Understanding the importance of proper hydration plays a key role in in safety of the football-playing athlete

It is almost August and football is just beginning. Preseason camps – from the NFL to high schools – are going full tilt. 

In the Midwest, August is considered the second hottest month of the year, coming on the heels of July, which takes top honors as the hottest month. 

It’s hot, it’s humid, and high school football players are wearing 12-to-15 pounds of equipment, sometimes practicing two times per day for the first two weeks. 

In some states -- Iowa and Illinois for one instance -- have moved up the regular-season starts of their respective high school seasons by one week. 

Athletes, coaches, parents and athletic trainers from Rock Valley Physical Therapy, are battling – and working together – to manage the heat, two-a-day practices in many cases and temperatures – on most days – in the 80s or low 90s. 

Despite a plethora of information, gifted and knowledgeable athletic trainers on site, and coaches preaching and providing ample hydration and heat-related breaks, issues still arise. 

The governing athletic bodies in the four states – Illinois, Iowa, Nebraska and South Dakota – that Rock Valley Physical Therapy provides athletic training services for – in concert with coaches – go to great lengths to help football players successfully navigate the heat, while working to help them understand proper hydration and nutrition. 

“Things have really shifted within the last couple of years regarding heat, what qualifies for extra breaks, adjusted play time and cancelled activities,’’ said Rock Valley Physical Therapy's Misti Thompson, LAT, ATC Regional Athletic Training Coordinator/Athletic Trainer Cedar Rapids (Iowa) Xavier High School. 

“What was used was a basic heat index score that would tailor activity level based on what the heat index level was at during the time of the practice or score. Last year (2025) the recommendations came out from the IHSAA (Iowa) in conjunction with what the NATA (National Athletic Trainers’ Association) has said is the “gold standard” when it comes to preventing heat-related illness is to use Wet Bulb Globe Thermometer (readings). You then apply restrictions to practice or play based on what numbers those readings are and what sport is participating.’’ 

A Wet Bulb Globe Thermometer reading Thompson says, is a more accurate reading of the environment the athletes are in. It measures the heat stress that factors in air temperature, humidity, and radiant heat. 

“WBGT factors in the temperature, “real feels,” humidity, wind speed and heat coming off the surface teams are playing on, including the difference between playing and practicing on natural grass or artificial turf,’’ Thompson points out. “This is also important because for those schools that do not have air conditioning, we can use this reading to determine if it is even safe to compete or be active inside or not. And this has made a difference in how coaches are structuring their practices and when they are practicing.’’ 

Some coaches, because of WBGT, have turned creative, moving practices to the early morning or late at night so they can complete their entire practice at one time. 

“We have also altered practices where they start inside and move outside once the readings are more manageable or within different ranges,’’ Thompson said. “There are regulations that once you start practice at one reading you cannot move down in the restrictions but can gain restrictions. We have also started late outside on the grass and moved to the turf when the readings were equal to that on grass. During any of those moderate-to-high readings we will always have a cold-water immersion tub ready to go just in case someone needs it.’’ 

Hydration is a key component to stressful and demanding athletic endeavors like football. The days of Coach Herman Boone from the movie “Remember the Titans” noting that “water is for the weak,” have – thankfully – been vanquished. 

Regarding fluid intake, Johns Hopkins Medicine recommends: 

Before a game or practice: 

• Two hours prior: Drink 16–to-24 ounces of water. 
• 10–20 minutes prior: Drink an extra 7–to-10 ounces of water. 
• Goal: Start activity fully hydrated without overloading the stomach. 

During the game or practice: 

• Every 15–to-20 minutes: Consume 6–to-12 ounces of fluid. 
• Choice of drink: Use plain water for short sessions, but switch to a sports drink with 6–to-8 percent carbohydrates and electrolytes if play lasts longer than 45–to-60 minutes or in heavy heat. 

After the game or practice: 

• Weigh in: Compare body weight before and after exercise to check fluid loss. 
• Recovery target: Drink 16–to-24 ounces of water or a sports drink for every pound of body weight lost, ideally within two hours. 

“For myself and for our (Xavier High School) coaches, we preach that you must hydrate, but don’t wait until game day to hydrate,’’ Thompson said, noting that she and the coaches at Xavier spend a great deal of time education parents and players on proper nutrition and hydration, sharing the positives and rewards of following a correct path and the negatives of straying from what works. 

“We always encourage athletes to keep a water bottle with them, to drink before practice," Thompson added. “There is always water available on the sideline at either field we practice at as well as all athletes bring their water bottles on the sideline. Coaches never restrict when kids can get a drink and will take frequent intentional breaks throughout practice. After practicing it is always reiterated to hydrate with Gatorade and water. If I have athletes that have a lot of issues with cramping or not feeling well during practice, especially in the beginning, I am always asking what have you eaten, what have you drank today and spend a lot of time educating the athlete and parents.’’ 

If there is an issue – with heat exhaustion or heat stroke, Thompson says there is a strict protocol in place. 

“If a player suffers from heat exhaustion, they will not return to play that day,’’ Thompson said, noting that educating players, coaches, parents and others involved, is always the best first step when dealing with proper hydration, diet. “They must have complete symptom resolution, and I will require a clearance note from a physician. Once they are cleared it is much like the acclimation period of practices where they will begin with light cardio activity, no equipment, short duration and light heat stress environment and increase activities gradually and gradually involving equipment until they get to full participation while they are closely monitored."

Dealing with caffeine-dense energy drinks and things players consume that will increase their chance of cramping or being dehydrated during activities is important, Thompson points out. 

“Again, it’s about education regarding proper hydration techniques before activities,’’ Thompson said about caffeine and sugar-laced energy drinks. “By the time a player is cramping in the game it is usually too late to hydrate.’’ 

“Game days, our Xavier players – will have a Gatorade, chocolate milk and a banana to replenish and refuel,’’ during halftime. “During games if an athlete is cramping, we will try to “break” the cramp and stretch, sometimes massage/stick roller. During that time, I usually offer a Pedialyte while stretching. If they continue to cramp, they will usually get a shot of mustard. Some people use pickle juice, mustard, apple cider vinegar, or hot sauce for the acidity that usually helps with cramping. If someone is habitual and they think they are properly hydrating, I usually refer them out for bloodwork to ensure there isn’t anything more going on. I always take the opportunity during stretching or after the game to re-educate them about proper hydration, what they should be consuming after the game and the next day and things to avoid.’’ 

By: Johnny Marx, Rock Valley Storyteller