The athletes playing football in this extreme heat, especially two-a-day practice sessions must think seriously about dehydration.
Coaches, captains and parents must encourage the player to increase fluids and be well hydrated by drinking before, during and again after practices.
The athlete who begins exercise with less than normal amount of body fluid runs the risk of adverse reactions to the cardiovascular system, body temperature regulation, and performance during the practice or game.
Athletes playing football can lose as much as 10 quarts of fluid during the sweat rate each day. Large losses of sodium and chloride occur when one sweats. These must be replaced during the practice sessions from day to day. The athletes should begin their strength training exercise conditioning before going out for preseason practices. This helps them to become acclimated to warm weather.
If one begins to exercise dehydrated, this will create the risk of heat illness and poor performance. The athlete should get into a habit of drinking at least 16 ounces of fluid in the evening, before retiring and another 16 ounces upon awaking to maintain fluid balance.
It is important to drink 16-32 ounces one hour before and another 16 ounces about 20 minutes before the training sessions start. One may get into a method of weighing oneself before and after exercise to make sure one has taken enough fluid to prevent dehydration.
At times, with heavy sweating, fluids that contain carbohydrate and small amounts of sodium chloride will be helpful in fluid and mineral replacement during the practices or competition.
If the athlete has the slightest sign of thirst, this is a warning sign of dehydration and possible heat illness. Drink at least 8 ounces every 15 minutes to replace fluid loss and 24- ounces for every l pound of body weight loss after exercise.
In case you haven’t noticed — it is hot! With participation in outdoor fall sports beginning, schools and coaching staffs are taking extra precautions to keep their athletes safe from heat-related issues. In recent visits to both area high schools, coaches and staff members were following strict guidelines to help ensure the safety of their players.
According to the National Weather Service, heat is a leading weather-related issue in the United States that results in fatalities or illnesses. With heat advisories popping up throughout the state, it is important to monitor the heat index, a measure of how hot it really feels when relative humidity is factored together with the actual air temperature. During extremely hot and humid weather, the body’s ability to cool itself is challenged, which can result in heat cramps, heat exhaustion or even a heat stroke.
Cortney Bowers, certified athletic trainer for Colleton County High School, is cranked up for football season – meaning she’s on-duty during practice to help ensure the players’ safety. According to Bowers, South Carolina does not have actual heat regulations, but most athletic trainers within the state use a work/rest/water and continuous work/water consumption guideline made available by Fort Jackson.
“The guidelines are a way for us to categorize the temperature-vs.-work ratio to gauge when we should stop practice due to temperatures,” explained Bowers. “Athletes often don’t realize the toll heat takes on their bodies until they are suffering from a heat-related condition. As temps hit the high notes, I hit the water bottles and get out the Kestrel,” said Bowers. “The Kestrel is a dry-bulb/wet-bulb globe thermometer which measures temperature, humidity and heat index. It will work standing in the middle of a football field.”
Bowers is also charged with helping keep the players hydrated during practice. “I try to keep every player as hydrated as possible throughout practice, with plenty of water on the practice field,” said Bowers. “I have 18-20 sets of water bottles, so each coach has two sets of their own in groups. I have two 20-gallon water boys that I use on opposite sides of the practice field. The linemen, who tend to be bigger, have 4-to-5 sets of bottles and a 20-gallon water boy to help keep them hydrated. Last year, we had a continuous feed water boy purchased for us, which enables me to put ice in the chest and plug it up to a water hose for a continuous flow. On standby, I have 7-8 ten-gallon coolers filled with just ice to replenish the smaller water boys as needed and keep a seven-gallon cooler with towels, ice, water and ice bags in it for emergency.”
The Cougars will go full gear on Wednesday, which means Bowers will be going a step further in her preparation. “Once we put pads on, I will have a tent on the sidelines,” said Bowers. “I’ll keep the water under the tent and have tubs set up for emergency cold soaks or just for the guys to take a nice dip after practice. I also have the whirlpool inside that is ready to go if needed.”
According to Bowers, part of staying safe in the dangerous heat begins before athletes step on the field. “I preach to these kids to drink lots and lots and lots of water,” she said. “Although some Gatorade is acceptable, nothing beats water. Gatorade, which is heavy in sugar, can actually cause cramping. So, I always tell players if they drink Gatorade, fill the empty bottle back up with water. It is also very important to eat in the mornings before practice — whether it’s eggs and bacon or a peanut butter sandwich, it gives them the necessary energy for practice and helps reduce overheating. Dressing in loose fitting, comfortable clothing or heat gear, is another component to staying cool.”
