Hydration is a lot more complicated than drinking water.  In this article we break down the important factors in keeping yourself hydrated and minimizing hydration related injuries.

by Alexander Stone, DPT

If your health and performance matter to you, then your hydration should too. In fact, very few things are as essential to your sense of wellbeing and ability to prevent injury as proper hydration. Unfortunately, many athletes and gym enthusiasts don’t know where to start with their hydration habits.

In this article we’ll cover the essential facts about water, how hydration relates to injury prevention, and how to optimize your water intake for peak health and performance.

Short on time? Here’s what you need to know:

• Water plays a key role in maintaining the health and performance of body tissues such as joints, muscles, and nerves.
• Without proper hydration, health problems and injuries become much more likely due to decline in physical and mental performance.
• The amount of water you need to drink will depend on your body weight, environment, and the specifics of your exercise routines.
• Pairing your water with the right amount of electrolytes is an important part of optimizing your hydration regime for optimal performance.

The Basics of Water and Hydration

There are very few things as essential as water in your daily life, so understanding the basics of water is a necessity. Not only is your body over 60% water, but that water is used during vital functions like regulating blood volume, clearing waste, and hydrating your tissues (1, 2).

All of the joints, muscles, and other tissues of your body need blood to function properly. This is because blood is a vehicle for important nutrients such as oxygen, glucose (blood sugar), and amino acids that provide the building blocks and energy for cells. If you are well-hydrated, your blood will be a normal volume and viscosity (thickness) for optimal tissue health, blood pressure, and performance. If you are poorly hydrated, you will have less blood that becomes thicker, which can negatively impact things like blood pressure and performance (3).

As a bi-product of your diet and normal body function, waste products and toxins accumulate in and around the cells of your body. Some important mechanisms for removing waste products are urination and sweating, both of which use water to transport undesired compounds out of the body. In fact, sweating is also very important for regulating body temperature, making hydration even more important while exercising or working in a hot environment (4). If you are poorly hydrated, neither of these functions can occur normally and your performance can begin to suffer.

Water is also used in body fluids other than blood, such as synovial fluid and various membranes that line the body. Synovial fluid is especially important for lubricating the joints of the body to promote smooth, efficient movement during exercise. Healthy membranes are important for normal organ function and the prevention of infection. Additionally, water plays a big role in hydrating the intervertebral discs of your spine, which promotes normal disc height, healthy movement, and prevention of disc degeneration (5).

Now that you have a better understanding of how important water is for normal body function, let’s talk about hydration and injury more closely.

The Relationship Between Hydration and Injury

No matter how you slice it, hydration is essential for normal body function and optimal performance. When your hydration habits aren’t adequate, you’re more likely to struggle with performance and experience injuries. Three main connections between hydration and injury are tissue health, endurance, and mental clarity.

Tissue Health

When you think about the different tissues of your body such as skin, connective tissue, and muscle, it’s important to remember how important water is for each of these tissues to function normally. If you hydrate your body properly, you are providing your tissues the right environment to do their best work. This means that muscles are more ready to contract, joints are lubricated, and tendons are durable under stress (6).

Conversely, if your tissues are inadequately hydrated, many normal body functions will start to decline. For example, poorly hydrated muscles will not be able to contract as readily, putting them at a higher risk for strain or tear during exercise. Likewise, joints without proper lubrication from synovial fluid are more likely to experience friction-related injuries during movement. Since tendons and ligaments are put under extreme tension during exercise, when dehydrated, they are especially prone to sprain or rupture under stress.

Endurance

You may be familiar with weakened tissues causing injury, but might not consider the role endurance plays in preventing injury. In order to keep your body moving gracefully and efficiently, several important processes need to take place for ongoing energy production, temperature regulation, and coordination. Since all of these processes require water, hydration plays a vital role in optimizing these processes for peak performance (7).

When you’re not properly hydrated, several important body functions related to endurance will suffer. This means that your energy levels will replenish slower, your body will overheat more easily, and your coordination will be compromised. When your body reaches exhaustion faster, you’re more likely to experience accidents during sports or training. This can look like failing during a rep, landing wrong, or tripping over your own feet. Unfortunately, each of these scenarios can result in injury.

