EDUCATIONAL OBJECTIVES

The learner should, at the completion of the chapter, be able to perform the following:

• Recognize the various environmental conditions that affect sports.
• Understand the legal and ethical issues that face athletic trainers.

There are three basic environmental conditions that impact athletic performance: heat, cold, and altitude. All three can have a negative effect on performance. The athletic trainer, coach, and athlete must prepare for these conditions. The guidelines for prevention and symptoms of environmental distress are discussed in this chapter.

HEAT RELATED CONDITIONS

High temperatures and elevated humidity can negatively impact athletic performance, adversely affect health, and even threaten life. While environmental heat problems most often occur to football players, all athletes are susceptible.

Exercise generates heat, which the body must dissipate. If the body retains too much heat, the victim can die. The body cools itself mainly through the sweating mechanism; heat is carried away from the body as perspiration evaporates. This cooling process can be interrupted in two ways: the humidity can be so high that sweat does not evaporate, or the thermoregulatory system of the athlete can be disrupted, causing sweating to cease. The coach and student athletic trainer can help prevent heat related problems in several ways:

1. Prehydration and rehydration: Heavy fluid intake before, during, and after practice will help ensure that athletes function efficiently and safely. The weight an athlete loses through exertion is almost entirely related to fluid loss. A fluid loss of as little as 3% of total body weight can adversely affect endurance and coordination. Such fluid loss can initiate heat illness. There are several reasons for athletes to prehydrate. First, they need to replace lost fluid from the previous practice session. Second, thirst is not an accurate indicator of the need for fluid. A thirsty person will feel rehydrated well before the adequate intake of fluids. Third, drinking too much water at one time will give the athlete an uncomfortable feeling. Several smaller doses of water are better than one large amount. One strategy for replacing fluids is to drink cold water and 6-8% solutions of carbohydrate using the following formula:

• 34 oz. two hours before activity
• 13 - 17 oz. 15 minutes before activity
• 13 - 17 oz. every 30 minutes during activity

2. Acclimatization: While humans can not adjust to being deprived of water, they can get better acclimated to hot weather. This process can take 1-2 weeks of working out in heat with gradually increased intensity.

3. Preparticipation Physical Examination: With all individuals receiving a medical evaluation, athletes should be asked about previous occurrence of heat illness problems. Identification of susceptible individuals should be noted and monitored.

4. Wear proper clothing: Light, loose fitting clothing will allow air to move over the body. Clothing that bind can trap heat. Helmets should be taken off during breaks. Do not allow athletes to work out in rubberized clothing or sweatsuits in the false belief that they are accelerating weight loss. The weight loss will be easily replaced fluid, not fat loss. Also, perspiration will be trapped, the cooling process will be interrupted, and the stage will be set for dehydration and heat illness.

5. Use weight charts: The student athletic trainer can weigh all players before and after each practice. Athletes who do not regain their lost water weight by the start of the next practice should be encouraged to replace fluids. If there is significant fluid loss (3% or more of body weight), the team physician should be contacted.

6. Monitor environmental conditions: It is advised to monitor the environmental conditions through local weather monitoring systems. High temperature and humidity will effect an athlete's ability to release body temperature and physical activity should be monitored on these days.

7. Do not give salt tablets: The amount of water needed to balance the salt intake is much more than the athlete can comfortably drink. The best method for increasing salt is during meals. Fluids are much more important than salt in avoiding heat problems.

8. Be prepared to give first aid: Know the signs of heat exhaustion and heat stroke and be prepared to provide first aid.

Heat Stroke

Heat stroke is caused by high body temperature, dehydration and electrolyte imbalance. The body's mechanisms for dissipating heat will have stopped working, and a tremendous increase in body temperature will occur rapidly. Heat stroke is a medical emergency and must be treated as a life-threatening situation. The signs and symptoms of heat stroke are:

• The victim may be dizzy, weak, mentally confused, or have a sense of doom.
• The victim's skin may be extremely dry and will appear flushed. The pulse will be strong and rapid.
• The victim's temperature will be very high and the skin will feel hot to the touch. The axillary temperature will be above 101 degrees, and it may range as high as 107 degrees.
• With little warning, the victim may become unconscious.

• Cool the athlete with cool water and wet towels.
• Make immediate arrangements to have the athlete transported to the nearest medical facility. Severe neurological, circulatory, and hepatic (liver) conditions may occur if quick and definitive medical attention is not sought.
• Remove all clothing and pads and place the athlete in the coolest available place.
• Cool the athlete's body by using cold towels, cold showers, and ice massage.
• If the patient is conscious and can cooperate, give cold drinks to aid in fluid loss.

