Endurance Hypothermia

Hypo and Hyperthermia during long events Michael Gillan-ultra marathon recovery specialist

Hypothermia during endurance events

Hypothermia can happen to any athlete anywhere in endurance events-it does not just happen in cold countries-it can happen in moderate climates as well I live in Australia and it is not classed as a cold country when compared to most others-but for the unprepared, they might as well be in one cold + moisture + air flow = temperature drop=heat being pulled from the body=Hypothermia

There are four grades of hypothermia, these are • Impending Hypothermia • Mild Hypothermia • Moderate Hypothermia • Severe Hypothermia Impending hypothermia Impending hypothermia difficult to forecast but the main conditions for this are usually a hot day followed by a cool evening and frosty night. The athletes most prone to it are the ones who do not feel the cool air on the body as they still feel warm from the daytime heat. Mild Hypothermia Uncontrolled Intense Shivering starts. Coldness is creating pain and discomfort, they are still capable of moving and will still deny anything is wrong as judgment is affected-at this stage they are still recoverable and go back on track if they are pulled off and treated locally. Coping with Mild Hypothermia • Cover up with blankets to keep the heat in. •

Do not massage the hands, arms or legs to help warm someone up as it can push cold blood into the body possibly making the core heat cooler then the athlete may be pushed into moderate or worse, severe hypothermia.

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Give warm drinks but not coffee, alcohol or tea, soup is good as it give nourishment as well as heat.

Copyright 2008 Michael Gillan ultra marathon recovery specialist www.aching-legs-relief.com 1

Hypo and Hyperthermia during long events Michael Gillan-ultra marathon recovery specialist

Moderate and Severe and Hypothermia I have seen many people go into hypothermia after the event is finished. They had shown very few signs during the run and did not cover up immediately after the event. These people are in big trouble and need urgent medical help.

Never massage the limbs if the athlete is hypothermic, cold blood will be forced back into the body reducing core temperature further IF THERE IS ANY DOUBT WHETHER IT IS HYPOTHERMIA OR JUST FATIGUE OR SEE THE MEDICAL PEOPLE There are some simple steps to reduce the prospects of developing it, so if so this will be covered first. There is more chance of developing it at 24-hour events than at multi-day ultras because newer converts to the sport always turn up inadequately prepared and prefer to go for looks rather than practicality. They are more likely to stick with vest and shorts rather than the full tops and long tights the older hands wear. • As soon as it starts to get dark, get rid of the shorts and top, or at least cover them up. • Wear a hat • When the clothing gets wet with perspiration put on dry clothing even if it means 8 or 10 changes and associated down time during the night. • If it rains, put on a light waterproof top. • Have warm drinks and food during the night. • If the athlete is cold and they are considering going back out on the track immediately do not let them have a hot shower. • The second they stop, the athlete should be covered up with a warm blanket to preserve what core body heat they have. Prevention While most decisions concerning an event should be left to the athlete as they know their body better than anyone but they cannot see themselves though as others see them-the crew whoever they might be should be given the authority to call off the runner/walker when they see some of the symptoms appearing. Immediately the late afternoon starts get the athlete to start covering up in spite of their protests. At this stage, a light tracksuit top and bottom will be fine by late evening a heavier top is needed. Early morning, gloves, possibly two light layers of clothing rather than one heavier tracksuit. This is because the underneath set will be next to the body absorbing heat and perspiration, and the outer one will prevent it being radiated into the night air too rapidly. Do not let them have a hot shower to warm up While it may feel good, the hot water is helping heat loss by bringing more heated blood to the outside of the body where it is lost as soon as the water cools on the skin. As soon as the steam hits them they feel faint, suddenly without warning, they go into moderate or even severe hypothermia having by passed the first two grades. Change the top frequently for a dry one. It may be cold when changing in the night, but cold by itself is not harmful. Cold+moisture+heat loss+air movement across the body is fulfilling most of the requirements for setting up hypothermia. 2

Hypo and Hyperthermia during long events Michael Gillan-ultra marathon recovery specialist

