1
|
Warrick AE, Hassid B, Coleman B, Cansino C, Faustin M. Multidisciplinary physician survey assessing knowledge of the female athlete triad and relative energy deficiency in sport. J Eat Disord 2023; 11:70. [PMID: 37161433 PMCID: PMC10169360 DOI: 10.1186/s40337-023-00800-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Short and long-term health consequences surrounding Low Energy Availability can be mitigated by recognizing the risk factors and making early diagnosis of the Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S). While awareness of the Triad among physicians and allied health professionals has been studied, there are very few studies that assess physician awareness of both the Triad and RED-S. METHODS Our study assesses Low Energy Availability, the Triad, and RED-S knowledge with an electronic survey, educational handout, and follow up survey among physicians across multiple specialties at a single academic institution. RESULTS Among 161 respondents, respective Triad and RED-S awareness among surveyed specialties was highest in Orthopedic surgeons (100%, 100%), followed by Physical Medicine & