S

Dorn Spinal Therapy

Spine Healing Therapy

Get Instant Access

Table 8-14 Iron Content of Foods

Food

Milligrams of Iron

Liver (3oz)

7

Turkey, pork, beef (3oz)

4-5

Shrimp (3oz)

3

Chicken breast (3oz)

1

Fish (3oz)

1

Egg (1)

1

Dried fruit (4oz)

3-4

Kidney beans (1/ cup)

3

Cream of Wheat (1/> cup)

9

Fortified cereal (1/> to 3/4 cup)

18

PSYCHOLOGICAL ISSUES

"Growing Out" of One's Sport

Research studies have shown that girls play sports primarily to have fun, to exercise to get in shape, and to socialize with their peers. Boys reported that they play sports to have fun but also to gain improvement in sport skills and for the excitement of competition. When high school students were asked how they wished to be remembered, boys most frequently reported "for being an athlete"; girls answered "for being a leader in activities."66 During puberty, boys generally get taller and stronger; however, girls may increase in size and weight, but frequently do not gain proportionally in strength. Moreover, for some sports such as ballet, dance, and ice skating, the change from adolescence to the more curvaceous figure of womanhood, especially if the change is not accompanied by a proportional increase in muscle mass and strength, may result in a loss of sports fitness and abilities. The female athlete may become frustrated as she tries to cope with her new body and she may not wish to continue in the sport in which she excelled as a youth.

Frequently, these young women have a difficult time with confronting the reality that their bodies no longer fit their sport. As noted previously in the female athlete triad discussion, eating disorders are common in this age group. Some girls, feeling no longer comfortable in their sport, will present to their physician complaining of various aches and pains that limit sport participation. Often one must see the deeper problem beneath these superficial complaints and help the young athlete and her family face the reality of this young girl not wishing or not being able to continue in her sport.

Sport Burnout

Since female athletes have less of their identity tied to sport, young female athletes, even those very good at their sport, may decide to stop sport participation to have more time to spend with friends, on academics, or in other extracurricular activities. This sport burnout or change of activity focus can be difficult for coaches and parents to accept. The young athlete may find it more "socially acceptable" to have an "injury" that sidelines her. Once again, recognizing that the injury is merely a superficial expression of the deeper issue and helping the young athlete to recognize this as well are an important responsibility of the sports physician.

Overtraining Syndrome

Overtraining syndrome has been documented in elite athletes, especially endurance athletes such as runners or swimmers, or power athletes. This condition can have an impact on both the athlete's health and mental state. The athlete with this syndrome is training at such a high level of intensity that she is unable to adequately recover between sessions. The syndrome is a continuum from training fatigue to overload to full overtraining syndrome. The female athlete experiences worsening fatigue and inability to recover from the physical strain of workouts. Mental symptoms include fatigue, depression, anxiety, irritability, and difficulty concentrating.67 Physical symptoms include increased resting blood pressure, increased heart rate, weight loss, muscle soreness, and frequent illnesses and injuries. Numerous theories have been proposed as to the cause of overtraining syndrome including hypothalamic dysfunction, amino acid imbalance, changes in the hypothalamic-pituitary axis, auto-nomic nervous system dysfunction, immune dysfunction, and others.68-69

The syndrome is difficult to diagnose because it has no diagnostic test. A careful patient history is needed. The diagnosis is one of exclusion and is made following exclusion of biochemical abnormalities with simple laboratory tests such as electrolytes, blood count, thyroid, iron studies, cortisol, and testosterone. Treatment in principle is simple, but sometimes difficult to accomplish. Although rest is the most important treatment, many female athletes do not want to follow this treatment suggestion. In some cases, it is only after the athlete's performance has significantly declined that she will rest. Therapeutic rest, which may be more acceptable to the athlete, is not total rest, but training at a much reduced level with more complete recovery periods. Treatment also includes ensuring that there is adequate nutrition, addressing depression, and improving sleep quality. Overtraining syndrome remains a well-recognized but difficult to understand problem (Table 8-15).

Table 8-15 Stages of Overtraining Syndrome

Fatigue

Overload Training volume/intensity Beyond normal levels

Overreaching

Develops after intense training and overload

Overtraining syndrome

"Staleness," not able to recover

REFERENCES

1. Lowe TG, Edgar ME, Marguiles JY, et al: Etiology of idiopathic scoliosis: Current trends in research. J Bone Joint Surg Am 2000;82: 1157-1168.