Keep up warm fluids and food. Cold drinks and food taken during the night need heat to be converted to energy, and this will absorb heat from the body. Cover up on stopping. Make the person cover up as soon as the handler starts to feel cold. When the crew starts to feel cool and reach for their jackets, they should also get one for the athlete. As soon as the athlete stops for any reason or for however long, move them out of the wind and throw a blanket around them covering the upper body especially. Have a silver lined space insulation blanket available at all times, while being very light, their insulating properties rather than weight which is needed at this time. At the finish of the event cover them up as warmly as possible so their inner heat can be retained. I have found that when the muscles stop moving and producing heat, the heat that is left can dissipate within a very short time and the body shuts down within a few minutes. It is important to know the grades as if the athlete is pulled off the track in the mild grades, time spent recovering them will enable them to get back on the track doing productive distance rather than being in hospital recovering in the emergency department. It is obviously better to catch someone at the impending grade before they go into the other grades, although some people by pass even this stage and go straight into mild or even moderate levels. Impending and mild hypothermia can be worked on trackside with an excellent chance of the athlete getting back on track again. Moderate and severe hypothermia require immediate first aid and possibly hospitalization. Conventional massage and hypothermia When conventional forms of massage are used, the main requirement is that people are undressed or disrobed to have oil applied while the massage is done, heat may be lost from the body at this time by having the person undress or disrobe to have the massage, and they are then usually just covered with a towel. This is fine on a hot or warm day but if the same thing is done during the early hours of the morning or before the warmth comes back into the day, the conditions are in place for inducing hypothermia. If someone is already cold, having them lying still for 15-20 minutes is not going to warm them up. If we are massaging the legs to promote recovery, more cold is going to be allowed to the body. Any benefits gained are going to be reduced, as the body has to make up the warmth lost. Body heat is dissipated by a number of things during a conventional massage. • The person may be relaxing so the need for the body to pump blood at an increased rate is reduced

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Hypo and Hyperthermia during long events Michael Gillan-ultra marathon recovery specialist

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The room may be cold

Heat loss during a ‘hot’ massage Friction Friction produces heat and warms the local area of skin being massaged which causes vasodilation of superficial blood vessels expanding them and bringing warm blood to the surface of the skin where the heat is lost through conduction convection and radiation. Conduction Cold oil is applied to warm skin and the heat is lost through having to warm the oil up from the body, as the massage moves to different areas, the skin cools again. Convection Heat is removed by cooler air blowing across the skin surface when clothing is removed to allow oil to be applied. Radiation The exposed part of the body radiates heat away from the body. Evaporation Another way of losing body heat is by evaporation through perspiration, using oil as an aid in reducing friction can block the skin pores reducing the ability to perspire, but heat is still lost. If the skin is cold become pale numb and have a waxy feel it should be assumed that the body is going into vasoconstriction and that hypothermia is impending. The superficial blood vessels that supply oxygen to the muscle tissues have gone smaller restricting the flow of warm blood to them as the body attempts to limit the loss of heat and conserve it for the vital organs. The lack of shivering and the feel of the skin, which will be cold and wet with perspiration, is an indication of possible onset of hypothermia. In healthy perspiration the skin will be wet but warm to touch indicating that the superficial venous system is in a state of vasodilation with the blood vessels being open and supplying oxygen-enriched blood to the muscle tissue. Hyperthermia-seek medical help Hyperthermia is the opposite of Hypothermia, both are a danger to the runner and walker. The body becomes overheated and stressed; symptoms include headache, nausea and fatigue. On a hot day the athlete should be watched carefully to make sure they are drinking adequate fluids on a regular basis. Symptoms of Hyperthermia Heat stroke can be life-threatening and victims can die. A person with heat stroke usually has a high body temperature. Other symptoms include confusion, combativeness, bizarre behavior, faintness, staggering, strong and rapid pulse, and possible delirium or coma... Treatment for Hyperthermia If the athlete is showing signs of heat stroke emergency assistance should be sought immediately. Heat exhaustion may be treated in several ways: • •

get them out of the sun into a cool place, preferably one that is air conditioned offer fluids but avoid alcohol and caffeine - water and fruit juices are best 4

Hypo and Hyperthermia during long events Michael Gillan-ultra marathon recovery specialist • •

encourage them to shower and bathe, or sponge off with cool water urge them to lie down and rest, preferably in a cool place

The two most common forms of hyperthermia are heat exhaustion and heat stroke, heat stroke is especially dangerous and requires immediate medical attention. Heat stress occurs when a strain is placed on the body as a result of hot weather and the ultra athlete may be in this for a long time. Heat fatigue is a feeling of weakness brought on by high outdoor temperature. Symptoms include cool, moist skin and a weakened pulse, they may feel faint. Heat cramps are caused by a lack of salt in the body; they are painful muscle spasms in the abdomen, arms or legs following strenuous activity. Heat exhaustion is a warning that the body is getting too hot. The person may be thirsty, giddy, weak, uncoordinated, nauseated and sweating profusely. The body temperature is normal and the pulse is normal or raised. The skin is cold and clammy. Some years ago, there was a widely reported case in Australia of a fun runner who had 'muscle meltdown'. With a group of friends, he had attended a run, which because of the heat was cancelled. All the support people went home but the group decided to hold their own run. As all the drink stations had been moved, there was no fluid to be had on the route they ran. Consequently, the muscles just turned to jelly. They did not have the knowledge, or if they did, ignored the simple fact that on a run, fluids have to be kept up to the body to avoid dehydration. Clothing Needs to be light and light colored to deflect the heat. The most effective original clothing I have seen around the tracks belongs to Cliff Young and Sandra and Richard brown. Cliff’s outfit consisted of tracksuit pants with holes cut into them. This allowed air to circulate while keeping the sun off the skin. He also wore ‘kepi’ style hat with a skirt around the back half to keep the sun off the back of the neck, when it was soaked in cold water it would keep the top of the head cool for some time. Sandra and Richard’s track ensemble consisted of pajamas raided from the local second hand clothing store these provided color to the local scene on the track, were light, soaked up perspiration without being sticky could be washed and dried quickly, be changed quickly without too much downtime having to remove running shoes. The also wore Chinese coolie hats which also gave a parasol effect keeping the face shaded. For both heating and cooling, a new article of clothing to look at is called the arctic vest. This can be warmed for cold nights or cooled for extreme temperatures The web site for this is www.arcticheat.com.au

