January 2020 - 13

By Ken Mannie, columnist
Without question, the top priorities in athletics are the
health, safety and welfare of our student-athletes. This
responsibility is shared by administrators, sport coaches,
athletic trainers and, most certainly, strength and
conditioning coaches.
Unfortunately, in strength and conditioning
environments we are intermittently witness to
catastrophic events involving athletes. While some
of these incidents are the result of congenital
abnormalities that slipped under the screening
radar, or questionable personal life-style habits by
the athletes, others were either directly or indirectly
the result of poor judgement by the coaches in
implementing a protocol that was inappropriate
for the athlete's current conditioning level.
Let's examine a couple of the most significant health
and safety issues confronting the athletic population,
along with some preventative measures.
Exertional Heat Illness
Elevated body temperature (hyperthermia) can lead to
a variety of physiological disorders that include muscle
cramping, heat syncope (fainting), heat exhaustion (HE)
and a very serious condition known as exertional heat
stroke (EHS).
In general, hyperthermia is defined by a core body
temperature of 104 degrees Fahrenheit (40 degrees
Celsius). Core temperature is determined by metabolic
heat production and the transfer of body heat to and
from the surrounding environment. The body's natural
mechanism to dissipate heat is the vaporization of sweat,
though this process can be severely hampered when the
humidity level is elevated or athletes are wearing heavy
gear. Lack of an appropriate acclimatization process to
allow for adaptive physiological responses to heat and
humidity exposure also can be a culprit.
While it's possible for HE issues to surface in all
temperature ranges, it usually occurs more readily
in hot and humid environments. HE normally causes
cessation of exercise due to extreme fatigue, and it can
be a precursor to EHS. Symptoms of HE include an
elevated pulse, low blood pressure, and sweaty or pale/
ashen skin.
EHS is a serious condition and is ranked as the third
highest cause of death among collegiate athletes. Football
has the highest incidence rate among intercollegiate
sports. EHS is defined by a rectal temperature of greater
than 104 degrees Fahrenheit and central nervous system
disturbances. Key symptoms of EHS range from cessation
of sweating, red/dry skin, dizziness, vomiting, inability to
walk, collapse and seizure. Don't be fooled - athletes can
be sweating profusely and still be a victim of EHS.
It cannot be overstated that EHS is a life-threatening
medical emergency. The first priority is to cool the
victim's body on-site prior to evacuation to the hospital.
Cold/ice water immersion offers the fastest whole-body
cooling rate. When water immersion isn't available, ice
water towels on the head, trunk, and extremities, along
with ice packs to the neck, groin, and armpits offer slower
but helpful cooling rates.
Acclimatization is a crucial element in in preventing
EHIs. It involves a series of adaptive physiological
responses to heat exposure of the course of
approximately 10 to 15 days. The body will adapt to
gradual, progressive exercise in the heat by reducing
rectal temperature, lowering cardiovascular strain and
increasing blood plasma volume. Obviously, an athlete's
ability to acclimatize is dependent upon the initial level
of fitness, and the intensity and frequency of the training
sessions.
Exertional Rhabdomyolysis
Exertional Rhabdomyolysis (ER) is the result of
the breakdown of skeletal muscles and the release of
muscular biochemical substances (e.g., myoglobin,
potassium, creatine kinase and other intracellular
components) into the blood stream.
Athletes who have sickle cell trait - which is the
occurrence of sickle-shaped red blood cells that may
block small blood vessels - are more prone to ischemic
ER. ER may result in nausea, vomiting, mental confusion,
cardiac arrhythmias and kidney damage. Common
symptoms of ER include muscle pain (aching and
throbbing), muscle weakness (inability to stand up),
muscle swelling and disorientation. Urine is often very
dark in ER cases - cola or tea colored. If not judiciously
and immediately attended to, ER can become a lifethreatening
situation, as kidney failure and liver problems
can ensue. Hospital treatment is paramount, where IV
fluids and management of electrolyte abnormalities to
protect the heart and other vital organs may be put in
motion. Dialysis may be necessary to help the kidneys
filter waste while recovering.
Precautionary measures
A joint consensus by the Collegiate Strength and
Conditioning Association (CSCCa) and the National
Strength and Conditioning Association (NSCA)
recommends a 50/30/20/10 conditioning protocol for
returning from an extended break in activity. Simply
put, for returning athletes coming off a break two weeks
or longer - or with new athletes - there should be four
consecutive weeks of introductory training approached in
the following manner:
* Week 1: A minimum of a 50% reduction in the
uppermost volume of the conditioning program with
at least a 1:4 work-to-relief ratio. If a test is conducted
for assessment purposes, it would be no more than
50% of normal test volume (e.g., the 16x110s test would
be reduced to at least 8x110s) with at least a 1:4 workto-relief
ratio.
* Week 2: A minimum of a 30% reduction in the
uppermost volume of conditioning with a 1:4 work-torelief
ratio.
COACHAD.COM 13
http://www.COACHAD.COM
January 2020

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