2. Becker TJ: Scoliosis in swimmers. Clin Sports Med 1986;5:149-158.

3. Hellstrom M, Jacobsson B, Sward L: Radiologic abnormalities of the thoraco-lumbar spine in athletes. Acta Radiol 1990;31:127-132.

4. Wojtys EM, Ashton-Miller JA, Huston LJ, et al: The association between athletic training time and the sagittal curvature of the immature spine. Am J Sports Med 2000;28:490-498.

5. Warren MP, Brooks-Gunn J, Hamilton LH, et al: Scoliosis and fractures in young ballet dancers. Relation to delayed menarche and secondary amenorrhea. N Engl J Med 1986;314:1348-1353.

6. Tanchev PI, Dzherov AD, Parushev AD, et al: Scoliosis in rhythmic gymnasts. Spine 2000;25:1367-1372.

7. Davids JR, Chamberlin E, Blackhurst DW: Indications for magnetic resonance imaging in presumed adolescent idiopathic scoliosis. J Bone Joint Surg Am 2004;86:2187-2195.

8. Mooney V Gulick J, Pozos R: A preliminary report on the effect of measured strength training in adolescent idiopathic scoliosis. J Spinal Disord 2000;3:102-107.

9. Omey ML, Micheli LJ, Gerbino PG 2nd: Idiopathic scoliosis and spondylolysis in the female athlete: Tips for treatment. Clin Orthop 2000;372:74-84.

10. Rubery PT, Bradford DS: Athletic activity after spine surgery in children and adolescents: Results of a survey. Spine 2002;27:423-427.

11. Flatow EL, Warner JJP: Instability of the shoulder: Complex problems and failed repairs. J Bone Joint Surg Am 1998;80:122-140.

12. Neer CS 2nd, Foster CR: Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder: A preliminary report. J Bone Joint Surg Am 1980;62:897-908.

13. McFarland EG, Kim TK, Park HB, et al: The effect of variation in definition on the diagnosis of multidirectional instability of the shoulder. J Bone Joint Surg Am 2003;85:2138-2144.

14. Borsa PA, Sauers EL, Herling DE: Patterns of glenohumeral joint laxity and stiffness in healthy men and women. Med Sci Sports Exerc 2000;32:1685-1690.

15. Brown GA, Tan JL, Kirkley A: The lax shoulder in females: Issues, answers, but many more questions. Clin Orthop 2000;372:110-122.

16. Kim SH, Kim HK, Sun JI, et al: Arthroscopic capsulolabroplasty for posteroinferior multidirectional instability of the shoulder. Am J Sports Med 2004;32:594-607.

17. Levine W, Flatow EL: The pathophysiology of shoulder instability. Am J Sports Med 2000;28:910-917.

18. Neer CS 2nd: Involuntary inferior and multidirectional instability of the shoulder: Etiology, recognition, and treatment. Instr Course Lect 1985;34:232-238.

19. Bak K, Spring BJ, Henderson JP: Inferior capsular shift procedure in athletes with multidirectional instability based on isolated capsular and ligamentous redundancy. Am J Sports Med 2000;28:466-471.

20. Choi CH, Ogilvie-Harris DJ: Inferior capsular shift operation for multidirectional instability of the shoulder in players of contact sports. Br J Sports Med 2002;36:290-294.

21. Ide J, Maeda S, Takagi K: Sports activity after arthroscopic superior labral repair using suture anchors in overhead-throwing athletes. Am J Sports Med 2005;33:507-514.

22. Mazzocca AD, Brown FM Jr, Carreira DS, et al: Arthroscopic anterior shoulder stabilization of collision and contact athletes. Am J Sports Med 2005;33:52-60.

23. D'Alessandro DF, Bradley JP, Fleischli JE, et al: Prospective evaluation of thermal capsulorrhaphy for shoulder instability: Indications and results, two- to five-year follow-up. Am J Sports Med 2004;32:21-33.

24. Miniaci A, McBirnie J: Thermal capsular shrinkage for treatment of multidirectional instability of the shoulder. J Bone Joint Surg Am 2003;85:2283-2287.

25. Bennett WF, Doherty N, Hallisey MJ, et al: Insertion orientation of terminal vastus lateralis oblique and vastus medialis oblique muscle fibers in human knee. Clin Anat 1993;6:129-134.

