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More about Sickle Cell Trait and Athletes

People who have sickle cell trait (SCT) can compete in sports and become world-class competitors. Athletes, coaches, and trainers need to be aware that competitors who have sickle cell trait have to be well hydrated and should have rest periods during high-intensity training. People who have sickle cell trait can have serious problems if they are not well hydrated and engage in new forms of high-intensity training without gradually increasing training to reach a new level of exercise. Most problems occur during training, not competition. Athletes and those who are their coaches and trainers have to be aware of the signs and symptoms of exertional rhabdomyolysis, a term used to describe a severe complication of dehydration and overheating during high-intensity training. Many athletes do not know their trait status. If you do not know your trait status, ask your physician. Approximately one in twelve (1:12) Black Americans have sickle cell trait (SCT); 3 million Americans have sickle cell trait (SCT). These recommendations should apply to all athletes but are particularly important if you have sickle cell trait (SCT) as there have been serious injuries and deaths from exertional rhabdomyolysis during high-intensity training in sports predominantly in athletes who have sickle cell trait and as noted earlier, usually during training. Exertional rhabdomyolysis can happen to anyone in extreme situations, so everyone should be aware of this possibility.

Hydration & Pacing

Hydration is even more essential for athletes who have SCT and are sweating and challenging their bodies.

The key to keeping up with your game and being safe is hydration and rest periods. During training and in competition athletes need to maintain a normal level of hydration. This requires access to water at all times. During training, particularly during high-intensity training, there is a large loss of water especially if the environment is hot, this water loss needs to be replaced. In a hot environment, there is much more water loss from sweating that may not be noticed. Your body controls your core temperature by increasing blood flow to the skin and sweating. If you are dehydrated this cannot occur efficiently and your core body temperature increases which is dangerous and in extreme circumstances, life-threatening.  

Hydration starts before you exercise. Begin hydration a couple of hours before your workout, drink frequently during strenuous exercise, and continue to hydrate post-exercise. People who have sickle cell trait are unable to conserve water with their kidneys as well as others, so there is also increased water loss with urination. The amount of water to drink prior to and during exercise is determined by the athlete’s weight, and the amount of hydration needed to replace losses should be determined by your coach or trainer. Additionally, do not drink or take supplements that can increase urination like caffeine, which is found in some sports drinks. Make sure what you are doing to stay fit is safe by talking to your doctor, coach, and trainer.

Rest & Recovery

Timed exercises should be done at a manageable pace and the pace should only increase over time gradually to avoid any serious issues. Athletes with Sickle Cell Trait may take longer to recover and experience prolonged fatigue. Coaches should monitor their athletes’ recovery times and athletes should communicate their condition if they feel they need more rest.

Following strenuous exercise, hydration needs to continue and there should be a cooldown. In some cases, athletes lose weight during strenuous exercise due to water loss. This is dangerous and means you are not drinking enough fluids during exercise.  Loss of water causes changes in blood circulation, blood pressure, and the ability to maintain body temperature.  During exercise and during recovery the athlete and the coach need to know the signs of dehydration and impending exertional rhabdomyolysis.  

Signs of impending exertional rhabdomyolysis:

  • Muscle burning, pain, weakness, and/or muscle tenderness
  • Muscle cramping
  • Rapid breathing or breathlessness
  • Feeling like you are overheated and can’t cool down
  • Decreased sweating (meaning you are so dehydrated you cannot sweat to decrease core body temperature)
  • Prolonged or extreme exhaustion or fatigue during or after exercise

Athletes should report these symptoms to their coach, who should know that these are signs of impending collapse from exertional rhabdomyolysis and seek medical aid depending on the situation. Adequate hydration and rest, gradual increases in exercise, and awareness can make participation in sports safe. Remember when you are in training or in a game your “adrenalin” can mask symptoms. Be aware and take care if you do not feel you are up to your usual abilities to play your sport.


Heat & Altitude

Any signs of severe pain in the left side of the chest as well as nausea can be a sign of a Splenic Infarction and a doctor should be consulted immediately.

High altitude and heat can increase the risk of exertional rhabdomyolysis. High altitudes can have very dry conditions and there is less oxygen pressure at high altitudes. This can be made worse by heat. Denver Colorado is one mile high; this could cause problems for people not acclimated to this elevation. Hydration, Recovery, Pacing, and watching for symptoms are always important, but at high altitudes these risks are greater. One notable example that was not related to exertional rhabdomyolysis occurred in 2007 to Pittsburg Steelers safety Ryan Clark who has sickle cell trait. He had played in Denver and had abdominal pain in 2005, but in 2007 had a splenic infarct during a game, eventually requiring a splenectomy. It is not known whether this could have been prevented with hydration, rest, or any other measure. Splenic infarcts at high altitudes have occurred in people who have sickle cell trait while engaging in sports like skiing and are an additional risk at high altitudes besides exertional rhabdomyolysis. Splenic infarcts can be serious; the symptoms are pain on the left side of your abdomen, sometimes pain in your left shoulder, and sometimes nausea. If you have this symptom, you need to be evaluated for a splenic infarct.