Mental Focus 

Research shows that hydration is especially important for cognition and focus throughout your day. This is because when you’re properly hydrated, the neurons that make up your brain and spinal cord can communicate more efficiently. More efficient communication of neurons can translate to improved mental performance, better mood regulation, and more efficient exercise (8).

Without adequate hydration, neurons become slower and less efficient. This can look different for everyone, but can result in difficulty focusing, mood fluctuations, and impaired decision making. During exercise, thinking clearly is essential to prevent injuries from happening. When judgment or emotions are affected, you’re more likely to make risky decisions that could result in injury.

Remember, these causes of injury rarely occur in isolation. This means that tissue health, endurance, and mental focus can be affected simultaneously if your hydration habits aren’t up to par. This is ultimately how hydration can contribute to major injuries during exercise.

How Much Water Should I Drink?

Hopefully the importance of water is apparent at this point, but knowing how much to drink can be confusing for many people. Let’s break down some key facts to consider when planning your hydration for the day.

You’ve probably heard a lot of different recommendations for water intake over the years, and it’s hard to find consistency. A common recommendation for water intake is 8 glasses (64 ounces) per day for most adults. While this is a great starting point, the actual amount of water that you’ll need will depend on your weight, activity level, and environment.

A good way to estimate your water needs during exercise is the Galpin equation. Outlined by exercise physiologist Dr. Andy Galpin, this equation uses your body weight to help calculate your water intake during bouts of mental or physical exertion. Start by dividing your body weight by 30, then consume that amount of water (in ounces) every 15 minutes on average. 

For example:

• If you weigh 150 lbs, you would need to consume 5 ounces of water per 15 minutes, 10 ounces of water per 30 minutes, or 20 ounces of water per hour.

Although the Galpin equation is not an official recommendation, it aligns very well with water intake recommendations from other sources (9). When it comes to exercise, the National Strength and Conditioning Association (NSCA) also recommends drinking 3 to 8 ounces (90 to 240 ml) of water every 10 to 20 minutes during exercise lasting longer than an hour (7).

Your environment can have a big impact on your water needs. The hotter your training environment is, the more difficult temperature regulation becomes for your body. This often means sweating more, which can cause your body to lose water quickly. This has big implications for athletes training outdoors on a hot day and should be considered carefully when planning out exercise.

For example, if you’re planning a hard workout in the heat, then your water needs may double or even triple depending on the intensity of your exercise. This is also true in the sauna, a popular tool for recovery and relaxation among many fitness enthusiasts. The recommended temperature range for a sauna is 180-200 degrees Farenheit, so you’re going to sweat! Making sure you keep your water closeby and follow the recommended water intake guidelines is especially important for preventing heat exhaustion, heat stroke, and other injuries.

What Drinks and Food Count as Hydration?

Something you might forget when planning your water for the day is accounting for the different types of drinks, and even food, that you’re going to consume. A good rule of thumb is: water is water. This means that if your drink or food has water in it, it will count towards your daily intake goal. In fact, here are some great sources of water you might not have considered:

• Your morning coffee or tea
• Fruits, vegetables, and smoothies
• Water in the air from a humidifier

Yes, certain food and drinks can affect your hydration. For example, caffeinated and alcoholic drinks can make you need to urinate more. However, depending on the specifics of the drink, these can still count towards your daily hydration goal.

What About Electrolytes?

One of the most commonly understood yet vital components of hydration is electrolytes. Electrolytes are minerals like sodium, potassium, calcium, and magnesium that influence how water is used in your body. In many cases, getting the right electrolyte balance can be just as important as getting enough water during your day.

While it can be easy to get hung up on specific numbers for electrolyte intake, it really depends on how much water you’re consuming. A good rule of thumb is to aim for a 1:4 ratio of sodium to potassium and source most of your sodium intake from salt (10). This is because salt also contains chloride, which is lost in sweat along with sodium in relatively high amounts. Whether it’s through food or drinks, also make sure that you’re getting other electrolytes such as calcium and magnesium in your diet every day.

