PUSHING THE LIMITS CONSEQUENCES OF GETTING TO THE IDEAL BODY

Transcription

1 PUSHING THE LIMITS CONSEQUENCES OF GETTING TO THE IDEAL BODY Stephanie Chu, DO Associate Professor University of Colorado SOM Team Physician Colorado Buffaloes

2 AS AN ATHLETE YOU ARE CONSTANTLY BEING PUSHED TO YOUR LIMITS, EVERY PART OF YOU IS MEASURED DIET, STAMINA, PACE, TIME, POWER THE WORLD SEES YOU AS HAVING THE PERFECT FORM YOU ARE SUPPOSED TO BE PERFECT, A CHAMPION, THE EMBODIMENT OF CONFIDENCE AND STRENGTH. InfluencePub 2014

3 Objectives Sports most at risk for having athletes with disordered eating Injuries and medical complications associated with aesthetic sports and endurance sports Gracie Gold Top U.S. Woman in Figure Skating at Sochi Olympics Has not competed since Jan 2017 U.S. Championships in treatment for an eating disorder, depression and anxiety

4 Sports/Events Included as High-Intensity Sports

5 High-Intensity Sports Skiing Badminton Figure Skating Gymnastics Judo/karate/Taekwondo Kickboxing Middle distance running Rowing Tennis Speed Skating Swimming Ballet Wrestling

6 Heidi Guenther ( ) Ballet dancer who struggled with anorexia after being advised by the Boston Ballet to lose 5lbs Heidi died at the age of 22 because of complications associated with anorexia After her death a program was created to raise awareness and reduce eating disorders in dancers

7 STRESS FRACTURES Cause, Locations, Diagnosis and Treatment

8 Stress Fractures Dieting athletes Disordered eating Serious eating disorder Osteopenia/ Osteoporosis Imbalance bone remodeling Disruption of normal menstrual cycle Stress Fractures

9 Common Stress Fracture Locations Metatarsals, Navicular, Tibia/Fibula Ballet, Cross Country, Track & Field, Figure Skating Femur Cross Country, Track & Field Lumbar Spine/Pelvis Swimming/Diving, Wrestling, Ballet, Gymnastics, Cross Country, Track & Field Forearm, Elbow Rowing, Gymnastics

10 Stress Fracture Imaging X-rays are typically NEGATIVE Usually needs MRI or Bone Scan

11 Stress Fractures Treatment

12 Stress Fractures Rehabilitation Resistance training Muscular endurance training CORE and pelvic girdle stability Balance and proprioception Flexibility training Gait retraining

13 Nadia Comaneci Romanian gymnast best know for the first to achieve a score of a perfect 10 Won 9 Olympic Gold medals Struggled with BOTH anorexia and bulimia She has overcome these eating disorders today through eating disorder treatment

14 GYN and Reproductive Secondary amenorrhea Weight loss of between 10-15% of normal weight disrupts menstrual cycle Weight gain restores menstrual cycles (~9mos, 90-95% of ideal body weight) NOT suggested to use hormones for purposes of treatment Vigorous exercise or athletic women is not cause for amenorrhea, menstrual cycles should return with less activity and weight gain Christy Henrich U.S. Gymnast with Anorexia and Bulimia She was told by a judge she was too fat to excel in gymnastics, died at age 22, weighing 47 lbs

15 GI Disorders Anorexia Nervosa Gastroparesis Delayed gastric emptying Develops with food restriction and weight loss of 10-20lbs Constipation Frequently accompanies weight loss Usually treated incorrectly with laxatives Weight restoration will restore previous bowel patterns Mia St. John Female Boxer Lightweight Champion Overcame anorexia during career

16 Gastroparesis Symptoms Bloating usually occurring AFTER eating and worsened with high fiber diet or fiber laxatives Early satiety, fullness, nausea and vomiting (not self-induced) Heartburn Bloating usually used by athletes as a reason why they can t eat more to gain weight Management Reassure athletes the eating does NOT cause gastroparesis Usually resolves with weight restoration around 4-6 weeks Generally improves with partial weight gain, significant improvement occurs with 10lb weight gain Resolves with weight gain to 80% ideal body weight, or if BMI gets to 17 or 18

17 Bulimia Nervosa Cathy Rigby First U.S. gymnast to win a medal at Worlds Battled bulimia for 12 years Zina Garrison U.S tennis player who won 2 Olympic golds Age 19 developed bulimia likely due to stress

18 Bulimia Electrolyte Imbalances Dehydration Hypokalemia Muscle weakness, cardiac arrhythmias, impaired renal function In healthy athletes is highly specific for bulimia Hypochloremia Hyponatremia Metabolic Acidosis Routine screening detects electrolyte abnormality. Corrected by discontinuing purging behavior. Martina Eberl German golfer with bulimia from ages before seeking any treatment

19 Consequences of the Ideal Body Nancy Kerrigan Winner of 2 Olympic medals Struggled with eating disorder possibly due to Tonya Harding drama Recognition that underlying cause of certain injuries and medical issues may be due to eating disorder Multidisciplinary treatment team necessary to manage these athletes Treatment of eating disorder typically will correct medical issues Recurrent stress fractures would need further assessment of RED-s

20 Multidisciplinary Treatment Team Athletic Trainer Strength Coach

21 Take Home Points Recognize High Intensity Sports associated with disordered eating Consequences of getting to the Ideal Body for sport Stress Fracture Amenorrhea Gastroparesis Constipation Electrolyte Abnormalities Multidisciplinary Team approach for treatment

22 QUESTIONS???

23 References Sundgot-Borgen, S, Torstveit, MK. Aspects of disordered eating continuum in elite high-intensity sports. Scand J Med Sci Sports Oct;20 Suppl 2: Rizzone, KH, et al. The Epiemiology of Stress Fractures in Collegiate Student-Athletes Through Academic Years. Journal of Athletic Training. 2017;52(10): Saunier J, Chapurlat R. Stress fracture in athletes. Joint Bone Spine May Hail, Lisa, and Daniel Le Grange. "Bulimia nervosa in adolescents: prevalence and treatment challenges." Adolescent health, medicine and therapeutics 9 (2018): 11. Joy E, Kussman A, Nattiv A update on eating disorders in athletes: A Comprehensive narrative review with a focus on clinical assessment and management. Br J Sports Med Feb;50(3):