Article by Zoe Russell

Heatstroke and Injury Prevention

What is Heatstroke?

Heatstroke, or exertional heat illness, is a group of conditions that result from doing strenuous exercise or excessive activity in the presence of heat, humidity, or other factors that make it difficult for the body to maintain a constant balanced temperature. Heatstroke can be a medical emergency, but often the lesser transient type of heat illnesses are the ones we are all familiar with (Giersch, Belval & Lopez, 2020).

What Causes Heatstroke?

Our bodies are very good at achieving and maintaining a state of balance in all of the systems required for survival, a state of being called ‘homeostasis’. Imbalance occurs when we can’t regulate our body temperature due to exposure to excessive external heat or a lack of ability to cool down, e.g. dehydrated from excessive sweating.

Medically speaking, heatstroke is occurring when the core body temperature is higher than 40℃. However, the patient doesn’t need to have a temperature at or above 40℃ for life-threatening situations. So while a high temperature is dangerous, a lack of a high temperature shouldn’t be a sign that nothing serious is going on (Giersch, Belval & Lopez, 2020).


Dehydration is a condition where there is a lack of fluids in the body or a lack of specific dissolved salts or electrolytes in that fluid, leading to poor body and mind function. Dehydration can occur in various ways, including illness, forgetting to drink enough water, and excessive sweating. Our bodies cool by sweating, but if we’re dehydrated, we can run out of water to sweat out, and our core body temperature rises (Vic State Govt, 2015).

Heatstroke and dehydration can occur together, although this is not always the case. Both are common in our active and sporty Australian society; both in our organised sports for both children and adults, recreational sports like surfing and hiking, and outdoor lifestyle, like beach days and backyard cricket.

Lack of Airflow, Crowded Conditions

If you’ve ever been to a summer music festival, hiking in waterproof clothing, inside a busy nightclub or stuck inside a full elevator, you’ve experienced this one. Escaping the radiating body heat from yourself or others when you’re insulated can be tricky, even impossible. When you’re close together for long periods, your body can’t escape this radiating heat, and your internal temperature stays high (Giersch, Belval & Lopez, 2020).

Sun Exposure

Everyone loves a nap after a morning spent at the beach, but this exhaustion is a form of heat illness often accompanied by dehydration. Not to mention the thirst, fatigue and pain if you wake up from that nap with a sunburn.

Australia routinely runs sun exposure and sunburn awareness campaigns, and workplaces often supply mitigation – hats, sunscreen, water, and shade resting areas. About a quarter of the Australian workforce, who work in the sun, particularly people who work in the middle of the day, are at increased risk for sun and heat exposure (SafeWork Australia, 2020).


Even if you’ve never had the bad luck to experience a full-blown bushfire, you’ve probably stood a little too close to the campfire. A slightly lesser version, but you might have had an oven, stove and slow cooker going in a sunny kitchen – the heat feels inescapable. Radiant heat can quickly cause dehydration, heat illness and exhaustion. Bushfires typically occur when the air is scorching and dry, compounding the dehydration and heat illness risk factors (Vic State Govt, 2015).

Heatstroke Symptoms

Usually, heatstroke and dehydration can be diagnosed clinically, with a check for these signs and symptoms. Scans or blood tests typically aren’t needed.

The simplest way to tell if you’re experiencing dehydration is to have a look at the colour of your urine. You might have seen charts like this pop up on the back of toilet doors in the last few years, especially in public toilets.

(Healthdirect, 2019)


Why is this Important for Physiotherapy and Sports Performance?

As physiotherapists, it is our job to keep our athletes safe when looking after them from the sidelines. Player wellbeing includes understanding the complex interactions between ‘medical’ health factors and ‘physical’ health factors, as well as emotional, psychological and societal factors. Heat illness is becoming increasingly important to understand as average temperatures rise (Kakamu et al., 2017).

There is a lack of research around whether extremes of temperature lead directly to injury during sport. The lack of research is possible because it is unethical to subject people to hard work at various temperatures to see who gets the most injured. After all, we already have researched how detrimental it can be to our brains and bodies. There is evidence mostly in occupational, military and industrial settings, as well as lab research that guides us in decision making for keeping our patients (both athletes and workers) safe in sweltering conditions. Several factors loosely point towards increased heat exposure leading to an increase in injuries.

