• With the recent explosion of participation in women's sports has come an understanding of musculoskeletal problems seen more commonly in the female athlete.

• The rate of noncontact ACL injuries has been found to be higher for women in numerous sports, and strategies for injury prevention have gained popularity.

• The medical issue of greatest concern in women has been termed the female athlete triad: disordered eating, amenor-rhea, and osteoporosis.

delayed menarche and prolonged intervals of amenorrhea may predispose ballet dancers to scoliosis. Tanchev et al6 found a 10fold higher incidence of scoliosis in rhythmic gymnastic trainees, which they related to asymmetrical loading, delayed menarche, and ligamentous laxity.

Similar to the male athlete, the diagnosis of adolescent idio-pathic scoliosis is made only after a thorough history, physical examination, and appropriate radiographs. The spine should be examined with particular attention given to the neurologic examination. Secondary sex characteristics should be assessed and the skin should be examined for cafe-au-lait spots, suggesting neurofibromatosis.

The Adams forward bend test is one of the most common screening tests used (Fig. 8-1). The patient bends forward as if to touch the toes. This enhances the spinal curve and demonstrates imbalances in the rib cage. This test is most sensitive to curves in the thoracic region.

Concern that significant deformity is present during screening justifies radiographic evaluation, typically a long anteropos-terior and lateral radiograph of the torso that includes the thoracic and lumbar spines on one film and also includes the iliac crest. In addition to curve evaluation, radiographs are also useful for determining skeletal maturity. Additional tests such as a magnetic resonance imaging are indicated in patients with idio-pathic scoliosis in the presence of neurologic abnormalities7 or if the presenting complaint is back pain that does not respond to several weeks of conservative care (rest from activity, back exercises, and anti-inflammatory drugs). It is generally accepted that scoliosis is normally a painless condition.1 The presence of pain may indicate an underlying condition such as fracture, tumor, spondylolysis, or disk herniation and therefore warrants investigation. Routine magnetic resonance imaging evaluation of all patients with adolescent idiopathic scoliosis is not recommended.

Figure 8-1 The Adams forward bend test.

In the past, athletes identified with scoliosis were largely restricted from athletic participation. This philosophy was grandfathered from traditional teachings and based on studies demonstrating exercise was of no benefit in preventing progression. Experience and increasing understanding of scoliosis have begun to reverse this trend. Becker2 believed that exercise and cross-training might help counteract overloading forces secondary to sport-specific training. Mooney et al8 discuss this in a report on the effect of measured strength training in adolescent idiopathic scoliosis. These authors found measured strength differences between sides ranging from 12% to 47% and describe a benefit to rotary torso strengthening. Encouraging adolescents with scoliosis to participate in sports is now generally accepted as it is now thought that activity can help maintain endurance and flexibility, minimizing the asymmetrical forces on the spine.

The use of bracing has been shown in several studies to halt progression. Bracing is generally recommended in those whose curve is greater than 20 to 25 degrees. With the development of newer materials and evidence of the efficacy of nighttime brace wear, athletes now can participate both in and out of brace, depending on their unique situation (e.g., degree of curve, sport).

Discussion of specific indications and therapeutic options for athletes with progressive or severe curves is beyond the scope of this chapter. In deciding treatment, the type of sport and level of performance should be considered in combination with the severity of the deformity.9 Much controversy exists over athletic participation after surgical intervention. Rubery and Bradford10 polled members of the Scoliosis Research Society on athletic activity following spine surgery and presented the opinions of 261 surgeons active in treating spinal deformities. They discovered that the most common time to resume low-impact, noncontact sports was 6 months and that contact sports were generally allowed after 12 months. However, athletes were encouraged not to participate in collision sports.

In summary, increasing numbers of female athletes with idio-pathic scoliosis are participating in sports. It is prudent for the treating physician to identify sport-specific risks associated with spinal deformity. Care for these athletes should be individualized. Increased knowledge and improvements in bracing protocols and surgical techniques have enhanced the quality of life for female athletes with scoliosis by allowing continued involvement in their athletic endeavors.

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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