The State of South Carolina has mandated that all coaches take an annual test through the National Federation of State High Schools on heat illness prevention, concussions and sudden cardiac arrest. This precaution allows coaches to know the signs and symptoms and to both stay educated and help educate.
“With coaches and athletic trainers understanding what to watch for, it means more eyes to watch for signs and symptoms, which is better for our athletes,” said Bowers.
The death of 14-year-old Lewis Simpkins has once again raised questions about whether we are doing enough to prevent sudden deaths in sports.
The sophomore defensive tackle at River Bluff High School stumbled through the end of a 2-hour, 15-minute football practice before collapsing in the locker room on Aug. 10. Coaches gave him CPR and used a defibrillator. Paramedics took him to Lexington Medical Center, where he was pronounced dead.
Over a recent 20-year period, 243 deaths occurred during high school and college football practices and games. That’s about 12 per season. The most common causes were heart failure, brain injury and heat illness. The cause of Simpkins’ death has not yet been determined.
A recent article in The State newspaper pointed out that South Carolina high schools show poor compliance with guidelines to prevent sudden death. These guidelines come from the Korey Stringer Institute, a leader in research and education to improve safety and prevent sudden deaths for athletes and the military.
In the article, South Carolina High School League commissioner Jerome Singleton noted that he wasn’t familiar with the Institute or its guidelines. He did point out that coaches in this state must complete online courses regarding heat acclimatization and concussions. He also emphasized that the SCHSL reviews its medical policies annually.
Korey Stringer was an NFL offensive lineman for the Minnesota Vikings. He died from exertional heat stroke after an August practice in 2001. His wife Kelci partnered with heat stroke expert Dr. Douglas Casa at the University of Connecticut to create the Korey Stringer Institute. The NFL, Gatorade and other companies and organizations contribute to the Institute’s efforts.
One area of concern for football teams in the South is the heat, with 63 percent of deaths from heat stroke in football occurring in the South. Fortunately, these deaths are largely preventable. Unfortunately, South Carolina does a poor job complying with guidelines that can prevent these deaths.
While North Carolina and Georgia, as well as Alabama, Mississippi, Arkansas and Texas, meet the minimum best practice guidelines for heat acclimatization, South Carolina only meets one of the seven KSI guidelines. These guidelines include limits to the number and length of practices in the first weeks of summer football and recommendations for gradually adding protective equipment.
South Carolina schools also meet none of the guidelines regarding the use of Wet Bulb Globe Temperature (WBGT). The WBGT requires a special device to measure the outside environment for heat stress. It’s likely that the cost of the device plays a factor in our poor compliance, but Georgia meets all nine of the best practice guidelines for WBGT.
South Carolina does somewhat better with access to automated external defibrillators (AEDs) and training in CPR and AED use — meeting five to six of the Korey Stringer Institute’s eight best practice guidelines.
In terms of plans for emergencies like the tragedy at River Bluff, South Carolina again needs work. Of the 11 guidelines issued by KSI regarding emergency action plans — schools coordinating with local EMS, athletic trainers and physicians on-site to develop plans should a medical emergency occur — South Carolina meets none of them.
The South Carolina High School League needs to adopt these heat acclimatization and emergency action plan guidelines. It should work with its high schools and the state legislature to arrange funding for WBGT and certified athletic trainers for each school.
Schools, though, don’t have to wait for a statewide mandate to take action. Concerned parents of high school athletes can talk to the athletic directors and coaches to discuss plans to treat and prevent deaths from cardiac arrest, heat stroke and brain injury.
This isn’t about pointing blame at the SCHSL or the high school athletic directors and coaches around the state. My goal is to raise awareness and encourage change.
As tragic as the sudden death of a high school athlete is, it creates a perfect time to take steps to prevent another one.
Almost 2 million children could be suffering from concussions, according to a new study, and many of them may go untreated.
The good news is that there’s been a huge increase in the amount of attention concussions have gotten over that past several years, but there’s still a lot of progress that can be made when it comes to taking action, and that’s something coaches in Louisville are working on.
“We realize the importance of it. It’s a danger to the game itself, because a lot of parents will say if my kid’s at risk for suffering a concussion, I don’t want them to play,” said Larry Handley, the player safety coach for the St. Stephen’s Bulldogs.
