Preventing Injuries Next Season Begins in the Summer

As the school year ends and the summer begins, injury patterns in high school students change as well. Athletes are spending more time in the weight room and conditioning. Coaches, athletic trainers and administrators are positioned to help reduce minor and serious injuries and illnesses.

Injury Prevention
Prior to beginning summer high school workouts, all athletes should schedule a pre-participation physical examination. This examination is important to evaluate the athlete for the development of serious medical conditions, re-evaluate injuries from the prior season or year, monitor the athlete for proper growth velocity, and counsel the athlete on injury prevention strategies.

Athletes should be counseled on the importance of regular sleep of 8-10 hours duration nightly and the importance of eating at regular intervals a well-rounded varied diet. High-impact athletes can decrease their risk of stress fracture by consuming 2,000 mg of calcium a day and 800 I.U of Vitamin D. Foods with high levels of iron (red meat, green leafy vegetables, fortified cereal, chocolate and lentils) are important for the prevention of iron-deficiency anemia.

Muscle strains tend to become more and more common. These often occur when athletes increase their workload to get stronger. However, when a proper 5-10 minute warm-up and dynamic stretch are neglected, the risk of muscle strains and tears increases. Athlete education and creating an environment encouraging warm-up and stretching before beginning workouts with significant resistance can go a long way in preventing these injuries, which could potentially linger into the fall sport season. Demonstrating proper form and weight progression will aid in reducing injury. Finally, teaching athletes to strengthen both agonist and antagonist muscle groups and lifting through the joints full range of motion will increase the effectiveness of the program.

Overuse injuries, such as shin splints and stress fractures, are very common in cross country athletes. The high school freshman is at particular risk because the practices occur daily, and the distance of the races is longer than middle school. It is critical that prior to pre-season, the athlete begins a gradual progression back to regular running.

A baseline distance of 15-20 miles/week completed prior to season onset and a rate of increase in weekly mileage by 10 percent per week is recommended. Running athletes should purchase the proper running shoe for their foot type. Runners can receive guidance on footwear from a specialty running store or knowledgeable coach. Running shoes should be replaced every 300-500 miles and is dependent on the individual athlete. Athletes should keep a log of their running mileage and shoe purchase date. When they start feeling arch, ankle, shin or knee discomfort they should note the amount of mileage on their shoes. This is their baseline mileage per shoe. Shoes should be gradually broken in, so it is a good idea to purchase the next pair before the first pair is completely worn.

Cardiovascular conditioning is usually pretty low risk; however, sprinting increases the risk of certain injuries. Again, the importance of warm-up and stretching cannot be over-emphasized. Some sprinters can generate enough force with either their hip flexors or hamstrings to pull off part of the pelvis where the muscles attach causing an avulsion fracture. These tend to be slow healing fractures, usually taking two to three months to heal and often require a period on crutches. Warming-up and stretching significantly decreases the risk of these injuries.

Heat Illness Prevention
Exercising in environments with high heat and humidity increases the risk of heat illness. Heat illness can range from heat cramps to life-threatening heat stroke. Exertional Heatstroke (EHS) is the leading cause of preventable death in high school athletics. Students participating in high-intensity, long-duration or repeated same-day sports practices and training activities during the summer months or other hot-weather days are at greatest risk.

The NFHS has an existing position statement on Heat Acclimatization and Heat Illness Prevention available on the NFHS website. Fundamentals of a heat acclimatization program include physical exertion and training activities that should begin slowly and continue progressively, keeping each athlete’s individual level of conditioning and medical status in mind and adjusting activity accordingly.

Athletes with previous history of heat illness, sickle cell trait, fever, skin disorders and those individuals requiring some medications (diuretics, Attention Deficit Hyperactivity Disorder medications, allergy meds and hypertensive meds) must be monitored most closely when the head index is elevated. If the heat index is elevated, adjust intensity (lower), rest breaks (increase frequency/ duration), timing and duration of practice, and reduce uniform and protective equipment. More specific guidelines can be found at https://ksi.uconn.edu/wet-bulb-globe-temperature-monitoring/

Hydration
Hydration is also a very important component of heat illness prevention. Athletes exercising more than 90 minutes a day are recommended to supplement water with electrolyte replacement drinks or consume more salty foods such as pretzels, popcorn or pickles. A general recommendation is for athletes to consume 400- 600 ml (13-20 ounces) of fluid two hours prior to practice and then 150-300 ml (5-10 ounces) of fluid every 15-20 minute of exercise.

A general guideline is for athletes not to lose more than two percent of their body weight in one practice. An athlete can determine fluid loss by doing pre- and post-practice weigh-ins. Sixteen ounces of fluid should be consumed for every pound lost. Urine color can also be used to monitor for satisfactory fluid consumption. An athlete’s urine should be the color of lemonade (light yellow appearance).

It is important to recognize more serious signs of exertional heat illness (clumsiness, stumbling, collapse, obvious behavioral changes and/or other central nervous system problems), immediately stop activity and promptly seek medical attention by activating the Emergency Medical System (or Call 9-1-1). On-site rapid cooling should begin immediately. An Emergency Action Plan (EAP) with clearly defined written and practiced protocols should be developed and in place ahead of time.

Proper hydration is also important to consider during the summer months not only for competitive sport conditioning but also for other activities such as cheerleading and marching band. The NFHS has an additional position statement on recommendations for Maintaining Hydration to Optimize Performance and Minimize the Risk for Exertional Heat Illness (also found on the NFHS website).

It should be recognized that athletes with high body fat percentages can become significantly dehydrated and over-heat faster than athletes with lower body fat percentages, while working out under the same environmental conditions at the same or similar workload. Athletes have different sweating rates, and some lose much more water and salt through their sweat than others. “Salty sweaters” will often have noticeable salt stains on their clothing and skin after workouts, and they often have a higher risk of developing exertional muscle cramps. It’s also important to recognize that poor heat acclimatization/fitness levels can greatly contribute to an athlete’s heat intolerance and exertional heat illness risk.

Even naturally dry climates can have high humidity on the field if irrigation systems are run prior to early morning practices start. This temporary increase in humidity will continue until the water completely soaks into the ground or evaporates. A heat safety table should be followed to help determine if practices/contests should be modified or canceled. The National Athletic Trainers’ Association (NATA) Guidelines for Wet Bulb Globe Temperature (WBGT) can be found at: https://kestrelinstruments.com/mwdownloads/download/link/id/356/