26. Powers CM: Patellar kinematics, part I: The influence of vastus muscle activity in subjects with and without patellofemoral pain. Phys Ther 2000;80:956-964.

27. Sakai N, Luo ZP, Rand JA, et al: The influence of weakness in the vastus medialis oblique muscle on the patellofemoral joint: An in vitro biome-chanical study. Clin Biomech (Bristol, Avon) 2000;15:335-339.

28. Fulkerson JP, Arendt EA: Anterior knee pain in females. Clin Orthop 2000;372:69-73.

29. Ficat RP, Hungerford DS: Disorders of the Patellofemoral Joint. Baltimore, William & Wilkins, 1977, pp 22-35.

30. Dye SF: The knee as a biologic transmission with an envelope of function: A theory. Clin Orthop 1996:325:10-18.

31. Farahmand F, Senavongse W Amis AA: Quantitative study of the quadriceps muscles and trochlear groove geometry related to instability of the patellofemoral joint. J Orthop Res 1998;16:136-143.

32. Crossley K, Cowan SM, Bennell KL, et al: Patellar taping: Is clinical success supported by scientific evidence? Man Ther 2000;5:142-150.

33. Salsich GB, Brechter JH, Farwell D, et al: The effects of patellar taping on knee kinetics, kinematics, and vastus lateralis muscle activity during stair ambulation in individuals with patellofemoral pain. J Orthop Sports Phys Ther 2002;32:3-10.

34. Saxena A, Haddad J: The effect of foot orthoses on patellofemoral pain syndrome. J Am Podiatr Med Assoc 2003;93:264-271.

35. Arendt E, Dick R: Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med 1995;23:694-701.

36. DeHaven KE, Lintner DM: Athletic injuries: Comparison by age, sport, and gender. Am J Sports Med 1986;14:218-224.

37. Gomez E, DeLee JC, Farney WC: Incidence of injury in Texas girls' high school basketball. Am J Sports Med 1996;24:684-687.

38. Garrick JG, Lewis SL: Career hazards for the dancer. Occup Med 2001;16:609-618.

39. Daniel DM, Stone ML, Dobson BE, et al: Fate of the ACL-injured patient: A prospective outcome study. Am J Sports Med 1994; 22: 632-644.

40. Griffin LY, Agel J, Albohm MJ, et al: Noncontact anterior cruciate ligament injuries: Risk factors and prevention strategies. J Am Acad Orthop Surg 2000;8:141-150.

41. Griffin LY, Albohm MJ, Arendt EA, et al: Understanding and preventing non-contact ACL injuries: A review of the Hunt Valley II meeting, January 2005. Am J Sports Med (in press).

42. Garrett WE Jr: Non-contact ACL injuries in female athletes: Risk factors and biomechanical considerations. Instructional Course Lecture Series, 78th Annual American Academy of Orthopaedic Surgeons Meeting, New Orleans, LA, February 9, 2003.

43. Malinzak RA, Colby SM, Kirkendall DT, et al: A comparison of knee joint motion patterns between men and women in selected athletic tasks. Clin Biomech (Bristol, Avon) 2001;16:438-445.

44. Ireland M: The female ACL: Why is it more prone to injury? Orthop Clin North Am 2002;33:637-651.

45. Barber-Westin SD, Noyes FR, Andrews M: A rigorous comparison between the sexes of results and complications after anterior cruciate ligament reconstruction. Am J Sports Med 1997;25:514-526.

46. Ferrari JD, Bach BR, Bush-Joseph CA, et al: Anterior cruciate ligament reconstruction in men and women: An outcome analysis comparing gender. Arthroscopy 2001;17:588-596.

47. Barrett GR, Noojin FK, Hartzog CW et al: Reconstruction of the anterior cruciate ligament in females: A comparison of hamstring versus patellar tendon autograft. Arthroscopy 2002;18:46-54.

48. Colombet P, Allard M, Bousquet V et al: Anterior cruciate ligament reconstruction using four-strand semintendinosus and gracilis tendon grafts and metal interference screw fixation. Arthroscopy 2000;18:232-237.

49. Pinczewski LA, Deehan DJ, Salmon LJ, et al: A 5-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 2002;30:523-536.

