-held instrument
Able to detect storm occurring within 40 miles
Allows you to know level of activity and direction
When it detects a lightening stroke it emits an audible warning tone
Inexpensive alternative to setting up contract with weather service
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Air Pollution
Significant problem throughout the United States
Two types
Photochemical haze: nitrogen dioxide and stagnant air acted on by sunlight to produce ozone
Smog: combination of carbon monoxide, sulfur dioxide, and particulate matter
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Ozone
Formed by the action of sunlight on carbon based chemicals (hydrocarbons) in combination with nitrogen dioxides
Minimum activity levels - ozone will not impact
Higher intensity will have a negative effect on work output
May experience shortness of breath, coughing, chest tightness, pain with deep breathing, nausea, eye irritation, fatigue, lung irritation, lowered resistance to lung infection
Asthmatics are at greater risk
May become desensitized over time
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Sulfur Dioxide
Colorless gas that is a component of burning coal or petroleum
Causes increased resistance to air movement in and out of the lungs, decreased ability of lungs to rid themselves of foreign matter, shortness of breath, coughing, fatigue and increased susceptibility to lung diseases
Adverse effects mostly on asthmatics
Nose breathing lessens the effects due to filtering of nasal mucosa
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Nitrogen Dioxide
Produced through combustion (automobiles, power plants, home heaters and gas stoves)
Factor in atmospheric reaction to generate ozone and acid rain
Can irritate the lungs, lower resistance to respiratory infection and may increase incidence of respiratory disease in children
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Carbon Monoxide
Colorless, odorless gas.
Reduces hemoglobin’s ability to transport oxygen and restricts release of oxygen to the tissue
Interferes with performance, and various psychomotor, behavioral, and attention-related activities
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Particulate Matter
Solids found in atmosphere (dust, pollen, molds, ashes, soot, aerosol)
Generated through wood burning, factory smokestacks, mining construction
Small enough to be inhaled and absorbed into the bloodstream or remain imbedded
Exposure to this matter may trigger asthma attacks, cause whizzing or coughing, respiratory irritation in people with chronic obstructive pulmonary lung disease (COPD) including emphysema and bronchitis
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Prevention
To avoid problems, stop or decrease activity during periods of high pollution
Perform when commuter traffic is less and ambient temperature is lower
Avoid high times relative to ozone levels
Running should be avoided in areas of high traffic due to auto emissions and carbon monoxide
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60. Circadian Dysrhythmia (Jet Lag)
Desynchronization of biological and biophysical time clock
Body maintains cyclical mechanisms over 24 hour periods (circadian rhythms)
Body adapts over time to changes
Immediately (protein metabolism)
Over 8 days (body temperature)
Three weeks (adrenal hormones)
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Jet lag refers to physical and mental effects caused by traveling rapidly across time zones
Disrupts circadian rhythms and sleep-wake cycles
May cause fatigue, headaches, digestive disorder, changes in blood pressure, heart rate, hormone and endocrine releases, and bowel habits
Could negatively impact performance and predispose athlete to injury
May become ill, suffer short term anorexia, headaches, blurred vision, dizziness, insomnia and/or fatigue
Younger individuals adjust more rapidly
30-50% faster adaptation flying westward
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North-south travel has no impact unless time zones are crossed
Changes in zones, illumination and environment can be disruptive (>5 time zones)
To prevent
Depart well rested
Pre-adjust
Eat according to time changes
Avoid dehydration
Training schedule
Use caffeine when travelling west
Adopt local time on arrival
Avoid alcohol, before, during and after the trip
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Synthetic Turf
Believed to be:
durable, offer great consistency, usable with inclement weather, require less maintenance
offer greater performance in areas of speed and resiliency
Variety of surfaces have been created since 1960’s
Most recent is “resilient infill turf”
Similar to grass, polyethylene and polypropylene yarn on a base of sand, rubber pellets or combination
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Constant debate
Injury perspective- not conclusive evidence that synthetic surface increases injury rates
Empirically, athletes, coaches, and athletic trainers agree that injuries are more likely on turf
Most would prefer to play and practice on natural surfaces
Hybrid, more durable grasses are also available
Synthetic surfaces
Lose shock absorbing capabilities
Injuries are more likely to occur when training always occurs on turf
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Due to possibly of higher speeds obtained on turf, injuries involving collisions could be more severe due to increased force and impact
Shoes that don’t “stick” will significantly reduce likelihood of injury
Common injuries
Abrasions (reduce with padding)
Turf toe (less likely to occur if shoes has stiff, firm sole)
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