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Hypo and Hyperthermia during long events Michael Gillan-ultra marathon recovery specialist

The World Run Recovery System The World Run Recovery System offers an alternative way of assisting recovery without interfering with the healing processes that are already happening at the micro-cellular level of repair-and it does this without putting the muscles at risk of being injured by too much pressure generated by the ends of the fingers working into the tissues. The system works by using the bodies own mechanics of bones, joints, and muscles to push used blood and toxins from the lower legs-these can then be replaced by fresh blood-oxygen filled blood which will enhance recovery time and speed the recovery of the sportsperson Enhancing recovery quickly and easily using the principles of

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Simplicity

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Predictability

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Consistency

Using these 3 principles it is possible to not only enhance recovery times, but to do it without the inconvenience of disrobing or using oils or equipment such as massage table towels or needing the handskills or techniques of modern massage practises. This places easy recovery for anyone to use with very little training and without any equipment to buy or maintain

My only equipment for 24 hour run consisted of a chair next to the bottles to maintain the leg recovery of 20 people when I looked after the Danish team at the world championships in 2007

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Hypo and Hyperthermia during long events Michael Gillan-ultra marathon recovery specialist

In recovery there is nothing wrong with the legs, so they is basically nothing to fix on there is no point getting in using complicated recovery systems that •

Will cost a great deal of money

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Will take a lot end of study

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Will need equipment

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Will need SOMEONE to use it

The World Run Recovery System has been tested by many runners and walkers around the world ( www.worldrun.org) *References and citations PubMed-Manual massage and recovery of muscle function following exercise: a literature review. PMID: 9007768 [PubMed - indexed for MEDLINE] The mechanisms of massage and effects on performance, muscle recovery and injury prevention. PMID: 15730338 [PubMed - indexed for MEDLINE] http://www.webmd.com/content/Article/92/101950.htm SOURCES: Hinds, T. Medicine & Science in Sports and Exercise, August 2004; vol 36: pp 1308-1313.

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Hypo and Hyperthermia during long events Michael Gillan-ultra marathon recovery specialist

Results from 1995 Coburg 6 day footrace Name A Krouglikov

Day 1 237.2 539

Day 2 113.6 284

Day 3 130 325

Day 4 106 365

Day 5 126 315

Day 6 108 Kilometers 270 Laps

T Rusek

215.2 538

98.8 247

98 245

139.6 349

138.4 346

122.4 Kilometers 306 Laps

M T aylor

174.4 436

128.8 322

143.6 359

123.6 309

138.4 302

122.4 Kilometers 223 Laps

B Beauchamp

180.4 451

133.2 333

124 310

117.6 294

110 275

93.2 Kilometers 233 Laps

150 375

134 335

105.2 263

94.8 237

111.6 279

106 Kilometers 265 Laps

138.4 346

108.4 271

106.8 267

116.4 274

106 265

107.2 Kilometers 268 Laps

168 420

119.2 298

90 225

116.4 291

106 180

107.2 Kilometers 247 Laps

G Watts

132.2 328

96.4 241

99.2 248

104.4 261

92.8 232

133.6 Kilometers 334 Laps

C Young

142 355

91.2 228

90 225

97.6 244

88 220

92 Kilometers 230 Laps

D Kettle

138.2 332

86.8 217

90.8 227

95.2 238

94.4 236

84.4 Kilometers 212 Laps

R H ill

128 320

80.8 202

99.2 248

70 175

95.6 239

96.6 Kilometers 241 Laps

K Fisher

164 410

91.6 229

50 125

115.2 288

49.6 124

81.2 Kilometers 203 Laps

P Gray

D Parri s

I Davis

G Pollard

T Rafferty

61.2 Kilometers 120 74.8 73.6 68.4 69.6 300 187 184 171 174 153 Laps The above group came in for Light Manual Muscle Rel axation The below group did not or had their own recovery people 141.6 112.8 104.8 101.6 98 96.4 Kilometers 354 282 262 254 245 241 Laps