50. Siegel MG, Barber-Westin SD: Arthroscopic-assisted outpatient anterior cruciate ligament reconstruction using the semitendinosus and gracilis tendons. Arthroscopy 1998;14:268-277.

51. Mandelbaum BR, Silvers HJ, Watanabe DS, et al: Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. Am J Sports Med 2005;33:1003-1010.

52. Hewett TE, Myer GD, Ford KR: Current concepts: prevention programs; a meta-analysis of neuromuscular interventions aimed at the prevention of ACL injuries. Am J Sports Med (in press).

53. Hewett T, Myer G, Ford K: Prevention of anterior cruciate ligament injuries. Curr Womens Health Rep 2001;1:218-224.

54. Coughlin MJ, Pinsonneault T: Operative treatment of interdigital neuroma. A long-term follow-up study. J Bone Joint Surg Am 2001;83:1321-1328.

55. Stamatis ED, Karabalis C: Interdigital neuromas: Current state of the art-surgical. Foot Ankle Clin 2004;9:287-296.

56. Sundgot-Borgen J, Torstveit MK: Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med 2004;14:25-32.

57. Henriksson BG, Schnell C, Hirschberg AL: Women endurance runners with menstrual dysfunction have prolonged interruption of training due to injury. Gynecol Obstet Invest 2000;49:41-46.

58. Skolnick AA: 'Female athlete triad' risk for women. JAMA 1993;270:921-923.

59. Thomas DB, Taylor DC: The female athlete triad. In Garrick JG (ed): Orthopaedic Knowledge Update. Rosemont, IL, American Academy of Orthopaedic Surgems, 2004, pp 345-352.

60. Sangenis P, Drinkwater BL, Loucks A, et al: IOC Position Stand on The Female Athlete Triad. 2005. http://www.olympic.org/uk/organisation/ commissions/medical/index_uk.asp.

61. Khan KM, Liu-Ambrose T, Sran MM, et al: New criteria for female athlete triad syndrome? As osteoporosis is rare, should osteopenia be among the criteria for defining the female athlete triad syndrome? Br J Sports Med 2002;36:10-13.

62. Lane JM, Russell L, Khan SN: Osteoporosis. Clin Orthop 2000;372:13-50.

63. Nolte RM, Fieseler CM: The female athlete. In O'Connor FG, Sallis RE, Wilder RP, et al (eds): Sports Medicine: Just the Facts. New York, McGraw-Hill, 2005, pp 573-581.

64. Garza D, Shrier I, Kohl HW III, et al: The clinical value of serum ferritin tests in endurance athletes. Clin J Sport Med 1997;7:46-53.

65. Adams WB: Hematology in the athlete. In O'Connor FG, Sallis RE, Wilder RP, et al (eds): Sports Medicine: Just the Facts. New York, McGraw-Hill, 2005, pp 193-199.

66. Kane, MJ: The female athletic role as a status determinant with the social system of high school adolescents. Adolescence 1998;23: 253-264.

67. Hawley CJ, Schoene RB: Overtraining syndrome, a guide to diagnosis, treatment, and prevention. Phys Sports Med 2003;31:25-31.

68. Howard TM: Overtraining syndrome/chronic fatigue. In O'Connor FG, Sallis RE, Wilder RP, et al (eds): Sports Medicine: Just the Facts. New York, McGraw-Hill, 2005, pp 228-232.

69. Ketner JB: Overtraining. In Mellion MB, Walsh WM, Madden C, et al (eds): Team Physician Handbook, 3rd ed. Philadelphia, Hanley & Belfus, 2002, pp 215-218.

70. American Psychiatric Association: Diagnostic and Statistical Manual for Mental Disorders, 4th edition. Washington, DC, American Psychiatric Association, 1994.

71. Hobart JA, Smucker DS: The female athlete triad. Am Fam Physicians 2000;61:3357-3367.

72. Broström MPG, Boskey A, Kaufman J, Einhorn TA: Form and function of bone. In Buckwalter J, Einhorn T, Simon S (eds): Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2000, p 356.

Was this article helpful?

0 0
Lessons You Can Learn From Fitness Classes

Lessons You Can Learn From Fitness Classes

Greater Results and Better Health With Intense Fitness Classes Lessons. This Book Is One Of The Most Valuable Resources In The World When It Comes To Powerful Tips To Enjoy your Fitness classes.

Get My Free Ebook


Post a comment