Heat exhaustion may be difficult to recognize. Its symptoms generally are less severe than those of heat stroke and vital signs may even appear normal. Coaches and athletic trainers should look for the following signs to determine if the victim is suffering from heat exhaustion:

• The victim may experience progressive weakness and uncoordination.
• The skin is usually moist and clammy and may be pale or gray.
• The pulse may be weak and slightly more rapid than normal (less than 120 beats per minute).
• The pupils may be dilated.
• The victim may be nauseated.
• The victim is usually conscious, but fainting may occur.
• The victim may be suffering from muscle cramps.

• The athlete should lie in a cool place out of the sun.
• Encourage the athlete to drink as much cool water as possible.
• Remove excess clothing and rub the athlete's body with a cool, wet cloth.
• The athlete should be instructed to stay out of the heat until evaluated by a physician or referral to medical facility.

The following chart should help the athletic trainer determine whether the athlete is experiencing heat stroke or heat exhaustion.

Note: The non-white athlete will still exhibit a paling of the skin or red and flushed skin, but you need to examine the inner lip, gum area and nail beds for skin color.

Heat Cramps

Muscle cramps are painful, involuntary muscle contractions that usually occur from limited electrolyte intake or excessive water during strenuous exercise. Since this condition can exist in all athletes, the lower extremities and abdominal cavity are the most common sites for muscular cramps. First aid for heat cramps includes:

• Encourage the athlete to drink electrolyte solutions.
• Instruct the athlete to stretch and apply cool application (ice) to the affected area.
• Monitor athlete for other heat illness problems.

Dehydration, the primary cause of heat illness, can occur not only in hot, humid weather, but also during the coldest days of the year. Athletes can lose 5 to 10 pounds of fluid weight during one hot, humid practice session. Strenuous winter workouts in the gym can have the same effect. In addition, during the winter the body loses essential fluids in ways besides sweating. The air inside heated buildings and outdoors is almost always drier during the winter than in the summer. It must be warmed and moisturized before the lungs can absorb it. During this process, the body uses fluids and energy at a very rapid rate, calling for continuous fluid replacement. The body's thirst mechanism isn't always accurate, especially in the winter. Athletes may not feel as thirsty as they did on that hot summer afternoon, but may need as much fluid replacement as possible, preferably 8 ounces of fluid per every 20 minutes of exercise.

COLD WEATHER CONDITIONS

Frostbite

In severely cold conditions, frostbite becomes another major concern for athletes. Late-autumn football games are sometimes played in sub-freezing air temperatures. When combined with wind, these low temperatures can freeze unprotected skin tissue. The most susceptible areas are the fingers, toes, ears, and exposed parts of the face. Common frostbite warning signals include a tingling or burning sensation, pain, numbness, and discoloration of the skin (frostbitten areas have a yellow-white, waxy appearance). In extreme cold, however, flesh may freeze quickly, without warning, due to the cold's anesthetizing effect on the skin. Keeping cold and dampness away from the skin is the best protection against frostbite. You can also help ward off frostbite with physical actions, such as wiggling fingers and toes, making faces, and working the muscles to increase the supply of blood to various areas. If frostbite should occur, medical referral is recommended. Be sure to notify your athletic trainer if you suspect that an athlete is suffering from frostbite.

Hypothermia

Any athlete who participates in outdoor recreation should guard against excessive heat loss and recognize the following progressive signs of hypothermia, a potentially fatal condition. Those signs include:

• Constant shivering; this is an attempt by the body to generate heat.
• Apathy, slurring of speech, listlessness, involuntary muscle movement, croaky voice, sleepiness, and generalized rigidity of muscles.
• Unconsciousness, pupils that are abnormally dilated and that react sluggishly to light, and very slow pulse and respiratory rates.
• Freezing of hands and/or feet.

ALTITUDE

The third type of environmental condition that can be experienced by athletes is altitude. When an athlete trains at one altitude level and then must compete at another altitude level, these athletes can experience an impact on their performances. Typically the negative impact occurs when an athlete who has trained at a low altitude level must compete at a significantly higher altitude level. This impacts performance because the higher altitude has less oxygen concentration. This makes it more difficult for the athlete to supply the required amount of oxygen to the body’s systems. This negative impact is usually seen with sports that are aerobic in nature. Anaerobic sporting events result in less of an impact because the event is over before the body experiences an oxygen debt. To avoid this condition, athletes should be given the opportunity to train at the higher elevations for a period of time that allows their bodies to adjust to the limited oxygen atmosphere.

