As we approach the dog days of summer here in NYC, the practitioners at the Center for Spine Care and Mobility are having more conversations regarding heat-related injuries and prevention. As a member of Lake Placid’s Triathlon medical team, as well as being a part of several NYC Marathon medical teams, I have had the unique experience of treating these types of injuries.
Types of Heat-Related Illnesses
Heat-related illnesses (HRIs) in sports, such as heat cramps, heat exhaustion, and heat stroke, pose significant risks to athletes, particularly during high-intensity activities in hot, humid environments.
Heat cramps primarily involve the skeletal muscles, often affecting large muscle groups like the quadriceps, hamstrings, and gastrocnemius. These involuntary, painful contractions result from electrolyte imbalances (sodium, potassium, magnesium) due to excessive sweating and inadequate fluid replacement. The fascia and surrounding connective tissues may also become strained due to prolonged muscle tension.
Heat exhaustion involves systemic structures, including the cardiovascular system, as blood flow prioritizes skin cooling over muscle perfusion, leading to fatigue, weakness, and potential musculoskeletal dysfunction.
Heat stroke, the most severe, impacts the central nervous system and can cause widespread tissue damage, including rhabdomyolysis, where muscle breakdown releases myoglobin, risking kidney damage. Recognizing these structural involvements is critical for effective intervention.
Diagnosis & Treatment Protocols
Treatment begins with immediate assessment using tools like rectal thermometers for accurate core temperature measurement (preferred over oral or tympanic methods) and pulse oximeters to monitor oxygen saturation and heart rate.
For heat cramps, practitioners apply targeted stretching techniques to affected muscles, holding stretches for 20-30 seconds to relieve spasms, combined with myofascial release to address fascial restrictions. Electrolyte-rich fluids (e.g., sports drinks with 110-220 mg sodium per 8 oz) such as Gatorade, Powerade, and Gatorade Zero are administered orally, and localized cooling with ice packs wrapped in towels is applied for 10-15 minutes to reduce muscle temperature.
In heat exhaustion, athletes are moved to a shaded or air-conditioned area, placed in a supine position with legs elevated to improve venous return, and cooled with fans or wet towels. Intravenous fluids (0.9% saline) may be necessary if oral rehydration is insufficient. Heat stroke requires aggressive cooling within 30 minutes, ideally via cold-water immersion (35-59°F) for 10-20 minutes until core temperature drops below 102°F, monitored continuously.
As a musculoskeletal practitioner working at the annual NYC Marathon, I was able to collaborate with emergency personnel, ensuring spinal precautions if neurological symptoms were present.
Recovery & Prevention
Post-cooling, soft tissue mobilization, and gentle range-of-motion exercises are introduced to restore muscle function, avoiding aggressive manipulation due to tissue fragility.
Recovery duration varies by severity.
Heat cramps typically resolve within hours with rest, hydration, and electrolyte replenishment, allowing return to play in 1-2 days if asymptomatic.
Heat exhaustion requires 24-48 hours of rest, with gradual reintroduction to activity over 3-5 days, guided by symptom-free exercise tolerance and normalized vital signs.
Heat stroke demands 7-14 days of monitored recovery, with serial assessments of muscle strength, kidney function (via blood tests for creatine kinase), and neurological status.
Practitioners employ progressive rehabilitation, starting with low-intensity isometric exercises, advancing to dynamic movements, and incorporating proprioceptive training to address potential coordination deficits. Long-term prevention includes educating athletes on acclimatization (7-14 days of graded heat exposure), proper hydration (16-20 oz of water 2 hours pre-exercise), and wearable heat monitors (e.g., CorTemp sensors) to track core temperature. Musculoskeletal practitioners play a pivotal role in restoring function, preventing recurrence, and ensuring safe return to sport through a structured, evidence-based approach.
Whether you’re an athlete preparing for competition or simply staying active in the summer heat, the team at CSC+M is here to help you prevent, treat, and recover from heat-related injuries. Our evidence-based approach combines advanced diagnostics, personalized care, and sports medicine expertise to keep you performing at your best. Schedule an appointment today to ensure your body is ready for whatever the season throws your way.