“My responsibility is to make sure that all the coaches are trained,” explained Handley.
To do that, he put all his coaches through an hour and a half seminar, looking at the causes and signs of concussion, and what to do if someone gets one. “There’s a protocol we go through, it’s about a five-day thing to make sure that, that player has fully recovered. We do require a doctor’s signature saying that kid is clear before we can bring them back in.”
Handley say it’s important to talk with your players and keep a close on them. He says you should look to see “if a player is looking a little bit unsteady on his feet, like he’s a little dazed.” A player for getting a play, or a change in personality can also be symptoms that can be harder to notice.
Contact sports like football aren’t the only culprit leading to concussion. “It can occur on the setting of a playground. It can occur in a youngster that’s just out at the pool having fun during the summer,” explained Dr. Tad Seifert, the director of sports concussion program at Norton Healthcare.
“It’s a type of traumatic brain injury, more on the mild end of the spectrum and anytime someone is hit in the head, or even gets hit in the body, you have this movement of the head and neck and the movement of the brain within the skull it reverberates back and forth and moves back and forth and it’s that sudden movement of the brain within the skull that causes the injury of concussion,” said Seifert.
Studies show the force involved in a concussion are the same as if someone driving around 30 miles per hour ran into a solid wall. It’s a huge amount of force being put on the brain.
To help people recover, Seifert says, “the cornerstone of treatment is first and foremost to remove that individual from further contact risk to prevent them from further hurt and long term consequences from the injury.”
That’s exactly the plan Handley has to keep his players safe, making sure they don’t go back on the field before they’re ready. “Safety is more important than winning, safety is more important than the best player, it’s more important than anything,” said the coach.
To help prevent concussion before it happens Handley explains that they teach players “Heads Up Football.”
“It’s a method of tackling, and a method of blocking that teaches players when they block and tackle to always keep their head up and never lower their head, because that’s when you run the risk of not only concussions, but also neck injuries.”
Athletes at schools in Floyd County, Ind. have some new equipment to help prevent concussions this school year. With help from a grant and Norton Healthcare, the district will get more than 200 new football helmets, with some of the highest safety ratings available. Norton Healthcare did the same thing for JCPS last year.
A study released Wednesday states the number of people diagnosed with concussions is growing mostly in adolescents.
The study conducted by University of California San Francisco is advising adolescents to educate themselves about concussion diagnosis, prevention and treatment.
The research is in the Orthopaedic Journal of Sports Medicine online.
“Our study evaluated a large cross-section of the U.S. population,” said lead author Alan Zhang, MD, UCSF Health orthopaedic surgeon. “We were surprised to see that the increase in concussion cases over the past few years mainly were from adolescent patients aged 10 to 19.”
Zhang and other researchers looked at the health records of over eight million members of a huge, private payer insurance group called Humana Inc between 2007 and 2014. People under the age of 65 diagnosed with an concussion were classified by the year they were diagnosed, sex, concussion classification, age group and where they were diagnosed.
About 44,000 people were diagnosed with a concussion and 55 percent of them were men. The highest age group with this diagnosis were between the ages of 15 and 19 with 16.5 concussions for every 1,000 patients.
Fifty-six percent of those diagnosed in with a concussion found out in the emergency room while 29 percent found out in a doctor’s office.
During Daniel Longoria’s helicopter ride to UAB hospital, he wasn’t sure what was happening — but he felt he might be getting abducted by aliens.
The then-senior offensive lineman at Alexandria High School had just suffered a concussion during a preseason scrimmage. He was in and out of consciousness, had a tube put down his throat and had strangers prodding him.
Although he has since recovered, it was a scary time for the Longorias and the Alexandria football team. His twin brother, Joshua Longoria, couldn’t bring himself to go to the hospital at first.
“When this happened, you almost thought he was dead,” Joshua said. “He was barely breathing, he was unconscious, he wasn’t responding. We couldn’t get him to wake up no matter what he did.”
Concussions and how high school sports teams handle them have become a much more serious issue from the days when coaches simply said an athlete “got his bell rung” and allowed him to continue playing.
While the National Football League wrestles with how to diagnose and treat concussions, high school football teams are no different.
A concussion is defined by the Centers for Disease Control and Prevention as a traumatic brain injury that causes the head and brain to move back and forth, often because of a blow or bump.
