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  • Preventing Heat Injury

    by Guest Blogger | Aug 11, 2016

    By: Jason Zaremski

    From August 5 through August 22, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in international competition. Be sure to follow the blog as well as Facebook, Twitter and Instagram (acsm1954) and share using #ScienceofSport.

    With international competition now underway and fall sports beginning, concerns of heat injury and illness are rising. It is imperative that all athletes, coaches, volunteers and parents are trained to identify and respond to a potential Exertional Heat Injury (EHI). Simple tips can help detect, treat and prevent bad outcomes associated with this injury.

    There are many reasons why our core temperature begins to rise. Some reasons include: wearing darker clothes and equipment, being dehydrated or not prehydrated before practice or training, a history of sickle cell trait or disease, increased air temperature, humidity, wind speed, direct sunlight, not being prepared for the start of training; being sick and/or with a fever, and use of any diuretics, stimulants (such as caffeinated drinks) or alcohol.

    Recognizing EHI is important to prevent progression. If caught early, muscle cramping may be treated with cessation of exercise, stretching affected muscles and drinking cold liquids such as water or an electrolyte replacement drink. If not recognized early, EHI may develop into heat stroke (which is defined as core body temperature greater than 104 degrees Fahrenheit). Symptoms of heat stroke include syncope, exhaustion, weakness, fatigue and mental status changes. Treatment for heat stroke includes immediate ice-water tub immersion. If one is not available, place ice packs around the armpits and groin. A rectal temperature must be obtained and EMS should be called as well.

    Here are some pearls to keep in mind:

    PEARL #1: A high school or youth league may purchase a rubberized large bath tub (100-150 gallon) for a minimal amount of money by going to a local hardware store or through online websites. Money should not be an excuse as cost is nominal. 

    PEARL #2: A rectal temperature is the only way to accurately assess for core temperature. If one is not taken, then you cannot determine if the core temperature has risen to a dangerous level.

    PEARL #3: If a patient is suffering a heat stroke, do not have EMS or another individual remove the athlete from the cold water tub immersion until core temperature has decreased below 102degrees Fahrenheit or until s/he is shivering. There is a 100 percent chance of survival if core temperature is decreased to less than 102 degrees Fahrenheit in less than 30 minutes. Follow the mantra of “Cool first, transport second.”


    There are many ways to reduce your risk for heat injury.

    1. Allow for frequent rest and hydration during practice or competition. Also remember to pre-hydrate. Drink 24 ounces of noncaffeinated fluid two hours before exercise as well as an additional eight ounces of water or electrolyte replacement 15 minutes prior to exercise. While you are exercising, break for eight ounces of cool fluids every 20 minutes.

    2. Wear light weight and colored clothing as well as sunscreen

    3. Check the color of your urine (yes, you read that correctly). Clear or light yellow means you are in the appropriately hydrated zone, but dark means you are dehydrated.

    4. Practice and train in cooler times of day (early morning, sundown or at night, if possible)

    5. Increasing the intensity and duration of exercise or practice should occur gradually over a one-to-two week period. Longer practices lead to more rates of EHI.

    Jason Zaremski is a sports medicine physician at the University of Florida.

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