TIME TRAVEL CONDITIONS (JET LAG)

One additional condition that can impact athletes is circadian dysrythymia. This is when the body’s internal clock is confused. This occurs when athletes travel across numerous time zones and is typically seen when the athlete travels from the west to the east. Both the eating and sleeping rhythm are disrupted and the athlete’s internal clock is trying to adjust, but is having difficulty because of the day/night sequence.

LEGAL AND ETHICAL CONSIDERATIONS
An awareness of legal and ethical issues in sports is important. All health care providers in sports are governed by federal, state and local laws as well as guidelines established by their respective sports governing bodies. Every provider must work within those parameters. If a person decides to practice beyond the scope of their respective profession, that person should understand that they are subjecting themselves to the scrutiny of the legal and judicial system. In addition to the legal aspects, health care providers must be fully aware of the ethical issues and dilemmas facing each health care provider. To clear an athlete to return to competition before they are medically and/or psychologically fit is an example of an ethical violation. Ethical issues are identified as either "right" or "wrong" and may or may not involve actual legal infractions and are usually determined by the national sports governing body or respected professional association.

RECREATIONAL AND PERFORMANCE ENHANCING DRUGS

The increased use of' "recreational drugs" (alcohol, marijuana, cocaine) by high school, college, and professional athletes has been recently exposed in the media, as well as the use of "performance-enhancing" agents (such as anabolic steroids and caffeine) by world-class performers. This has led to another area of great concern, the abuse of chemical agents by the very young athlete. Besides possibly starting such an athlete down a road of chemical dependency, drug use can have serious and sometimes irreversible side effects.

Alcohol

This is the most commonly abused drug at all levels. The peer pressure to drink is extreme. Because of its universal acceptance in our society, alcohol remains the most difficult drug to control. Alcohol, even taken after the contest, ultimately results in deterioration of the psychomotor skills of reaction time, eye-hand coordination, accuracy, balance, and complex coordination. Alcohol also impairs body temperature regulation, especially during prolonged exercise in cold environments. In addition, alcohol consistently decreases strength, power, local muscular endurance, speed, and cardiovascular endurance. Even though the athlete generally consumes alcohol in an attempt to gain psychological benefits, the psychomotor performance deteriorates first and most profoundly.

Marijuana

Marijuana is the second most commonly abused substance by the young athlete. The athletes who use marijuana, even on a casual basis, experiences very significant effects that have a direct bearing on athletic performance. These effects include:

• Inhibition of the sweating mechanism in hot environments, which can lead to heat illness
• Major impairment of coordination as measured by hand steadiness, body sway, and accuracy of execution of movement
• Impairment of tracking performance, perceptual tasks, and vigilance
• Slowed reaction time to visual and auditory stimuli
• Altered perception of speed, time, and space
• Short-term and long-term memory loss
• Prolonged learning time

Tobacco Products

Recently, national sport governing bodies have taken the position that tobacco products are detrimental to the athlete and to the sport. Therefore, all persons associated with athletic participation have enacted rules and regulations to curb the use of tobacco products. Those tobacco products that have been identified as having a negative impact on the health of the athlete include all smoking, chewing, and snuff tobacco products. Case studies have shown that cancer is linked to the use of these products. The sport of baseball has seen the most recent regulations enacted to control the use of these products while at practice and in game situations.

Anabolic Steroids

Anabolic steroids, synthetic derivatives of the male hormone testosterone, are some of the most controversial drugs linked to athletics. Athletes hope to increase their strength and the size of their muscles through steroid use. Commonly, athletes on steroids also feel more aggressive and self-confident, which encourages them to train harder. There have been additional claims that steroids will do everything from increase red blood cell counts to act as glycogen-sparing (or energy-sparing) agents. The problem is that there is little conclusive evidence concerning the benefits of steroid use. Researchers agree that when normal, healthy men take steroids without training, there is no effect on muscle size or strength. The harmful side effects of steroid use have been much better documented than any strength gains. Among the side effects in males are liver damage (including liver cancer), impaired kidney function, enlargement of the prostate gland, decreased levels of natural testosterone, testicular atrophy resulting in sterility, growth of breast tissue, and weight gain caused by fluid retention which often leads to elevated blood pressure. Some of these side effects can even lead to death. In addition, the majority of athletes using steroids experience an increase in libido and detrimental aggressive behavior. In women, steroids can produce a deepened voice, growth of facial and chest hair, liver damage, clitoral enlargement, menstrual irregularities, and impairment of reproductive capacity.

Caffeine

Moderate amounts of caffeine can increase mental alertness, but too much may cause anxiety, hamper performance and increase heart rate. In endurance events lasting more than two hours, caffeine can enhance performance as it allows the body to burn more fatty acids as fuel. In addition, beverages containing caffeine have a diuretic effect. They stimulate the flow of urine, which may cause discomfort during activity or decrease the body's water level before competition, adversely affecting performance.