According to figures provided by the National Federation of State High School Associations, high school football participation has dropped 2.6 percent from 2009 to 2015, which is the most recent year figures are available.
While the statistics don’t include a reason for the drop, Roger Blake, executive director of the California Interscholastic Federation, told Sports Illustrated, “Think of how far we have come in the last 20 to 30 years when it comes to concussion awareness, tackling techniques, equipment. And yet we’re still having these discussions about declining participation and safety concerns.”
Daniel’s injury was not the first experience the Longorias had with concussions. Joshua sustained one in Alexandria’s jamboree game in 2014. He remembers the exact play.
“I was pulling around to make a block,” Joshua said. “It happened so fast. It was a guy about my size, and instead of raising my arms … I reared back and head butted him in the chest. It was kind of a stupid move, and it rung my bell.”
He felt like everything was moving slower and spinning, but he didn’t tell anyone until the third quarter. His coaches didn’t notice at first because he didn’t seem to have any symptoms.
But when he finally sat down, his symptoms hit. Everything was really loud and bright and an intense headache set in. His teammates thought he might have a concussion when he started acting strange. By the time the trainer came over, he couldn’t stand. Five minutes later, he was losing strength, and his mom, Rebekah Longoria, drove him to the hospital. At Anniston RMC, light caused him to shake.
“They asked me who the president was, and I said Nixon. I don’t know where that came from,” Joshua said. “They asked me what my name was … I told them my name was Big Longo.”
The next morning, he could remember football, but he couldn’t recognize his family or remember his name.
After more than 30 years coaching, Michael Shortt, head football coach at Cleburne County High School since 1998, has seen gradual changes in how concussions are assessed and treated — changes for the better, in his opinion.
“Anything safety-wise that can enhance our game and make it safer for kids, I’m all for that,” Shortt said. “We’re going to do that here.”
Shortt remembers sustaining concussions during his playing days.
“My coaches took care of me then,” Shortt, a 1980 graduate of Cleburne County, said. “They knew something wasn’t right.”
Last year, the state limited the number of hours of live contact in which football teams could participate, according to the AHSAA.
Ron Ingram, an AHSAA official, said a school ignoring the state’s concussion protocol is rare. The protocol was adopted by the state Legislature in 2011 to apply to all youth associations. If a doctor, trainer or coach suspects an athlete is suffering from concussion signs or symptoms, such as dizziness or confusion, that athlete is removed from play and cannot return until he or she is cleared by a medical doctor.
“There’s three things the AHSAA puts most importantly,” Ingram said. “One is health and safety. Second, fair play and the third thing is sportsmanship.”
State regulations serve as a baseline for schools’ concussion protocols, according to Randy Beason, athletic trainer at Cleburne County and Alexandria high schools.
Beason uses the Standardized Assessment of Concussion, which measures orientation, immediate memory and concentration among others. He also uses the Balance Error Screening System, to assess potential concussions. An athlete is assessed a day later. After Beason observes concussion-like symptoms, he takes the athlete out of practice and informs the parents and coach. A physician then takes over and determines the next steps. Beason typically will enact the concussion protocol if he observes more than two symptoms.
“I treat them like my own child,” Beason said. “If I’m not going to let my child play, I’m sure not going to let anybody else play.”
At Cleburne County, Shortt will keep a player with a concussion out for at least seven days.
Athletes who suffer a concussion need brain rest, which extends beyond the football field, according to Michael Herndon, who served as team doctor at Jacksonville State University for 10 years and Alexandria’s team doctor for 17.
“Our typical protocol is if you get a concussion … shut it down, do nothing, no exercise, no contact, no nothing, until all neuro symptoms abate,” Herndon said. “That may be days to weeks, depending on the kids.”
After symptoms abate, Herndon looks at how long symptoms lasted and determine when athletes can be eased into play. If there are no symptoms after days of exercise, the athlete can return.
“Everybody wants that crystal ball answer, when can I go back,” Herndon said. “Well, when you quit having neuro symptoms. And that’s different for every individual and that’s even different for every concussion.”
Issues with self-reporting
Ingram said coaches and trainers are taught to recognize symptoms because athletes won’t self-report.
Beason said athletes not self-reporting concussions are only hurting themselves.
“Football’s never worth dying over,” Beason said. “I don’t care who thinks it. I would prefer them to self-report it. That way it’s less damaging to everyone, team included.”