Cognitive Functions

A study completed by researchers in Iran (Mazloumi et al., 2014) found that working in heated conditions led to a slow down in reaction time and a more inferior selective attention ability (the ability to focus on one thing without getting distracted).

The Journal of American College of Nutrition (Lieberman, 2007) published an article called ‘Hydration and Cognition: A Review’. The article discussed a variety of different studies grouped by the way they induced dehydration. The research they found was most robust in the ‘heat or exercise’ method of dehydration, showing a consistent downward trend of cognitive abilities with dehydration measured at 1%, 2%, 3% and 4% of body weight when subjects tested for hand-eye coordination, symbol substitution and a concentration test.

Again, don’t forget your day at the beach – that nap that you need..? Well, it’s shown that the cognitive deficits (like poor coordination, reduced information processing, decreased memory and attention span) may show up after 1-2 hours after exposure, from as little as a 1.8℃ increase in core body temperature (Walter et al., 2016). You need a nap because your brain is slowing down to recover!


In a large multi-country study, 30% of workers worldwide experienced a reduction in productivity while working in hot conditions (Flouris et al., 2018). Also, the same study found that proper medical assessment and risk prevention measures for mitigating heat stress in employees significantly reduced lost-injury time and returned workers to their jobs safely in mining, military, and firefighting industries, as well HAZMAT workers.

Muscle Cramping

Muscle cramps are painful sustained muscle contractions or spasms. We know that these cramps are due to changes in the nervous system, but there is some weak evidence to suggest that heat and dehydration can contribute to an increased incidence of cramping (Miller, 2018).

Muscle Function and Strength

In a 2019 study (Racinais et al.), researchers took volunteers and asked them to perform sustained maximal muscle contractions. They found that when volunteers were heated up first, they subjectively reported their strength felt the same, but in fact, their muscle contraction wasn’t as durable over time. The peak torque and peak voluntary activation of fibres both dipped after only 20% of the contraction length. However, it found that heat acclimatisation can partially compensate for these effects. This finding is in line with other research suggesting that training in the heat can maximise competitive performance in hot weather.


Proprioception is also known as joint position sense and is used to balance and orient us in the world around us.

A joint Qatari-French study from 2018 (Mtibaa et al.) showed that inducing a state of hyperthermia (increased internal body temperature) produced worse results on several balance tests. This finding is suggesting decreased ankle proprioception. Participants asked to balance on one foot in various tasks found that the participants were balancing after they were passively heated up needed more contact with the ground to compensate for lack of joint sensation. Plus, quicker active electrical signalling to the muscles from the brain after the heat suppressed the regular stretch H-reflex from the spinal cord.

The same group of researchers took another look the following year (Mtibaa, 2019) to look at ankle proprioception in a treadmill test. Participants were asked to run at their own pace, either with or without environmental heating, ran in the heat ran slower, and with more movement error at the ankle. But this was well compensated for further up the body. This change in movement was consistent with other previous studies showing this change with runners experiencing exercise-induced fatigue.

Intestinal Permeability

It’s a funny term, but intestinal permeability refers to the ease with which certain substances and bacteria pass through the intestinal wall into the bloodstream. Usually, these gaps between cells are tiny, so the cells themselves act as a gatekeeper and filter. They decide which good things can come into the bloodstream, travel to the rest of the body, and keep the bad stuff like intestinal bacteria, indigestible food, and bile in the intestine to be passed out as waste.

Hyperthermia leads to a state of high intestinal permeability; that is, the gaps between cells get more prominent, allowing some substances to ‘slip through the net’ and pass into the bloodstream. If these things are nasty, the immune system creates a systemic inflammatory response to target and neutralise the potential danger. Systemic inflammation, significantly when prolonged, has contributed to disease risk and reduced sporting performance (Pires et al., 2017).

What are the Heatstroke Treatment Options?

Treatment for heat illness and dehydration is relatively simple – cooling and rehydration. It’s essential to treat slowly to allow the body time to readjust, or it’s possible to make things worse. If you’re not sure, a call to 1800 022 222 or 000 is appropriate for guidance.

