Cheryl Martin (Host): It's back to school time and that means school sports with lots of players and possible injuries. Here with some tips on how to best prepare and protect young athletes is Tanner Bleakley, an athletic trainer. This is Memorial Health Radio with Memorial Health System Ohio. I'm Cheryl Martin.

Host: Tanner, thanks for coming on to talk about kids and sports.

Tanner Bleakley: Yeah. Thanks for having me on.

Host: Thanks. What's the best way to keep student athletes healthy?

Tanner Bleakley: it's a multi-faceted approach really. The biggest thing you can do is stay hydrated, eat really well-balanced meals and get a lot of sleep. Sleep's how your body recovers. It's also how your brain recovers. So, that's kind of the three pillars, I would say, of athletic performance.

Host: And what about hydration and what needs to be done there?

Tanner Bleakley: So, for hydration, you would want to see ages 9 to 13, which is primarily part of the demographic that I work with. You would want to see about 9 to 10 cups of water per day. Ages 14 to 19, you'd want about 10 to 14 cups per day. All in all, you'd want about two to three liters of water per day to get you to the optimal level. Obviously, I know I'm guilty of this, of not drinking anywhere near enough water. But a loss of 2% of body weight in fluids is actually shown to produce adverse effects in performance. Those negative effects of dehydration are decreased endurance and performance, negatively affects the cardiovascular system; decreases thermoregulation, which is how your body cools itself through sweating; and central nervous system fatigue as well as perceived exhaustion.

So, early signs and symptoms of dehydration would be thirst, general malaise, headache, nausea or vomiting, lightheaded, irritability, muscle cramps, difficulty paying attention and just general weakness and fatigue. Now, obviously, everybody's different. Some people may sweat more, sweat less. Hydration is very much an individualized plan for everyone. Like I said, I've got student athletes that just sweat buckets during games and practices. So obviously, they need to focus on hydrating a little bit more than others. It also depends on the environment, the heat, humidity, things like that; the sport you play, the amount of equipment you wear as well as the intensity and duration of the activity. So, an easy way to see how much fluid you're losing during participation and activity is really easy. Just weigh yourself before the activity starts, and then weigh yourself after. However much weight you lose during that activity, you have to replenish that back in fluid ounces. So, 16 ounces of fluid is a pound, so that whole equation by itself.

Another indicator for hydration is urine color. It's a quick and easy one. Lemonade or a pale yellow color indicates being fairly well hydrated. And an apple juice or a darker yellow, indicates potential dehydration. I also wanted to talk about sports drinks. They can be beneficial. So, this would be like Gatorade and Powerade, things like that. Obviously, if they're used properly, they can be very beneficial. It also depends on the individual again. But really what their role is to replenish the lost electrolytes through sweating as well as give your body fuel through easily digestible carbohydrates and the sugars in the fluid and also just provide general fluids back to your body after activity.

Host: Tanner, what are you seeing as some of the most common injuries for student athletes?

Tanner Bleakley: I would say looking back, this is year number three for me at my current school, I would say ankle sprains are the most prevalent. A quick way to negate that is buying a decent set of ankle braces. Any sport where you are physically active on your feet, which is almost all of them. If you are in, I would say, crowded areas, like, say, basketball, if you're playing underneath the rim, and you're jumping for a rebound, you can come down on a foot, something like that, turn your ankle; skilled positions in football, trying to break free in open field situations. You just plant the wrong way. Turf is actually getting a really bad rep for possibly increasing injury rates in lower extremities. And then, the obvious, you know, muscle strains, as well as other ligamentous sprains.

Host: Any tips for avoiding those injuries?

Tanner Bleakley: A really good off-season weightlifting and conditioning program, really focusing on not just the big muscle groups like your quads, hamstrings, your calves, but the smaller muscles that don't really get paid a whole lot of attention to. In your shoulders specifically, I would hit the rotator cuff, so your subscapularis, supraspinatus, infraspinatus and teres minor, especially if you play an overhead throwing sport like baseball, softball, shot disc in track and field. The lower leg, I would say, hit your peroneals, your peroneal muscles. Really a lot of the internal lower leg muscles that also deal with shin splints. So, a lot of your posterior tibialis muscle is usually the main culprit for shin splints. So, anytime you can work that muscle in a controlled setting without running on it, that's very beneficial.

Host: Now, what has been in the news this year has been an incident of sudden cardiac arrest, and we saw that with what happened with LeBron James' son, a young athlete, Bronny. I'm sure that made a lot of parents nervous, and he just graduated from high school. What advice do you have there?

Tanner Bleakley: I would say, as far as prevention goes, having a thorough pre-participation physical process, as well as a very rigorous cardiac evaluation. I know at our physical events that we do it. The local high schools that we provide service to, every heart gets listened to at least for a minute to a minute and a half by ER docs, family docs, any doctor that wants to help us. They auscultate the heart. Some states are actually including 12-lead EKGs as a requirement for pre-participation physicals.