Shortt said that is why it is important for coaches to know their players and be able to spot the signs of injury.
“The athlete that really wants to be there … they’re not going to report an injury,” Shortt said. “That’s why it’s important for coaches to know your kids.”
Beason has had parents try to go over his head, but he typically is able to talk to them.
“They may only play sports in high school,” Beason said. “They’ve got the rest of their life to live, including a family.”
According to Ingram, the AHSAA member schools came up with the rules, and the AHSAA simply enforces them. Coaches are required to receive training to recognize concussion symptoms because he said most injuries happen in practice.
Though Daniel’s injury looked worse, Joshua had the worse concussion because he stayed in the game.
“(Joshua) scared us in the long run; Daniel scared us in the short run,” Gary said.
Both brothers received outpatient treatment at the concussion clinic at UAB. Rebekah said this helped them understand more of what was happening with Daniel’s concussion.
“They actually got our names mixed up a couple times,” Joshua said. “Because they thought it was me coming back for more appointments when it was actually Daniel.”
Joshua’s injury had lasting effects. Most of his childhood memories come from photographs and others’ accounts. He experienced some personality changes, too. He called himself a “book nerd” in the past, but is more impulsive now.
He suffered another concussion in a car wreck and was diagnosed with post-concussion syndrome. He had concentration issues and sometimes his vision would go black and white.
“Basically, it was like my head resetting itself,” Joshua said.
The whole experience was overwhelming, especially the depression that can come with head injuries, according to Daniel. School was especially difficult for Joshua because of all the people he didn’t recognize talking to him. Not being on the field hurt for the brothers. However, they had a support system of friends to help them through. Without his group, Joshua thinks he might have had a “meltdown.”
“I actually had my buddies, they would walk with me around to every class, and if I started getting a look on my face, they knew I was starting to go into panic mode because I was scared,” Joshua said.
Daniel added that the group of offensive linemen jokes around a lot. Said Joshua: “They really helped us become strong again.”
More than preps
Concussions affect more than just football, according to Ingram, who cited examples of people getting concussions from using their heads in soccer.
“The whole purpose is to make the game safer,” Ingram said. “It’s not just football, it’s all sports.”
Concussions are diagnosed more often now because people know what to look for, according to Beason. Diagnosing concussions is much different now than as recent as a decade ago, according to Beason, who called it a “night and day” difference.
“Back then, you could get your ‘bell rung’ and when symptoms subsided, hey, we may let you go back in,” Beason said. “That’s not the case now.”
Shortt said bigger and stronger athletes are affecting the game. He stressed the importance of teaching proper tackling and using safe equipment.
“Any coach that doesn’t spend his money on good equipment is crazy,” Shortt said.
And that extends beyond concussion protocols, Ingram said. Coaches must also take a class on heat safety and learn the signs of someone going into cardiac arrest. They also must have a current certification to perform CPR and use an Automated External Defibrillator.
Beason believes concussion safety extends beyond high school. He said parks and recreation coaches must receive concussion safety training now.
“You’ve got some parents out there, old-school dads, that remember, ‘Hey, I got hit like that before, and I’m fine,’” Beason said. “Well, just how fine are you? At the same time, the education is there, we’ve just got to utilize that education.”
Love of the game
Through his sons’ experiences, Gary has learned a lot about concussions. He now thinks concussion patients should stay out longer. As Daniel and Joshua were preparing to return to football, many of the tests assessed reaction time. Joshua was held out even after he had no physical symptoms for a while because his reaction time was still slower than normal.
“These tests they do pick up on subtle things,” Rebekah said. “They know your brain’s not completely healed yet.”
Rebekah, who is a registered nurse, had a hard time relaxing at the Valley Cubs’ football games after the concussions. Gary and Joshua said Rebekah was always calm during crises.
“I told the doctor, ‘I live to watch them play ball,’” Gary said. “If the doctor told us, ‘It’s over. He can’t play any more.’ it was going to be a hard decision, but we were going to accept that.”
Despite the risks, they still love football.
“To tell you the truth, I wish I had another year to play,” Daniel said. “I kind of miss all the summer workouts and stuff.”
Added Joshua: “The game outweighs the risk. You can get hurt just riding a bike down the road, you can get hurt walking out to get your mail out of your box. If you’re going to get hurt doing something, you might as well be doing something you love.”