Stephen Strasburg vs Heat Illness: A Success Story

Ace pitcher Stephen Strasburg left Saturday’s game after the 3rd inning because of heat illness and dehydration.  The 106-degree temperatures in Atlanta were brutal for players and fans alike.

The Washington Nationals’ athletic trainers Lee Kuntz and Mike McGowan did an outstanding job by made the right call to take care of one of the best hurlers in the game.  They recognized the signs of heat illness and they did their job in an admirable fashion.

I applaud Lee Kuntz,ATC and Mike McGowan,ATC for handling this incident the right way.  The management of Strasburg’s heat illness is a powerful example which could, in time, actually save lives of young athletes around the country.  Parents and coaches are always looking for help to properly take care of their future All-Stars in the heat and the Nationals’ medical staff provided a perfect example of how to do it the right way.

Competitive athletics at any level requires dedication and hard work in all types of environmental conditions.  When the temperature rises on the field or on the track, an athlete’s body core temperatures will do the same.  There are a few simple steps to keep an athlete “cool under pressure” to help him/her avoid complications in the heat like Strasburg did this weekend.

Heat illness is a life threatening condition yet it’s a very preventable problem.  Educating the athlete is the first step to taking care of the athletes, young and old.  Replacing an athlete’s fluids including sodium (salt) and electrolytes is the most effective method to keep an athlete safe in any environment.

The responsibility for preventing heat illness needs to be shared by the athletes, the team medical staff members and, when appropriate, the parents of the athletes.

Signs of Heat Illness

Sudden and rapid decrease in sweating

When an athlete who was sweating profusely suddenly stops sweating, it’s a sign that he/she is experiencing serious problems.

Confusion and disorientation

A severely dehydrated athlete can become confused and irritable with rapidly diminishing mental and performance skills.

Nausea, cramping and/or vomiting

With an upset stomach or vomiting, the athlete’s ability to absorb fluids is drastically reduced.  Vomiting obviously produces a rapid loss of fluids, which will accelerate the dehydration process.

Tips to Exercise Safely in a Hot Environment

  1. Any athlete who has demonstrated vomiting and/or diarrhea within the previous 24 hours should not be allowed to participate in exercise within a hot environment.
  2. Question the athletes and his/her family for a history of past heat related problems.
  3. Pre-hydrate the athletes using the Ryan 50/50 Plan – a 50% water/50% Gatorade combo – starting no later than two (2) hours prior to any exercise.
  4. Provide unlimited access to fluids and salty snacks for all players and staff members before, during and after activity.
  5. Provide a cool settings for the “breaks periods” allowing the athletes to get away from direct sunshine, get off their feet, consume cold fluids, be exposed to cooling fans and ice sponges to lower their body core temperatures.
  6. Following exercise, each athlete should continue to implement the Ryan 50/50 Plan – a 50% water/50% Gatorade combo.
  7. Weighing the athletes before and after all workouts in hot environments to determine if the proper amount of fluids were consumed.  A dehydrated athlete should replace at least 120% of his weight lost during exercise.  For example, if a 200 lbs athlete loses 5 lbs. or 2 ½% of his/her body weight, they should replace it with 6 lbs of fluids and healthy foods.

Treating Heat Illness

  1. If an athlete demonstrates dizziness, difficulty breathing, confusion, vomiting, rapid fatigue, excessive sweating or concern for their health, remove the athlete from the sports field and move into a cool environment.
  2. Contact the appropriate medical personnel to assist in the monitoring of the athlete’s symptoms.
  3. Strongly encourage the athlete to continue to consume sports drinks and water while cooling the entire body with cold ice towels and water.
  4. Remove all heavy clothing and gear.  If possible, replace with cooler breathable clothing.
  5. Monitor the athlete to ensure that the symptoms are improving.  If the symptoms continue to worsen, call 911 to implement emergency medical services for possible IV fluid replacement and/or transport.

Keeping the players cool requires preparation and planning to minimize the potential of a serious medical condition.  As the Washington National did with Strasburg on Saturday, removing him from the game was the smart move.  He was immediately placed in a cool setting, encouraged to continue to consume the proper types of fluids, administered 3 liters of IV fluids and forced to rest.  The athlete reported the following day that he felt great and he’s ready to pitch again this week.

As a member of the Corey Stringer Institute Medical & Science Advisory Board, I appreciate the application of sound heat illness management.  As one of the most respected heat management experts in the world, Doug Casa, PhD, ATC, makes a great points when he states that “heat-related illnesses are largely preventable”.

Too often the preventative steps and/or the management steps for an athlete suffering from heat illness are not taken and the results can be deadly.  Having a certified athletic trainer, a medical expert trained to care for athletes exercising in hot conditions, is often the best safety measure for athletes at all levels of athletics.

We need more stories like this one with a happy ending to help all of us learn how to keep athletes healthy and safe.

Author: Mike Ryan

After 26 seasons as a full-time certified athletic trainer and registered physical therapist in the National Football League, Mike Ryan has outstanding first-hand experience. His unique professional and athletic background has sharpened his skills in the arts of sports injury management, elite rehabilitation, performance enhancement and injury prevention. Mike is now taking his experience to mainstream America. His mission is simple: Sports Medicine advice that is easy to use and brings fast results. Learn more about Mike Ryan

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