Updated January 11, 2005

By: Mary Bengtson, M.D., Medical Director, NC State Student Health Services
Deborah Constantine, PT, Director, NC State Student Health Physical Therapy

When 2005 arrived, many likely made resolutions about exercising or taking better care of the body. Resolutions often fade in February and March to resurface in April when the improved weather and the time change make exercising more appealing. Contributions of exercise to the health of the body and mind and to combating the epidemic of obesity are in the media almost daily. Knowing how to exercise safely can be important as you continue or begin your physical fitness program.

First, know your physical limitations and listen to your body if you are ill or injured. If you have concerns about heart disease, see a health care provider for clearance for exercise. If you have asthma, use your medication as directed and carry your inhaler to practices and competition if your medical provider has recommended inhaler use. If you are diabetic, know how exercise may affect what and when you need to eat and your insulin dosing. A certified diabetes educator is available at Student Health. If you are out of shape, take your time proceeding with full-scale physical activities. Rest often and pace yourself.

Know “when to say when” if you are ill or injured. It is not unusual to hear “no pain, no gain” or “he got his bell rung”, and it is often glorified when an athlete continues competition despite injury. There are times when being heroic and exercising anyway will be of little or no benefit or may be harmful. If you have a fever or body aches due to illness, do not stress your body that day with a workout. If you have been diagnosed with mono, there may be a risk of rupturing the spleen during strenuous activity. Pay attention to the medical provider’s warning if you are advised to avoid contact sports for three weeks or longer. If you have a skin infection that is contagious, such as Herpes simplex or tinea (ringworm), follow your medical provider’s advice about covering the rash or avoiding contact sports altogether until the rash is resolved.

Signs and symptoms of head injury may vary and include a vacant stare, being slow to answer questions, disorientation, difficulty completing tasks, lack of coordination, loss of memory of events before or after the injury, loss of consciousness, vision change, headache, nausea and vomiting, slurred speech, and having a seizure. The term concussion is often used if any of these signs or symptoms develop from a head injury. If you have had a head injury that was not witnessed, let someone know that you have been injured. Stop your practice or competition immediately if you have any signs or symptoms from a head injury and consult with a medical provider as soon as possible. Serious head injury may require evaluation at an emergency room and CAT scan of the head. It is appropriate to apply an ice pack to the part of the head that was injured. Return to play decisions need to be individualized and depend on the nature of the injury and signs and symptoms, past history of head injury, and the risk of the sport. It is not unusual to be kept out of sports until all signs and symptoms have cleared and for several days more if there were significant initial symptoms. An important complication called second-impact syndrome has been described in which rapid brain swelling can occur if there is a second head injury while the athlete is still recovering from the first injury.

Second, warm up prior to becoming engaged in a sporting event. Warm up may prevent delayed onset muscle soreness and decrease injury. It should include walking or light jogging for 5 minutes followed by stretches to the major muscle groups in the arms and legs. Hold each stretch for 30 seconds and repeat the stretch for each muscle group 3 times.

Third, proper equipment, including shoes, is important. Injuries may occur due to old or ill-fitting shoes. Your shoes should be less than one year old with the proper fit. Improper footwear can lead to pain of the foot, hip, knee, and back due to poor shock absorption and poor foot positioning associated with old shoes. Wear shin guards, other padding, head, eye, or mouth protection appropriate to the sport.

Fourth, respect the environment, whether you participate in a warm or cold weather sport.
Acclimation to heat takes several sessions of exercising. Go to practice or your event hydrated, wear light water-permeable clothing, bring plenty of fluids, and take frequent water breaks. Do not wait until you are thirsty to drink. If event lasts less than 1 hour, water replacement is adequate. If event lasts 1-3 hours, a sports drink, along with water, should be used. If you are ill with a fever on the day of competition or practice, participation in sports is discouraged.

Heat syndromes include:
HEAT CRAMPS—painful muscle cramps and weakness with normal body temperature due to body salt deficiency. Treatment is cooling, hydration with electrolyte solution, stretching, and massaging muscles.
HEAT EXHAUSTION—characterized by depleted volume or dehydration with symptoms of weakness, nausea and vomiting, headache, profuse sweating. Temperature may be slightly elevated. Treatment is cooling down, removing excess clothing, spraying with water and cooling with fans, and hydration with water or electrolyte solutions. HEAT STROKE—results from thermoregulatory failure and is characterized by high temperatures, hot, dry skin, vomiting, diarrhea, coma, and seizures. Rapid cooling by removing clothing, spraying with water and cooling with fans, and transport to a medical facility should occur.

Pay attention to whether there will be sun exposure during your sport. Apply sunscreen at least an hour before activity outdoors, especially if the activity is between 10 a.m. and 2 p.m., hours most risky for burns. Remember, also, that you can experience sunburn on a cloudy day or while doing winter sports. Remember to include lip protection and to wear sunglasses when appropriate.

Listen to weather reports and dress accordingly. If there is a possibility of storm, either thunder or snow, you may choose to delay or cancel your workout. If you choose to do your workout, make sure someone knows of your plans, that you are dressed appropriately for the weather, that you know your options for seeking shelter, and that you go to that shelter should a storm approach.

Dressing for cold weather likely will include layering of clothing and including clothing made of fabrics with high insulating properties that continue to be effective when wet, such as wool, wool/synthetic blends, acrylic, polyester, and polypropylene. A silk layer is sometimes used under the previously mentioned fabrics. Cotton has poor insulating ability. Remember to protect the head, face, hands, feet, and eyes (if appropriate).

Hypothermia is the term used when the core body temperature falls. The first signs and symptoms of cold injury may be intense shivering, difficulty performing tasks, difficulty speaking, and sluggish thinking or feeling confused. If you begin to experience these symptoms, get out of the cold immediately. Replace any wet clothing with dry. Use dry clothing, blankets, dry warming devices, such as hot water bottle or heating pads, until the temperature normalizes. Drinking warm beverages, such as decaffeinated tea, is appropriate if you can swallow without difficulty. Cold exposure can, in some cases, result in heart rhythm abnormalities and other complications, and transport to a medical facility for additional care may be needed.

Frostbite can occur with cold exposure. Prevention is best, but if you experience numbness, color change (may be red, white, or blue), swelling, blistering, or any combination of these signs or symptoms, you may have frostbite. Treatment includes getting out of the cold, replacing wet clothing with dry, not massaging the body part, and seeing a medical provider as soon as possible for rewarming in the controlled setting of a hospital.

Another outdoor environmental concern is being exposed to poison ivy, oak, or sumac, and the rash that may develop after exposure to urushiol, the antigen from these plants. Shower as soon as possible after possible exposure to poison ivy, oak, or sumac, including laundering clothing that may have contacted the plant. Remember that you can still risk problems with poison ivy, oak, and sumac even when the plants shed their leaves in the fall and winter since urushiol, the antigen, moves to the stems and roots of the plant. If the plant is burned, urushiol resin can be carried in smoke. Showering immediately after a workout in the woods and laundering clothing remain important even in the fall and winter.

If you develop a poison ivy rash despite your best prevention efforts, treatment varies with the severity. A rash involving multiple areas of the body, the eye or genital area, or that is interfering with your life despite your best efforts to self-treat may be best managed by seeing a medical provider. Steroid pills may be prescribed for severe cases and steroid cream for milder cases. Remember to avoid steroid use near the eyes. Patients sometimes get relief by self-treating poison ivy/oak/sumac rashes with Calamine lotion or treating a weepy rash using a Domeboro packet added to cool water, dipping a washcloth into the Domeboro solution, and placing the sloppy-wet washcloths on the rash. Rewet the washcloth every couple minutes for a total of 15 minutes a couple times daily. Domeboro packets and Calamine are both over-the-counter products. If you have showered after exposure to the antigen and have assured that urushiol is no longer on your clothing that was worn at the time of exposure, your friends do not have to be concerned about being around you. You are not “contagious”, and the fluid in any blisters you develop does not contain poison ivy and does not cause the rash to spread.

West Nile Virus received has received much media attention since 2003. Wearing clothing that protects against mosquito bites and use of insect repellents containing DEET are important preventative measures. If you become ill with fever, malaise, sore throat, fatigue, nausea, vomiting, or feel mentally not as sharp after mosquito exposure, contact your medical provider for an opinion.

Limit tick exposure by using insect repellent that contains DEET and wearing clothing that makes it more difficult for ticks to reach the skin, such as long pants and closed footwear or boots. Ticks can be seen more easily on clothing that is light in color. Inspect yourself for ticks after being outdoors.

Important tick-related illnesses include:
Rocky Mountain Spotted Fever (RMSF)—After incubation period of 3-14 days, the most common symptoms are fever, headache, muscle aches, and nausea. A rash may or may not be present. If present, the rash usually begins on wrists, forearms, and ankles, later developing on the palms and soles. A tick bite may or may not be recalled. If you think you have RMSF, see a medical provider immediately since this disease can be deadly.

Lyme Disease—After incubation of 3-32 days, Lyme disease sometimes presents with a rash that is red and expands over several days. The next stage of illness may involve fever, muscle or joint pain, weakness, sensitivity to light, heart rhythm changes, and neurologic changes, such as problems with memory, concentration, or nerve function. Late stage may include arthritis. See a medical provider for testing and antibiotic treatment if you think you have Lyme disease.

Fifth, pay attention to nutrition with a daily balanced diet. Try to complete eating a light meal at least 2 hours before competition. Within 1 hour of completion of your practice or event, consume carbohydrates to begin replacing glycogen stores for your next practice or competition. The carbohydrates can be as simple as a sports drink or piece of bread and banana.

Sixth, have a plan if you are injured. Know where the nearest first aid kit is located and the hours and location of the nearest medical facility should you require medical attention. Know that RICE (Rest-Ice-Compression-Elevation) is considered appropriate for most fresh injuries. Do not apply heat to a fresh injury. Do not put your life at risk by heroic participation if you are injured. This is especially true if you have had a head injury. If you experience head trauma and have amnesia of events before or after the trauma or if you had or have light-headedness, headache, visual change, or nausea and vomiting, arrange to be examined at a medical facility immediately.

If you need medical advice before participating in a sport or become ill or injured during participation, Student Health Services is located at Cates at Dan Allen (2815 Cates). Appointments are available weekdays by calling 515-7107. Work-In Clinic operates weekdays without appointment for those with illnesses and injuries that need attention now rather than waiting for an appointment slot. In addition, no appointment is required to be seen by the evening nurses or to see the physician at Saturday Clinic.

Services and items offered by Student Health that might interest those involved in sports include lab, x-rays, physical therapy, pharmacy, diabetes education, dietician consult, ice, crutches and other orthopedic devices (such as Aircast ankle brace and elastic wraps), wound care, stitching, tetanus shot, IV fluids, EKG, cholesterol and anemia screening.

All NC State students are eligible to use Student Health. There is no charge for seeing the physicians, physician extenders, and nurses. Over-the-counter medications are free or available for a nominal charge. There is a charge for all prescription medications, most lab tests, all x-rays, orthopedic supplies, and Physical Therapy. Charges at Student Health are usually less than charges for comparable services in the community.

For information about Health Improvement Program (HIP) offered through Health Promotion, return to the front page of the Student Health website and click on Health Promotion.