Your pitch-side physiotherapist is trained in advanced first-aid, including heat-related illnesses, in addition to their injury treatment training and experience. In the case of suspected acute heat-related illness, you can ask the physiotherapist or other health professional present at the game to assess you and guide you on the next steps for treatment and advice, if appropriate. Suppose you’re looking to improve your balance, muscle function, efficiency of movement and strength to counteract the effects of heat while playing your sport. In that case, you can book in to see one of our physios who will thoroughly assess you and recommend a treatment plan.

If you have any further questions, please ask your physiotherapist.

Common Muscle Injuries

A Physiotherapist's Guide


Muscle injuries, presenting as muscle strain, pain or myalgia, are prevalent health issues affecting a wide range of individuals. This detailed guide, from a physiotherapist's perspective, delves into various muscle injuries, elaborating on their management, prevention, and the importance of professional advice. Explore the linked articles for an in-depth understanding of muscle injuries and their effective treatment.

Common Muscle Injuries

Neck & Back Muscle Injuries: Causes and Solutions

  1. Back Muscle Pain: This pain often results from prolonged poor posture or physical overuse. Key to relief is engaging in exercises that strengthen the core muscles and improve posture, thereby alleviating the strain on the back.
  2. Neck Sprain: Caused by sudden, awkward movements, a neck sprain can benefit from a combination of gentle stretches and targeted strengthening exercises to restore flexibility and strength.
  3. Text Neck: A modern ailment resulting from extended mobile device use, text neck can lead to chronic pain. Regular breaks, posture-awareness, and neck-strengthening exercises are essential for prevention.
  4. Whiplash: Commonly occurring in car accidents, whiplash requires a careful approach including neck stabilisation exercises and controlled movement to encourage healing and prevent further injury.

Lower Limb Muscle Injuries: Understanding and Treating

  1. Hamstring Strain: Particularly common among athletes, particularly runners, this strain demands rest initially, followed by a carefully structured rehabilitation program focusing on gradual strength building and flexibility.
  2. Thigh Strain: Often seen in sports involving sprinting and jumping, thigh strains need a combination of rest, ice, compression, and elevation (RICE) in the initial stages, followed by carefully planned strengthening exercises.
  3. Groin Strain: This injury requires a nuanced approach, including sufficient rest and targeted exercises, to ensure a safe and effective recovery.
  4. Calf Muscle Tear: Key to recovery is a balance of rest, gentle stretching exercises, and a gradual return to full activity, ensuring the muscle heals correctly and strength is regained.

Upper Limb Muscle Injuries: Prevention and Care

  1. Golfer's Elbow and Tennis Elbow: Both these conditions involve inflammation of the tendons and require a rest period, followed by ice therapy and specific exercises tailored to strengthen the affected muscles.
  2. Corked Thigh: Resulting from direct impacts, these injuries demand immediate application of ice and a controlled, gradual exercise regime for recovery.
  3. DOMS, Fatigue-Related Cramps & Myalgia: Adequate rest, good hydration, and gentle stretching are crucial in alleviating these conditions.
  4. RSI: Regular stretching, ergonomic workplace adjustments, and taking breaks are key preventive measures for repetitive strain injury.

Systemic Causes of Muscle Pain: A Holistic View

  1. Fibromyalgia: This complex condition demands a holistic treatment approach, including exercise routines, stress management techniques, and sometimes medication.
  2. Rheumatoid Arthritis: Effective management combines medication, gentle exercise, and regular physiotherapy sessions.

Prevention and Management Strategies

  • Regular Exercise: Regular physical activity helps maintain muscle strength and flexibility, reducing the risk of muscle injuries.
  • Posture Improvement: Good posture, both in motion and at rest, is crucial for preventing muscle strain.
  • Proper Warm-up and Cool-down: Adequate warm-up before and cool-down after physical activity is vital in preventing muscle strains and injuries.
  • Ergonomic Adjustments: Making ergonomic adjustments at work and during daily activities can significantly reduce the risk of repetitive strain injuries and other muscle-related issues.
  • Maintaining a Healthy Weight: Keeping a healthy weight reduces the strain on muscles, particularly in weight-bearing joints.

What to Do? Seeking Professional Advice

Consult a physiotherapist or doctor for personalised advice and treatment plans. Remember, early intervention can significantly improve recovery outcomes and prevent chronic problems.