Creatine

This supplement has recently gained notoriety in the world of athletics. This nitrogen compound combines with phosphate to burn a high energy compound stored in muscle. The theory is that this will enhance energy and stimulate muscle growth. The current research can not collaborate this theory and additional research must be conducted to identify either benefits or disadvantages of this compound. Advice to athletes must include caution and a clear understanding of the detrimental side effects of creatine. There are indications that large dosages of creatine will contribute to dehydration.

RECOGNITION OF DRUG USE

Spotting a drug user or abuser can be a difficult and complicated task for a coach, athletic trainer, or student athletic trainer. Some of the changes that may be seen in an athlete using drugs resemble the symptoms of severe personal or emotional problems. It is imperative to treat the athlete as an individual and to talk to him or her privately about the nature of the problem.

Signs of drug use include:

• Motivation variations
• Change in personality or behavioral patterns
• Withdrawal from companionship
• Decline in performance, both physically and academically
• Frequent missing of classes, especially physical activity classes
• Inability to coordinate (standing or walking)
• Poor personal hygiene and grooming
• Muddled speech
• Impaired judgment
• Restless, jittery
• Muscular twitches, tremor of hands
• Heavy sweating, bad breath, nervousness (amphetamine abuse)
• Red eyes, listlessness, increased appetite with special craving for sweets (marijuana abuse)

World class, professional, and college athletes have been drug tested for decades. This is an attempt to make the playing field as equal as possible for all participants. The trend is to conduct drug testing on the high school athlete and those participating at the recreational levels. This has developed because performance enhancing drug use has become common at those levels. Another factor that has influenced this trend is the cost and reliability of drug tests. As with all issues of drug testing, the key is to educate the participants as to the detrimental effects of drug use. Most claims as to the beneficial effects of drug use are exaggerated. The best way to counter this is through proper education of the coaches, athletic trainers, athletes, and parents. For futher information regarding the NCAA and drug testing visit http://www.ncaa.org/sports_sciences/ or the USOC at http://www.olympic-usa.org/inside/in_1_3_7_1.html.

SUMMARY

Environmental issues must be clearly understood in order to avoid unnecessary injury and illness. Practice and competition place the athlete under great physical and mental stress. Establishment and adherence to guidelines can help control the number of environmentally related incidents. Monitoring the weight gains and losses of individuals plus the adequate hydration of athletes is effective in the identification of individuals susceptible to environmental heat stress. Knowledge of both legal and ethical issues will help the health care provider avoid unwarranted problems. Federal, state and local laws plus guidelines by national organizations provide the framework for healthcare professionals. Professionally, work within those parameters. Develop an understanding of the problems existing in drug use and abuse in athletes.
 

REFERENCES

Anderson, M. & Hall, S. (1995) Sports Injury Management. Baltimore: Williams & Wilkins.

Appenzeller, H. (1985) Sports and the Law: Contemporary Issues. Charlottesville, VA: Michie.

Folinsbee, L. J. Environmental Stress Individual Human Adaptation. New York: Academic Press.

Marriott, B. & Rosemont, C. (1991) Fluid Replacement and Heat Stress. Washington, DC: National Academy Press.

Mueller, F. and Ryan, A. (1991) Prevention of Athletic Injuries: The Role of the Sports Medicine Team. Philadelphia: F.A. Davis.

Strauss, R. (1984) Sports Medicine. Philadelphia: Saunders.

Torg, F. and Shepard, R. (1995) Current Therapy in Sports Medicine. St. Louis: Mosby.

Welsh, R.& Shepard, R. (1985) Current Therapy in Sports Medicine. Philadelphia: Decker.

Chapter 13 - Review Questions

Completion:

1. The gradual process of adjusting to hot weather and cold weather workouts is known as ______. This process takes ______ weeks.
2. Adequate ________ is essential in eliminating heat illness.
3. A fluid loss of as little as ___ percent of total body weight can adversely affect endurance and coordination.
4. ________ is a medical emergency.
5. Heat stroke is caused by the body’s inability to ________ heat.
6. Besides fluid replacement, two special concerns during cold weather workouts are ________ and ________.

Short Answer:

1. Why is high temperature and elevated humidity dangerous?

2. What factors cause heat stroke?

3. What are the symptoms of heat exhaustion?

4. What are the symptoms of heat stroke?

5. What are the first aid procedures for heat stroke?

6. What are the progressive signs of hypothermia?

7. List three of the harmful side effects of steroid use.