Returning to Activities after Illness
Two questions I hear from athletes and coaches are “when should I return to practice/competition after suffering from illness?” and “what can we do to prevent becoming ill?”. The main variables associated with the decision-making process of when athletes return are strength and conditioning level (which depends on the amount of time lost due to illness) and whether or not they will infect other members of the team.
I don’t want to harp on a subject that has been extensively covered by most media outlets and in schools, but since we are discussing illness and return to sport, I am going to come out and say it…H1N1! This year may be one of the most worrisome years for athletes and coaches because of the H1N1 flu virus. I have received multiple questions on the virus and I, like many, don’t know truly what to expect. I have searched the CDC website and read through all of the information. The H1N1 virus seems to hit young adults very hard. In team settings and close contact sports it will likely spread rapidly if not properly contained.
My advice to coaches and athletes on whether they should practice through illness has not been affected much by the H1N1 virus. Athletes and coaches don’t want to miss practice due to minor illness or a simple head cold. There are some distinguishable differences between the common cold. Athletes can typically practice and compete with a common cold if symptoms allow. The seasonal flu or dreaded H1N1 is not allowed to practice or compete with those symptoms. The common cold usually presents symptoms gradually over a three to five day period, while flu symptoms occur very rapidly, as fast as three to six hours. With the common cold, you very rarely run a fever or have only a minor fever with few minor aches, while with the seasonal flu or H1N1, one typically has a fever present and body aches are more severe. The common cold usually causes mild to moderate chest discomfort with a hacking, productive cough while the seasonal flu usually presents major chest discomfort with an unproductive cough. Other cold symptoms not typically seen as much with the flu include: sneezing, stuffed nose, and possibly a sore throat. Some other flu symptoms not typically associated with the common cold include: chills, headache, and with some cases of H1N1, vomiting and diarrhea have been reported.
Once the fever has subsided 24 hours without medications athletes can return to practice as tolerated but should be limited to no more than 50% capacity the first day. Although a heavy cough after the flu signals the person may need to wait a few more days and are potentially still contagious. Athletes who have been on bed rest for three or four days often feel very refreshed and tend to over-exert themselves. They will usually experience a loss of energy for the next few days if they over-work themselves the first day back. Athletes can be taken to 75% the second, and 100% the third day if symptoms do not return and the athlete is comfortable returning to full speed.
Preventing the spread of the illness to teammates is crucial. Athletes should never practice when they show the above symptoms for the flu; they should be sent home to rest until they recover and avoid as much contact with teammates as possible. Athletes should not be given punishment or benched for missing practices or games due to illness. That type of behavior usually causes athletes to practice when they should be resting and puts the rest of the team at risk of becoming ill.
Good hygiene practices and sanitation are crucial in preventing the flu virus as well. I have noticed a decline of athletes who shower immediately following practice over the last few years. Showering immediately after practice or competition should be completed for several reasons, most importantly is to rid yourself of any germs or bacteria obtained from athletic equipment, gym floors, or close contact with teammates and opponents. Athletic equipment should be cleaned frequently, especially shared equipment. Weight equipment should be sprayed down and wiped off after each use, daily at a minimum. Most equipment can be sanitized effectively with a 1:10 solution of bleach to water or other EPA approved sanitizers. Frequent hand washing and avoiding putting your hands or fingers in your mouth, nose, and eyes are also recommended in preventing the spread of illness.
If you are unsure of your symptoms, you should always consult a medical professional before practicing or resuming practice after illness. Your school nurse, athletic trainer, or personal physician are available for questions concerning your health. Feel free to contact me at Labette Community College at 820-1027 with all your athletic injury/illness questions.
Ben McKenzie, MLS, ATC
Labette Health Sports Medicine
Head Athletic Trainer Labette Community College