If you’re unable to get the right amount of electrolytes from your diet, it’s important to consider specially formulated hydration supplements

Water Temperature and pH

Temperature and pH are popular topics in today’s fitness world, and there are many companies that now sell specialized water to improve health and performance. Temperature refers to how hot or cold your water is when you drink it, while pH describes how acidic or alkaline your water is.

When it comes to athletic performance and injury prevention, the temperature and pH of your water really aren’t that important. This is mostly because your body is very good at regulating the temperature and pH of water after you drink it. For example, if you drink a bottle of very cold water, your body will warm it up during digestion to help maintain your normal internal body temperature. Likewise, if you drink a bottle of high-pH water, your body will slightly modify the pH of the water to bring it into the optimal range.

While your body is very good at regulating temperature and pH of the water you drink, it’s not so good at telling you how to properly hydrate with water and electrolytes. This means that your efforts are going to be better spent focusing on your overall water and electrolyte intake, the source of your water and hydration supplements, and the timing of your hydration.

Conclusion

Proper hydration is an essential part of any fitness routine, but it can be tricky to optimize your hydration habits for injury prevention. The foundation of any good hydration plan should be made up of quality water, electrolytes like sodium and potassium, and other food sources that have a high water content like fruits and vegetables. While temperature and pH shouldn't play a significant role in your hydration efforts, understanding how much water you need every day and when to consume it can help keep you healthy and performing at your best level. 

Author Bio:

Alex Stone is a Doctor of Physical Therapy and Certified Strength and Conditioning Specialist. He is experienced in orthopedics and sports medicine with an emphasis on performance optimization.

Alex creates educational content for apps, websites and social media (@dr.alexstone). He is passionate about health science education, exercise science, and general health/wellness optimization.

References

1. Water and Healthier Drinks. Center for Disease Control and Prevention (CDC).
2. Popkin BM, D'Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev. 2010 Aug;68(8):439-58. doi: 10.1111/j.1753-4887.2010.00304.x. PMID: 20646222; PMCID: PMC2908954.
3. Watso JC, Farquhar WB. Hydration Status and Cardiovascular Function. Nutrients. 2019 Aug 11;11(8):1866. doi: 10.3390/nu11081866. PMID: 31405195; PMCID: PMC6723555.
4. Gagnon, D., & Crandall, C. G. (2018). Sweating as a heat loss thermoeffector. Handbook of clinical neurology, 156, 211–232. https://doi.org/10.1016/B978-0-444-63912-7.00013-8
5. Zhu Q, Gao X, Brown MD, Temple HT, Gu W. Simulation of water content distributions in degenerated human intervertebral discs. J Orthop Res. 2017 Jan;35(1):147-153. doi: 10.1002/jor.23284. Epub 2016 May 18. PMID: 27153106; PMCID: PMC5097704.
6. Judge LW, Bellar DM, Popp JK, Craig BW, Schoeff MA, Hoover DL, Fox B, Kistler BM, Al-Nawaiseh AM. Hydration to Maximize Performance and Recovery: Knowledge, Attitudes, and Behaviors Among Collegiate Track and Field Throwers. J Hum Kinet. 2021 Jul 28;79:111-122. doi: 10.2478/hukin-2021-0065. PMID: 34400991; PMCID: PMC8336541.
7. Hydration and Performance (Excerpt from NSCA’s Guide to Sport and Exercise Nutrition). National Strength and Conditioning Association.
8. Adan A. (2012). Cognitive performance and dehydration. Journal of the American College of Nutrition, 31(2), 71–78. https://doi.org/10.1080/07315724.2012.10720011
9. Riebl SK, Davy BM. The Hydration Equation: Update on Water Balance and Cognitive Performance. ACSMs Health Fit J. 2013 Nov;17(6):21-28. doi: 10.1249/FIT.0b013e3182a9570f. PMID: 25346594; PMCID: PMC4207053.
10. National Research Council (US) Subcommittee on the Tenth Edition of the Recommended Dietary Allowances. Recommended Dietary Allowances: 10th Edition. Washington (DC): National Academies Press (US); 1989. 11, Water and Electrolytes.