Commonwealth Sports Medicine

Treatment for Athletes by Athletes

10
Jan

’2-a-days’ The Latest Evidence in Preventing Injury

Tips for Safer Two-A-Days
Injury rates increase during two-a-day workouts whether athletes are in peak physical condition or not. In fact, many athletes don’t even make their starting lineup because of injuries incurred during preseason training.

Here are some tips to help ensure athletes stay at their best and prevent heat-related injuries during two-a-days.
Encourage Athletes to Begin Conditioning Before Two-A-Days
Encourage athletes to begin conditioning in the heat two weeks before official practice begins. This allows athletes’ bodies to cool more efficiently by increasing sweat production sooner than when they are not acclimated to the heat.
ACCLIMATE:
1. Acclimatization will reduce the negative impact of heat on athletic performance.
2. Acclimatization is most effectively achieved by exercise in the heat; heat without exercise and exercise without heat are less effective.
3. Acclimatization can be carried out by exercising in a hot room or by training in a hot climate.
4. The major physiological adjustments to heat acclimatization take about 7-14 days.
5. Training volume and intensity should be reduced on first exposure to the heat and then gradually increased. Some high-intensity training should be maintained throughout the acclimatization period.
6. Reducing the intensity and duration of the warm-up may be necessary to keep core temperature from rising too high before training and competing in the heat.
7. Monitoring responses of individual athletes is essential — individuals respond differently to physical activity in the heat.
8. Records of body mass, urine output and color, and subjective symptoms should be kept by athletes and reviewed periodically by coaches and trainers.
9. Acclimatization increases the athlete’s need for fluid to match the increase in sweat rate.
10. Dehydration impairs performance and negates the beneficial effects of acclimatization.

Avoid Workouts During Unusually Hot Temperatures
Practice sessions during unusually hot and humid conditions should be limited to very moderate workouts, postponed until cooler times of the day or brought inside to avoid the heat.
Make Fluids Part of the Playbook
Before, during and after competition, be sure to consume adequate amounts of fluid. Athletes can make sure they are properly hydrated by checking their urine color: lighter urine color indicates athletes are better hydrated. The longer the workout session, the more frequently fluids need to be replaced. Research shows
that a sports drink containing a 6% carbohydrate solution, like Gatorade, can be absorbed as rapidly as water. But unlike water, a sports drink can provide energy, delay fatigue and improve performance.
Signs of Dehydration and Heat Illness
Dehydration can seriously compromise athletic performance and increase the risk of exertional heat injury. That’s why it’s important to recognize the warning signs.
• Thirst
• Irritability
• Headache
• Weakness
• Dizziness • Cramps
• Nausea
• Decreased performance

Use the Shade
Before practice, warm up in the shade and be sure to rest in the shade during breaks. Even during rest, exposure to heat can raise the body temperature, increase fluid loss and decrease the blood available to the muscles during workouts.
Recommend Wearing Loose Fitting Clothing
Cotton blend, loose fitting clothing can help promote heat loss. The rule: the less clothing, the better.
Be Prepared for an Emergency
Always have a cell phone on hand and be familiar with emergency numbers. Also keep ice and ice towels on hand in case of heat-related emergencies.
Fluid Guidelines for Two-A-Days
Proper hydration is the best safeguard against heat illness. Remember to have athletes drink before, during and after training and competition.

Before Exercise
• 2 to 3 hours before exercise drink at least 17 to 20 oz of water or a sports drink.
• 10 to 20 minutes before exercise drink another 7 to 10 oz of water or a sports drink.

What to Drink During Exercise
Drink early—Even minimal dehydration compromises performance. In general, every
10 to 20 minutes drink at least 7 to 10 oz of water or a sports drink. To maintain hydration, remember to drink beyond thirst. Optimally, drink fluids based on amount of sweat and urine loss.
• Athletes benefit in many situations from drinking a sports drink containing carbohydrate.
• If exercise lasts more than 45 to 50 minutes or is intense, a sports drink should be provided during the session.
• The carbohydrate concentration in the ideal fluid replacement solution should be in the range of 6% to 8% (14 to 18 g/8 oz).
• During events when a high rate of fluid intake is necessary to sustain hydration, sports drinks with less than 7% carbohydrate should be used to optimize delivery.
• Cool beverages at temperatures of 50° to 59° F are recommended.

What Not to Drink During Exercise
• Fruit juices, carbohydrate gels, sodas and those sports drinks that have carbohydrate levels greater than
8% are not recommended as the sole beverage.
• Beverages containing caffeine, alcohol and carbonation are discouraged during exercise because they can dehydrate the body by stimulating excess urine production, or decrease voluntary fluid intake.
After Exercise
Immediately after training or competition is the key time to replace fluids. Weigh athletes before and after exercise. Research indicates that for every pound of weight lost, athletes should drink at least 20 oz of fluid to optimize rehydration. Sports beverages are an excellent choice.

Managing Two-A-Days
Stay Cool
• Get in shape and acclimate
• Know the warning signs of dehydration and heat illness
• Drink on schedule
• Monitor body weight
• Watch urine color and caffeine intake
• Key in on meals as an opportunity to increase fluid intake
• Stay cool when you can
From: Eichner, E.R. (1998). Treatment of Suspected Heat Illness. Int. J. Sports Med. 19:S150-153.

Stay Healthy
• Minimize the stresses of life
• Avoid salt tablets as these don’t meet an athlete’s fluid needs.
• Avoid carbonated beverages, which may cause bloating and reduce the amount of fluid consumed
• Eat a well-balanced diet
• Avoid overtraining
• Sleep well
• Avoid rapid weight loss
• Avoid people with colds
• Keep hands away from nose and mouth
• Get a flu shot
• Stay hydrated and ingest carbohydrates during exercise

Stay Hydrated
• Drink throughout the day
• Drink at least 17 to 20 oz of fluid 2 to 3 hours before a practice or game
• Drink an additional 7 to 10 oz of fluid 10 to 20 minutes before competition
• Drink 28 to 40 oz of fluid per hour of play (at least 7 to 10 oz every 10 to 15 minutes) to replace sweat loss during exercise
• Drink at least 20 oz per pound of weight loss within two hours of finishing training or competition
• Optimal to have fluid intake match sweat and urine loss.
From: Casa, D. et al. Journal of Athletic Training 35(2): 212-224, 2000.

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Commonwealth Sports Medicine
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Glen Allen, Va 23060

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- Dana Blackmer Ph.D., Sports Psychologist
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- Shelly Taylor, M.S., VATL, ATC, CSCS
- Dee Crowley, Billing Specialist
- Jennifer Grieshaber, CMT, CPT
- Karen Holloway, Office Assistant
- Stefanie LaForce, Practice Manager

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