Signs, Symptoms, and Treatment of Heat Stroke in Athletes

By Dr. Katie Kennedy, DPT


Risk factors of heat stroke

  • Hot environment
  • Lack of fitness
  • Lack of adaption to exercise in heat
  • Clothing which does not allow evaporation of sweat
  • Strenuous exercise
  • Lack of sleep
  • Illness, especially any that involves vomiting, diarrhea, and/or fever
  • Use of diuretics, emetics, laxatives, or alcohol prior to or during exercise
  • Use of medications that cause dehydration - be aware of side effects of all medications you use

Initial symptoms of heat stroke

  • Emotional instability or irrational behavior, including irritability, confusion, apathy, belligerence, and/or giddiness
  • Fatigue disproportionate to level of physical activity
  • Vomiting
  • Chills and goose bumps
  • Difficulty breathing
  • Headache

Late-stage symptoms

  • Hyperventilating to shed heat (just as a dog pants) - this can cause tingling fingers followed by fainting
  • Incoordination and staggering — "running like a puppet on a string"
  • collapse with seizure and/or coma


  • TIMING IS OF THE ESSENCE! When core temperature is very high, body and brain cells begin to die from the heat.
  • Immediately cool the athlete’s trunk.  
  • Dump the athlete into an ice-water tub. Submerge the trunk — shoulders to hip joints. Research suggests ice-water immersion cools runners twice as fast as air exposure while wrapped in wet towels.
  • Ice bath or apply cold wet towels.
  • COOL FIRST, TRANSPORT 2ND (to ER) - Most athletes will recover if quickly cooled (Holschen, 2018).


  • Provide shade, ice water, and misting fans for rest breaks
  • As the temperature rises, reduce practice pace and duration and increase rest breaks
  • Have players sit in cold tubs after practice
  • Hold practices earlier and later, with more time between — time for rest, recovery, and cooling
  • Acclimation to heat: A week or two of moderate physical activity in the heat, say jogging 30-45 minutes a day, can jump-start heat acclimation
  • Hydration
  • Pacing of exercise
  • Rest breaks

Athletes at risk of heat stroke may benefit from pre-cooling before workouts. A half hour in a cold bath will reduce core temperature and increase the buffer against heat stroke. Using cold towels or splashing cold water on face, head, and neck provides a psychological boost but little physiological benefit.

Famous examples

  • Agonizing tableaus of endurance were seen at the 1984 Los Angeles Olympic Games and the 1995 Hawaii Ironman Triathlon.In Los Angeles, marathoner Gabriela Andersen - Scheiss, not trained for heat, entered the stadium dazed and wobbling. In a final lap that seemed to last forever, she waved off help and collapsed at the finish. In Hawaii, seven-time winner Paula Newby-Fraser, losing her lead, skipped aid stations late in the run and collapsed near the end. After rest, cooling, and hydration, she was able to walk to the finish (Eichner, 1998).
  • In July of 2018, University of Maryland football player Jordan McNair died of heatstroke after an intense workout in 80-degree heat (Hahn, 2018).