Extreme heat has been the lead story of this year's Australian Open, with temperatures climbing north of 100 degrees Fahrenheit for four days of the tournament, reportedly reaching 110 degrees on Thursday. Athletes taking part in the matches have complained of cramps, hallucinations and vomiting, and the playing surface has melted the bottoms of tennis shoes and plastic water bottles.
STACK reached out to Douglas Casa, Ph.D., ATC, Chief Operating Officer of the Korey Stringer Institute at the University of Connecticut, which studies the effects of extreme heat and related illnesses to learn more about what athletes are up against in such severe temperatures. He also discussed how what's happening at the Australian Open highlights a larger problem: insufficient attention to heat safety at all levels of competition—especially youth.
STACK: The temperature at the Australian Open reached 110 degrees. Can you describe what happens to the human body under those conditions, even without being active?
CASA: That temperature alone puts a person at risk. The spectators, support staff and other people who aren't doing exercise are all at risk for heat stroke or heat related illness. So you can imagine what type of risk is involved in doing intense exercise.
STACK: How does being active exacerbate the situation? What extra risks does an athlete run by playing in those conditions?
CASA: When you do intense exercise in the heat, a three-way competition goes on inside your body. First, your muscles want a lot of blood flow to maintain their performance. Second, your skin desperately wants blood flow; it's bearing the brunt of the heat, and it needs more blood to help your body produce the sweat that cools your skin. And then there's your heart, which is working harder to maintain sufficient stroke volume to keep your blood pumping throughout your body; but the loss of fluids makes that process more difficult. So you have three competing mechanisms, and the body cannot sustain all three.
Usually, the first thing to give are the muscles—which is why cramps are so common. The skin is the second thing that gives away. When all three of those things become compromised, you end up in a heat stroke situation.
STACK: Is there anything unique to tennis that causes additional challenges, like the playing surface? ESPN UK is circulating a photo of an egg frying on the court.
CASA: That [photo] doesn't surprise me. If you were standing on a black surface in 110 degrees, it could easily be 140 or 150 degrees one to two feet off the ground. There's so much heat kicking back. The light blue color of the court won't be quite that hot, but it's still going to be a lot hotter than on a grass field.
Conditions on the court can also be stifling because big stadiums get less air flow. Another risk factor in tennis is that the intensity is high. The fact that players don't have to wear much clothing is helpful. But the biggest challenge at an event like this, a Grand Slam event, is that some players may have to play multiple matches in the same day.
STACK: What about athletes playing long matches? For example, Maria Sharapova was on court for three and a half hours in 110 degree temperatures on Thursday.
CASA: Thankfully, for her it's probably not that dangerous, because she has outstanding access to outstanding care. There are really smart people on the sports staff there who know how to take care of their athletes and identify exactly when they need care. But here's the problem: those sports medicine doctors don't have the power to change how things are operating at the tournament—that's left to the governing bodies. And unfortunately, the people who regulate these events don't have great regulations in place regarding heat safety. The sports medicine people have been working to get better regulations in place, but they haven't yet gotten the support of the people who run these organizations.
STACK: What are some examples of changes the sports medicine people would like to see?
CASA: As it gets hotter, you need to have the ability to alter the recovery period so players can have more time between sets. Or, you could have a two-minute break after two sets, depending on the temperature. We do things like this even on high school football practice fields—for instance, in Georgia high school football, there are protocols for when temps hit different benchmarks in the 80s, 90s, and upward. Those temperatures influence how much equipment you can have on, how long you can practice, and what types of drills athletes can do. The military has been doing this for like 30 years too, implementing more rest breaks as the temperatures go up. There a lot of things you can do to make an event like this safer. But organizers are hesitant to implement them, perhaps because they affect commercials and broadcasts and the like.
Other things that an event should have in place are body cooling strategies, or air conditioned places where athletes can escape during breaks.
STACK: How do policies at an event like this filter down to lower levels of competition?
CASA: I can't say for certain, but I can say that there have been some extremely unsafe things happening in youth tennis, such as all-day tournaments in places like Dallas, where 12- and 13-year-old kids were getting only one-hour breaks between matches. We did get them to extend that to two hours—we got intense pushback, but we needed it to happen. You have organizers trying to cram too many matches into a three-day weekend, and it's causing some kids to have to play in four matches a day.
The problem is that the people who make the policies at events like these have no background in health. They're sport people. They aren't doctors or experts in heat stroke. And that should worry parents.
Compare that to a great recent example set by FIFA, which just a couple of weeks ago issued new regulations for the coming World Cup matches in Brazil and Qatar. If the temperatures hit a certain level above 30 degrees Celsius, they're going to insert an extra halftime in the middle of each half. That's an enormously positive change, and I think it will have a profound effect on all of the lower levels of the sport. It just illustrates that at the highest level of sport, we can put safety as a primary concern.
STACK: Indeed. Let's go back to the Aussie Open. Some athletes there have been wearing ice vests or necklaces to cool off. Are those good strategies? How should athletes be protecting themselves?
CASA: There's no question that ice baths are the best thing athletes can do. That is the gold standard for treating heat stroke—cold water immersion. I would strongly advocate for ice baths. The necklaces and vests are helpful but not as effective.
STACK: Lastly, what about spectators—what should they be doing?
CASA: That's a really good concern—probably one of the biggest—because you have such a mix of health statuses among those who are watching. I guess my three recommendations for them would be: One, try to be in the shade as much as you can; two, pay attention to any signs or symptoms, like a headache or nausea, that you may experience; and three, try self-cooling however you can—ice towels, dumping cups of water over your head, whatever you can do to stay cool.
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