Clinical Issues for the

Female Athlete across the

Lifespan

Moderator: Dr. Manon Cote

Panellist

Dr. Laura Cruz

Panellist

Dr. Julia Alleyne

Panellist

Dr. Ghislaine

Robert

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.

The difference between

Sex and Gender

Q.What makes females genetically different from

males?

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

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

The Female Lifespan

Livia loves Volleyball

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

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

Observation

Physical Exam

Tenderness mid-tibia bilaterally

+vibration test for pain

+ trendelenberg in single leg ¼ squats

Investigations:

Increased tibiae uptake on bone scan

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?

Growth and maturation

Tanner Stages

Physical Activity Guidelines for Teenshttp://www.who.int/dietphysicalactivity/factsheet_young_people/en/

Frequency

Daily physical activity

Intensity

Moderate to vigorous intensity

Type

Aerobic and strengthening (3x / wk)

Time

60 min/day

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

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

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

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

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

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

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?

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

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

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

Team Approach to Care

Child centred approach

With consent/ assent

Parents

Coaches

Teachers

Medical Team

Rebecca Rows

27 year old 1st 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

Ultrasound Results

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?

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

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

Current Guidelines

T1 Inactive T1 Active T2 T3

Frequency None Maintain Initiate/ Increase Modify

Intensity None Light Moderate Light

Time None 30 minutes 30-40 minutes 30 min.

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

Training Concerns

Dehydration

Hypoxia

Uterine Trauma

Energy Balance

Iron, Calcium, Folic Acid

Musculoskeletal Changes

Cardiovascular effects

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

Training Modifications

Modify Frequency

Modify Intensity

Build in recovery time

Build in Nutrition

Monitor Mom

Monitor Baby

Creative Cross Training

Have it all !

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?