Host: So, you check the heart before every game?

Tanner Bleakley: Just in the physicals, the pre-participation physicals, not before every game. But yeah, some states are actually requiring 12-lead EKGs, which I think would be huge, if we were able to maybe bring in a portable EKG unit that could give us a printout and then bring in possibly a cardiologist to read those printouts in case something weird is found during the pre-participation physical.

Also, knowing your family history. If you have anyone that has passed away before the age of 35 unexpectedly from a heart disease or a heart-related issue, that usually increases your chance of having something cardiac related.

Also, having an AED on site, as well as people who know how to provide effective CPR. CPR alone in sudden cardiac events give you about a 50% chance of survival. But if you add CPR and an AED use within the first two minutes of the collapse, it bumps your chances up to about a 66.7% chance of survival. So, having an AED on site really gives you that extra opportunity to hopefully save the individual.

Host: What about heat illness?

Tanner Bleakley: So, there's different kinds of heat illnesses. There's the lesser, I would say, annoyances of being an athlete where everybody has cramps at some point or another, exercise-associated muscle cramps, which are just sudden and involuntary contractions of the muscle. And then, you step up into what we call heat exhaustion, which is manifested by an elevated core temperature of less than 103 degrees.

Main signs and symptoms for that would be headache, nausea, vomiting, cramping, tachycardia or a fast heartbeat; possible hypotension, which is low blood pressure; and syncope, which is fainting.

The main distinction between heat exhaustion and heat stroke is obviously the core temperature. With heat stroke, your core temp is above 104 degrees Fahrenheit, and it also includes central nervous system dysfunction, where heat exhaustion does not. So, like I said, heat stroke is an acute, life-threatening emergency characterized by neuropsychiatric impairment and a dangerously high core temperature of 104 degrees or above. Usually, they will collapse on the field. So, typically, if we can negate the problem before we get into heat stroke, if we're just entering into heat exhaustion, and we can remove that player, get them into a cool, shady area; get them away from the elements, the hot and humid temperatures; obviously monitor vitals and try to stop them from entering into that heat stroke condition; obviously, you'll have some aggressiveness with them because of the central nervous system dysfunction, also irritability, some confusion; they may also have a possible seizure, an altered state of consciousness because of that central nervous system dysfunction.

So, I would say prevention for heat illness, like we said with nutrition above, everything will play into that thermoregulation when you're hydrated, also promoting a 7 to 14-day acclimatization period is big, anytime you can get them out in the elements and get their body adjusted to the environment that they're going to be in. For football, it's a certain amount of days where they're just in their helmet. And then, they'll transition to a certain amount of days where they're just in helmet and shoulder pads. And then, we'll move into helmet shoulder pads, basically full gear with no contact. And then, we'll move into full gear with contact. So, it's a two-week cycle to get the players adjusted to the temperature, get them adjusted to their equipment in the environment.

Host: I also want you just to talk about the importance, I'm sure this is important, of recognizing injuries early, especially when a player is in pain or they're swelling. That's vital, the more important that the injury is noticed early.

Tanner Bleakley: So, a big indicator for me is when an athlete doesn't hop up immediately. If they are laying on the surface of play, grabbing an area, that usually sends my spidey sense going. Obviously, you want to make sure what's going on first, make sure it's not life-threatening. If it's a fracture, we'd managed that, get the splint kit out, activate EMS, get them the care that they need. But anytime there is swelling, that usually indicates that some sort of tissue has been disrupted. A lot of times it's usually a ligament, like an ankle sprain, if the ankle swells up immediately. Then, we would look at what are called the Ottawa Ankle Rules. So, that is basically just criteria of where the pain is, can they tolerate walking for three steps. And if they can't meet the criteria, then obviously we would refer them for x-rays just to make sure there's no fracture. And then, we would also special test the area with an anterior drawer to make sure the ATF ligament is intact; a talar tilt to make sure the CFL ligament's intact. So yeah, anytime there's swelling, it usually indicates that there is some sort of tissue disruption.

Host: In closing, Tanner, any more tips for parents and students?

Tanner Bleakley: I would say listen to your body. If your body's hurting, it will tell you. I know personally as athletic trainers, we know what you're feeling. And we know when something is just maybe soreness versus muscle strain versus an ankle sprain or possibly a serious injury.

Athletic trainers are here for you. Me personally, I have an open-door policy. A lot of my kids have my number. And they can text me whenever they need, if they need something. So yeah, I would say listen to your body, use your athletic trainer. They are free healthcare, which is a rarity in today's world. And we are 100% here for you.

Host: That's athletic trainer Tanner Bleakley who offered us some great tips for student athletes to thrive and stay healthy. That wraps up this episode of Memorial Health Radio with Memorial Health System. Head on over to our website at mhsystem.org/sportsmedicine for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Memorial Health System podcasts. Thanks for listening to Memorial Health Radio.