G McConnel

145.6 363

110.8 277

126.4 287

113.6 284

108.4 271

106 ki lometers 265 Laps

G Audley

152.8

110.8

126.4

113.6

114.8

95.2 ki lometers

S Scanlon

140.8 352

82 205

84 210

J Timms

127.2

98.4

74.8

34 0 85 pulled out-bli sters 0

0

0 Kilometers Laps 0 ki lometers

This is a result sheet when the World Run Recovery System was developed and shows the gradual changes from working on the muscles to working with them-if this was translated to the snowbunny with fatigued muscles they would back on the slopes in no time 8

Hypo and Hyperthermia during long events Michael Gillan-ultra marathon recovery specialist

What they say about the World Run Recovery System Michael’s methods of massage and blister care helped me to stay mobile throughout the race and to recover quickly afterwards. His techniques are safe and gentle. Unlike some treatments, which put the runners and walkers at risk of muscle tears or infection, Michael’s techniques are gentle, safe, reassuring, and highly effective. They enhance comfort and flexibility, build confidence, and promote success. This booklet will help others to learn and practice Michael’s methods. It is recommended reading for everyone who walks and runs and who wants to go further, go faster, or just to enjoy life more!!' SANDRA BROWN 1996 Ladies 1000 Mile World Record Holder

1999 Ladies 100 mile Race walking World Record Holder “I know that your massage kept a number of competitors in the event. The cold weather of Saturday afternoon and night certainly got to many of the walkers and your prompt action had them back in the race after a short stop. In years past, that would have ended up as a non-finish. A number of walkers were able to keep going for the full 24 hours on the basis of your expert help.” Tim Ericson Secretary Australian Centurions Club 'I have known Michael Gillan for many years and have always got quick relief for my aches and pains from the stretching he performs'. CLIFF YOUNG-75-80 24 Hour World Record Holder (150.07 kilometers) A word from Jesper Olsen World Runner about The World Run Recovery System “If I hadn't had the qualified help from the excellent masseur Michael Gillan, taking several thousands of km out of my legs, I could spare myself the effort!”

“My crew for the current stages, Michael Gillan, has proven to have other talents than the quite taxing job of taking care of all the requirements of a really tired ultra runner! He has since years back been working on a new approach to stretching and muscle-rebuilding for ultra runners. I have the last two days tried his careful stretch and massage, and a bit to my surprise the muscles are beginning to feel like before the start back in Greenwich, London!! Usually I doesn’t take massage as the legs of an ultra runner will often be quite sore during the long time events (and especially in an multi-year event like this...), and getting a massage can at times cause more injury and cramping up than good. For example my last massage was some 12 000km ago when I ran the 12-hour competition in Finland. And so far that has been the only one. But Gillan came with best recommendations from my main contact in Australia, Phil Essam, who besides being vice president in the Australian Ultra runners Association has heaps of good knowledge to share. And this new kind of mild massage for ultra runners is definitely one of the good tips! There should be a fair chance that I actually get fresh enough to do some decent running at the 6 Day Race that I have coming up in Colac from the 21.November. I quite look forward to that, even though I can’t expect to make a top class result :-)” He won! 756.2 kilometers (Jesper holds the record for the longest run in history over 26000 kilometers and the first person to run around the world Taken from www.worldrun.org The World Run Recovery System is a simple system that is easy to use without the need for equipment other than the hands

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Hypo and Hyperthermia during long events Michael Gillan-ultra marathon recovery specialist

Resource Box

Michael Gillan is an Ultra Marathon Recovery Specialist who has been a masseur around many ultra long distance events both in Australia and internationally since he was a student in 1993 In 1995 while working at a 6 day run, he changed the approach to recovery of the athletes from the conventional way of working on the muscles using the hands and fingers to increase muscle blood circulation, to working with the muscles and making them work on themselves The results from this changeover can be seen on the Coburg result sheet on page 5 In 1996 Michael went to the Nanango 1000 Mile 16 day event where it was tested and helped the worlds 4-5 and 11th to achieve their distances Other notable events the World Run Recovery System was tested on was World Run 1 with Jesper Olsen www.worldrun.org and the World Run 2 training camp in Denmark in 2007 For other events see www.aching-legs-relief.com

http://www.hypothermia.org/onland.htm http://facetshypothermia.info/hypothermia/ http://sg.dir.yahoo.com/Health/Diseases_and_Conditions/Hypothermia/

Copyright 2008 Michael Gillan ultra marathon recovery specialist

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Hypo and Hyperthermia during long events Michael Gillan-ultra marathon recovery specialist

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