Clinical Issues for the Female Athlete across the Lifespan. Moderator: Dr. Manon Cote

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Eugenia Johns
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1 Clinical Issues for the Female Athlete across the Lifespan Moderator: Dr. Manon Cote

2 Panellist Dr. Laura Cruz

3 Panellist Dr. Julia Alleyne

4 Panellist Dr. Ghislaine Robert

5 Definition of Women s Health Women s Health involves women s emotional,social, cultural, spiritual and physical well-being, it is determined by the social, political and economic context of women s lives as well as by biology. This broad definition recognizes the validity of women s life experience of health. Every woman should be provided with the opportunity to achieve, sustain and maintain health, as defined by that woman herself, to her full potential.

6 The difference between Sex and Gender Q.What makes females genetically different from males?

7 Sex versus Gender Sex: What makes females genetically different from males. - Anatomy - Physiology Gender: What makes women in society different from men. - Sociology - Psychology - Environment

8 Approach to Women s Health What is Common in Women Carpal Tunnel Syndrome Patello-Femoral Syndrome What is at Risk in Women ACL Tears Shoulder Capsulitis What is more severe in women Osteoporosis Medial Knee Osteoarthritis Fibromyalgia What is Exclusive in Women Female Athlete Triad Uterine Cancer causing Back Pain

9 The Female Lifespan

10 Livia loves Volleyball

11 History 5 weeks bilateral shin pain Intermittent, worse with running and quick walks Volleyball 4 practices/week plus tournaments Running 5k runs with Dad most days Past History Left Ankle Sprain 3 months ago Right Rotator Cuff Strain 4 months ago Lifestyle Piano lessons conflict with her sport Likes to run to keep in shape Straight A student

12 Growth and Development Pre-menarchal In last year, grew 4 inches and 16 lb weight increase Avoid milk products but has almond milk on breakfast cereal Breast budding is evident Tanner Scale 3

13 Observation

14 Physical Exam Tenderness mid-tibia bilaterally +vibration test for pain + trendelenberg in single leg ¼ squats Investigations: Increased tibiae uptake on bone scan

15 Clinical Questions What are the markers of normal growth and development? How many hours of physical activity is optimal in a 13 year old? Are there are risk factors for injury in her case?

16 Growth and maturation

17 Tanner Stages

18 Physical Activity Guidelines for Teens Frequency Daily physical activity Intensity Moderate to vigorous intensity Type Aerobic and strengthening (3x / wk) Time 60 min/day

19 Risk Factors for Injury Individual Injury Risk Growth related Training related Previous injury Sport Early specialization regardless of sport type Common injuries Society Body image concerns

20 Injury Risk Growth Open physes Apophyisitis Growth Velocity Training Increased volume with level of play Repetitive tasks lead to overuse injuries Surface of play Previous Injury

21 Sport Related Issues Increase in early specialization in single sport LTAD is a theoretical model in evolution Outlines training goals/ volumes based on developmental age Little data on injuries in many sports for younger elite athletes Adult volleyball players may have acute ankle, & overuse knee & shoulder injuries

22 Society and Body Image Internalization of thin body ideal occurs in girls as young as 5 yr old TV, magazine and music video viewing is a strong predictor for thin body ideal 8-10 yr old girls value looking good and are influenced by peers/ female celebrities Child- friendly media also reinforces the thin body ideal Walt Disney heroines

23 Are Athletes at Risk? DE/ED is present in 6-45% of female athletes Sport anxiety is predictive for increased drive for thinness in any sport Level of sport anxiety and level of competition are predictive for higher levels of body dissatisfaction

25 Low Energy Availability Results in altered levels of several metabolic, growth and reproductive hormones Leads to Reduced metabolic rate; increased energy conservation Menstrual disturbances Abnormalities of bone metabolism Anemia Altered Immune function These changes may affect health and athletic performance

26 Clinical Thinking What is the interpretation and management of her symptoms and physical exam? How do you constructively deal with weight concerns in young females? Would you involve her coach in this discussion?

27 Clinical Assessment of Livia Bilateral stress # s +ve bone scan Possible body image issues Societal factors Desire to be in shape (thin body ideal) Nutritional inadequacies Low calcium and Vit D intake Sport related stress

28 Current Injury Management of tibial stress fractures Relative rest Optimize biomechanics and muscle imbalances Assess jumping/ landing technique Education about Training volume Biomechanics Food as fuel

29 Other risk factors-body Image Food as fuel Adequate energy intake Avoid Low Energy Availability Calcium/ Vit D Stress management strategies Optimize schedule Relaxation techniques Achievable goals

30 Team Approach to Care Child centred approach With consent/ assent Parents Coaches Teachers Medical Team

32 Rebecca Rows 27 year old 1 st Pregnancy,10 weeks Past Olympic Rower Training for Competitive Masters Race 6x week x 90 minutes Very competitive nature Wants to know if she is doing any harm Wants to do this one last race

36 Ultrasound Results

37 Your Approach What are the issues? What are the guidelines for safe participation in pregnancy? How would you assess her objectively? What type of psychosocial issues are your facing with this patient?

38 Evidence Informed Advice Get out of the Boat Up to 28 weeks gestation Guidelines for low risk Monitoring Self-pacing 28 weeks Exercise is a relative contraindication

39 Key Questions Active or Inactive Low risk or High Risk Non-Contact or Contact Healthy Weight or Unhealthy Weight Healthy History or Health Problems Optimal Training or Overtraining

40 Current Guidelines T1 Inactive T1 Active T2 T3 Frequency None Maintain Initiate/ Increase Modify Intensity None Light Moderate Light Time None 30 minutes minutes 30 min.

41 Female Athlete Issues for the Team Physician Exercise in Pregnancy is generally safe but often limitations need to be applied. Assessment and Recommendations: Risk Stratification Sport Specific Risks Medication/Nutrition/ Environmental Increased Education of Professionals

42 Training Concerns Dehydration Hypoxia Uterine Trauma Energy Balance Iron, Calcium, Folic Acid Musculoskeletal Changes Cardiovascular effects

43 Monitoring in Pregnancy The Pregnant Woman Water and nutrition intake Urine Weight Symptoms Energy/ dizziness/weakness The Physician More frequent visits Growth and Development parameters Uterine health

44 Training Modifications Modify Frequency Modify Intensity Build in recovery time Build in Nutrition Monitor Mom Monitor Baby Creative Cross Training

45 Have it all!

46 Your Approach What are the issues? What are the guidelines for safe participation in pregnancy? How would you assess her objectively? What type of psychosocial issues are your facing with this patient?

Stress Injuries in the Young Athlete 3 rd Annual Young Athlete Conference Greg Canty, MD Medical Director, Center for Sports Medicine Asst Professor

Stress Injuries in the Young Athlete 3 rd Annual Young Athlete Conference Greg Canty, MD Medical Director, Center for Sports Medicine Asst Professor of Orthopaedics & Pediatrics Disclosures Neither I,