Beware of heat and head trauma as young athletes prepare for fall sports

footballrest-150x150Even before the school bells ring to bring kids back to classes, young athletes have taken to steamy fields and other facilities for fall training — making this an ideal time to remind coaches, trainers, players, and parents to ensure important steps are taken for safety’s sake.

While injury prevention of all kinds must be paramount in school sports — programs that must focus on young folks’ recreation and enjoyment as much as competition — two problems persist and require great diligence as players ramp up their conditioning: heat injury and head trauma.

Susan Yeargin, an associate professor of athletic training at the University of South Carolina and co-author of the National Athletic Trainers Association’s position statement on heat illness, told the Washington Post that it takes all people, but especially younger players, time to adjust to the heat and humidity of late summer and early fall:

“When an athlete of any age begins to exercise or train for a sport in hot conditions, the body needs time to adapt. In a natural outdoor environment, this is called heat acclimatization. In the first three days of heat exposure, the body hasn’t started to adapt, which is why those are the riskiest days for heat illness. Most acclimatization happens by the 10th day, but it takes about two weeks for the body to reach its peak heat acclimatization.”

She offered cautions about the calendar and rigorous fall training efforts:

“Athletes who live in milder climates should not be practicing in environmental conditions over 86.2 degrees Fahrenheit (30.1 degrees Celsius), based on wet bulb globe temperature. For those in traditionally hotter climates, like Texas, the recommended cutoff temperature for canceling practice is 92 degrees (32.2 Celsius). The risk is about more than the temperature — it’s also about humidity, sun and wind. Humidity hinders sweat evaporation, the body’s primary heat dissipation mechanism. So, when humidity is high, no matter the air temperature, that creates a heat safety concern.”

She noted that over-stressed athletes can suffer cramps, heat exhaustion, and heat stroke — three increasingly serious conditions. Coaches, trainers, team doctors, and others should safeguard athletes from these risks with preparation and precautions:

“[A]void exercising in the hottest part of the day, generally 10 a.m. to 6 p.m. The National Athletic Trainers Association also recommends using ‘weight charts’ to help players understand how much they need to drink to stay hydrated; having on-site athletic trainers with treatment resources, such as cold-water tubs; encouraging good sleep and nutrition; and providing a safe work-to-rest ratio during conditioning and practice sessions. Breaks should be in the shade, ideally with cooling devices such as fans, misters, and cold towels. If a hard or intense drill is completed, players should have an equally long break. A buddy system is also beneficial. With a buddy, someone is more likely to notice when an athlete isn’t feeling well or is starting to act out of character and needs to be stopped for evaluation.”

Head trauma: a risk not to be ignored

As for head trauma, concern continues to grow about its increasing prevalence in a variety of sports, including football, rugby, and now soccer, the news site Axios reported:

“A new study, carried out by nine universities and the Concussion Legacy Foundation, determined athletes in contact sports are 68 times more likely to develop [chronic traumatic encephalopathy, or CTE, an incurable brain disease] than the general public. The researchers are calling on sports and government bodies to implement prevention and mitigation efforts, especially for children, who are ‘too young to legally consent to any potential long-term risks.’ ‘It is time to include repetitive head impacts and CTE among child protection efforts like exposure to lead, mercury, smoking, and sunburns,’ said co-author Adam Finkel of the University of Michigan.”

As Axios reported, sports leagues and players have more urgently decided to deal with the problems associated with head trauma, as the injuries mount and becomes clearer in athletes’ lives:

“Two American athletes, Demaryius Thomas (NFL) and Scott Vermillion (MLS), were posthumously diagnosed with CTE in the past month. That remains the only way to diagnose the disease — for now. CTE is most often linked with hard-hitting sports like football and rugby. Now it’s soccer — which doesn’t have constant collisions but does have headers — that’s facing a reckoning. The [English Football Association] already recommends that pros limit headers, which have been linked to dementia, in training. If they completely ban them for kids, we could see the skill gradually fade from the game.”

In pro football, the NFL’s billion-dollar concussion settlement has demonstrated the challenges in not only averting life-altering head injuries but also in seeking to reckon with their long-term consequences. As the Associated Press reported:

“Two years after a pair of former players sued the NFL over the treatment of black retirees in the league’s $1 billion concussion settlement, hundreds of men whose medical tests were rescored to eliminate race bias now qualify for awards. The newly approved payouts … are a victory for NFL families in the decade-long legal saga over concussions. The 2020 lawsuit unearthed the fact that the dementia tests were being ‘race-normed’ — adjusted due to assumptions that black people have a lower cognitive baseline score. Changes to the settlement made last year are meant to make the tests race blind. The new results will add millions to the NFL’s payouts for concussion-linked brain injuries …

“Of the 646 black men whose tests were rescored, nearly half now qualify for dementia awards. Sixty-one are classified as having early to moderate dementia, with average awards topping $600,000, while nearly 250 more have milder dementia and will get up to $35,000 in enhanced medical testing and treatment …”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them by spinal cord and brain injuries, especially due to concussions and other head trauma. Brain harms change forever the lives of patients and their families. These injuries cannot be taken lightly or ignored, especially as growing evidence shows that severe damage can occur not only with big shocks to the head and neck but also due to repetitive lesser blows.

Progress has occurred in the battle against preventable head harms, especially in pro and amateur athletics. Better gear, more sensible rules and play, and other more positive steps are making a difference.

With heat-related problems and athletes, perhaps athletic programs in the region including Washington, D.C., Virginia, and Maryland may have greater awareness due to the tragic mishandling of the death of Terrapins football player Jordan McNair. His family has sought to prevent similar, unnecessary deaths and injuries due to heat-related causes by using some of the $3.5 million negligence settlement reached with the university for a safety foundation.

We have much work to do to safeguard promising, youthful athletes from preventable harms like heat-related injury and head traumas.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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