While muscle injuries are common, effective management and prevention are achievable with the right approach and knowledge. Understanding the causes, symptoms, and various treatments available empowers individuals to take proactive steps in their recovery and prevention. For the most tailored and effective treatment, always seek the guidance of a professional physiotherapist.

Common Muscle Injury FAQs

Managing and Recovering from Muscle Injuries

Welcome to our Muscle Injury FAQs. It's your comprehensive guide for understanding, treating, and bouncing back from muscle injuries.

We'll discuss the different muscle injury types, grasp the concept of muscle trigger points, and discover the reasons behind muscular pain post-exercise. Learn about effective treatments to speed up recovery, and explore the benefits of stretching exercises and foam rollers. Embrace the therapeutic effects of various massage therapies including remedial, relaxation, trigger point, acupressure, and sports massages. Gear up to play an active part in your journey towards recovery from muscle injuries.

For more detailed information simple the question hyperlinks below.

common muscle injuries
Muscle Injury Faqs

Diagnosing Muscle Injuries

  1. How Do You Know If It’s A Muscle Injury? - Understand how to identify a muscle injury, distinguishing it from other types of pain.
  2. What are the 4 Types of Muscle Injuries? - Explore the four main categories of muscle injuries, including strains and tears.
  3. What are the Most Common Muscle Injuries? - Learn about the most frequently occurring muscle injuries and how they affect your body.
  4. What is a Trigger Point in a Muscle? - Discover what trigger points are and their role in muscle pain.
  5. What Causes Post-Exercise Muscular Pain? - Uncover the reasons behind the muscular discomfort you feel after exercising.
  6. How Do You Know If Your Back Pain Is Muscular? - Find out how to determine if your back pain is due to a muscle injury.
  7. Tendinopathy vs Muscle Tear: What's the Difference? - Understand the differences between tendinopathy and muscle tears.
  8. Muscle vs Ligament Injury? - Learn the distinctions between injuries to muscles and ligaments.

early muscle injury treatment

Early Muscle Injury Treatment

Muscle Treatment & Recovery

  1. What is the Best Early Muscle Injury Treatment? - Discover the most effective initial treatments for muscle injuries.
  2. How Long Does it Take for a Muscle Injury to Heal? - Find out the typical healing times for various muscle injuries.
  3. How Does Dry Needling Help Muscle Injury? - Explore the benefits and process of dry needling in muscle injury recovery.
  4. How Can You Speed Up Muscle Recovery? - Learn strategies to accelerate the healing process of muscle injuries.
  5. What’s the Benefit of Stretching Exercises? - Understand the importance of stretching exercises in muscle recovery.
  6. How Do Foam Rollers Help Muscle Recovery? - Discover how foam rollers aid in the recovery of muscle injuries.
muscle injury treatment
Foam Rollers Are Excellent For Injury Prevention And Performance Improvement

Massage & Muscle Injuries

  1. Muscle Injury? What are the Benefits of Getting a Massage? - Explore the therapeutic advantages of massage for muscle injuries.
  2. What Is The Difference Between Remedial & Relaxation Massage? - Learn the distinctions between remedial and relaxation massage techniques.
  3. How Does Trigger Point Therapy Help? - Understand the role of trigger point therapy in treating muscle injuries.
  4. How Does Acupressure Help Muscle Injury? - Discover how acupressure can aid in the recovery of muscle injuries.
  5. What is Sports Massage? - Explore the specifics and benefits of sports massage for athletes and active individuals.
  6. When is the Best Time to Get a Pre-Event Massage? - Learn the optimal timing for a pre-event massage to enhance performance.
  7. When is the Best Time for Your Post-Event Massage? - Find out the ideal time to receive a post-event massage for effective recovery.


In conclusion, this FAQ article on managing and recovering from muscle injuries offers a wealth of information, from understanding different types of injuries like muscle strains and tears, to exploring various treatment and recovery options. Whether you're dealing with a recent injury, seeking preventive advice, or exploring therapeutic methods like massage and acupressure, this guide serves as a valuable resource.

Remember, the journey to recovery is unique for each individual, and this guide aims to empower you with knowledge and tools to aid in your healing process. Stay informed, listen to your body, and seek professional advice when needed, as you navigate the path to recovery and optimal muscle health.

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