Keeping Yourself from Falling Into the Danger Zone

What Is Heat Illness?

Heat Illness, also referred to as Heat Stress Syndrome, refers to a number of pathologic reactions to heat. These reactions in order of severity include Heat cramps, Heat Exhaustion and finally Heatstroke that can be fatal. Every summer, we hear of at least one athlete suffering from a heat-related illness leading to death. Just last year, a NFL football player died as a result of Heatstroke during pre-season practices. These needless deaths are avoidable if you know the signs of trouble and how to deal with them. Even better, prevention of any sort of heat illness is the key!

Heat cramps are muscle cramps principally in the abdominal and leg muscles caused by excessive fluid loss in the muscles. This loss causes an electrolyte imbalance resulting in the muscle cramping. Most frequently these cramps are felt in the calf muscles but certainly are not limited to this area.

Heat exhaustion is caused by excessive bodily fluid loss through excessive sweating, vomitting or diarrhea without adequate replacement of these fluids and body salts. Heat exhaustion results in weakness/dizziness and often leads to nausea, headache and skin changes such as becoming cold, clammy and ashen.

Heatstroke begins with body fluid depletion and results in the loss of all body cooling mechanisms. At this point, body temperature rises rapidly resulting in an all body system loss, a true medical emergency. A person suffering from heatstroke differs in appearance from the victim of heat exhaustion. With heatstroke, there is a loss of the ability to sweat so the skin appears hot, dry and often reddened. Emergency medical help should be sought IMMEDIATELY.

Risk Factors of Heat Illness

• Excessive weight
• Deconditioning
• Unacclimatized to the heat
• Dehydration secondary to inadequate fluid intake, nausea or diarrhea
• Previous history of Heat illness
• Other Factors Leading to Heat Illness
• Dark clothing when exercising
• Increased outside temperature and relative humidity. Hot, humid weather is likely to lead to heat illness.
• Lack of “warm-up” leading to too high of exercise intensity, too fast
• Pride can be a real factor because of the great desire to succeed, many athletes ignore the early signs of heat distress and keep training/competing resulting in a more severe problem.

Signs of Heat Related Trouble

Heat Cramps

Heat Exhaustion

Heatstroke

• Profuse Sweating
• Cramps involving abdominals or legs, often calf or thigh muscles

• Weakness
• Faintness
• Dizziness
• Headache
• Loss of appetite
• Nausea
• Pallor
• Profuse sweating
• Urge to defecate
• Skin appears gray/ashen, cold and clammy

• Irritability
• Aggressiveness
• Emotional instability
• Hysteria
• Progression to apathy
• Disorentation
• Unsteady gait
• Glassy Stare
• Skin appears hot and dry
• Pulse is rapid
• MEDICAL EMERGENCY!!!

Treatment of Heat Illness
Prevention of any sort of heat illness is always the best “treatment” but in the case where heat illness occurs, the key is to get cool and hydrated. Specific treatments for each sort of heat illness are described in the table below:

Heat Cramps

Heat Exhaustion

Heatstroke

• Rest in Cool environment
• GENTLE, Passive stretching of the cramping muscles
• Fluid intake either water or sport drink
• Discontinue exercise activity until cramping is resolved.

• Rest in a cool area or room by lying down preferably in a breeze or under a fan
• Fluid intake with either water or sport drink immediately.
• Increase fluid intake with sport drink over the next several hours
• Discontinue exercise activity until all symptoms are resolved, body weight and temperature are back to normal.

• MEDICAL EMERGENCY- Contact Emergency Medical System (EMS) immediately.
• Immerse athlete/self in bathtub cooled with ice or wet compresses in groin and armpits with fan blowing.
• Transport to hospital ASAP

COOLING is top priority taking precedence over fluid replacement.

Prevention of Heat Illness

To prevent any sort of heat illness, you must stay cool and hydrated. Frequent breaks to allow yourself to hydrate with either water or a sport drink; as well as cool off are essential in hot, humid weather. The best place to take these breaks is in the shade, out of the sun where there is a breeze coming through the area. The breeze allows your body to cool through the evaporation of sweat. Wearing light colored, moisture wicking clothing while exerting in the heat assists with this evaporative, cooling process. 

Carefully choose the time of exercise, avoiding the hottest, sunniest part of the day. If you know that you must train/exercise in the upcoming hot weather, then acclimatize yourself by starting with minimal and moderate exercise levels as the weather starts heating up. A few days of 60 – 90 minutes of moderate activity in the heat will allow your body to improve its sweat response (cooling), provide greater blood volume and improved efficiency handling the fluids provided. This will allow better performance and higher intensity training/exercise in the heat without as great a risk of heat illness. If multiple training sessions are expected, monitor your body weight and replace any weight loss due to fluid loss PRIOR to resumption of activity/exercise. For every pound of body weight lost, you need to drink at least 12 oz. of fluid to replace the fluids lost in sweat and breathing. For further information regarding what to drink – water vs. Sport drink, see accompanying article. Tables to monitor pre and post exercise weights are available online in the Coaches corner section.

Avoidance of any sort of heat illness is the key here. Prevention of heat illness require the athlete to stay well hydrated to allow proper cooling procedures through sweating and breathing.  Remember that if you develop any symptoms of heat illness, ACT on them and stop exercising, hydrate and cool yourself in the shade. 

For further information on this and other sports medicine subjects, feel free to contact the specialists at

Skyline Hospital’s Physical therapy and Sports Medicine Department at (509)493-1101 ext. 3396 or .