MUSCLE CRAMPS
Muscle cramps during intense activity in hot or humid environments may be caused by “dehydration, electrolyte imbalances, altered neuromuscular control, fatigue or any combination of those factors.”1 Immediate relief of the cramp is achieved by placing the affected muscle on stretch with simultaneous massage to break the spasm. Increasing the sodium intake through a specialized commercial fluid replacement drink (like those sold by Gatorade) and through foods may offset any future problems. In severe cases, evaluation of overall hydration status using urine USG is recommended prior to return to activity.

HEAT SYNCOPE
Typically occurs in less fit and/or poorly acclimatized individuals and is associated with dehydration, low blood pressure or venous pooling of blood. Symptoms include dizziness, decreased pulse rate and tunnel vision immediately before collapse. The incidence of heat syncope is highest during the first week activity before an individual has fully acclimatized to a hot/humid environment.

HEAT EXHAUSTION
Associated with cardiovascular insufficiency, hypotension, energy depletion, dehydration and fatigue, the symptoms of heat exhaustion include:

• Minor changes in central nervous system (CNS) function including:
  • Headache
  • Confusion
  • Disorientation
  • Headache
  • Irritability
  • Dizziness
• Nausea or vomiting
• Lightheadedness
• Low blood pressure
• Impaired muscle coordination
• Syncope
• High rate/volume of skin blood flow
• Excessive sweating

Individuals suspected of suffering from heat exhaustion shall be removed from activity and cooled immediately using either cold towels or cold-water immersion (see below). Reassess the individual at regular intervals and if symptoms improve, discontinue cooling and continue to monitor. If symptoms do not improve or worsen, continue cooling and activate EMS.

HEAT STROKE
Heat stroke is a medical emergency associated with both metabolic heat production through exercise and exertion in hot/humid environmental conditions and occurs when the body’s ability to regulate its body temperature is overwhelmed. Heat stroke is characterized by neuropsychiatric dysfunction and significant central nervous system (CNS) changes including:

• Collapse
• Aggressiveness
• Irritability
• Confusion
• Seizures
• Altered consciousness

If heat stroke is suspected, remove the individual from activity, activate EMS and cool the individual immediately using cold-water immersion.

For most of the country, the next four months will be spent training in the cold. Whether your high school football program is making a run at the state title, you’re playing in outdoor tournaments, or you’re training in the parking lot while you wait for volleyball to be done in the gym - you need to be prepared for cold weather training!

Here are some tips for keeping up with hydration in cold weather:

Hydration is tricky in the cold

• Cold weather moves fluid from your extremities to your core, increasing your urine output, dehydrating you further.
• Cold weather also decreases your thirst sensation up to 40%.
• When you can see your breath, you’re losing more fluid than normal.
• As a general rule, for every pound of body weight you lose through sweat you should replace it with .45L of water; about the amount of water in the average 500ml bottle of water.

Sunscreen is your friend

• A moisturizing sunscreen will reduce wind burn on areas that are exposed to the elements such as face and neck.
• Purchase an spf chapstick. Just because it’s cold out doesn’t mean you can’t get sunburnt. 

The order of your layers matters!

• Choose a moisture wicking material for your base layer with an insulating material like fleece on top.
• Have a wind/waterproof resistant top layer handy for protection against wind and rain during rest breaks.
• Exercising in the cold/wind drops your core body temperature, and wet clothes can double heat loss. 

Get Acclimated

• Start training outdoors EARLY & OFTEN! Just like in the warmer months, our bodies need to acclimate to changing temperatures.
• Your body regulates its core temperature by limiting blood flow to limbs in cold weather, causing your muscles to work less efficiently. This puts you at a greater risk for soft tissue injuries like strains and sprains.
• Fatigue can also impair your ability to regulate body temp in the cold, which can translate to injury.
• Getting 8-10 hours of sleep as a young athlete helps you acclimate to cold training.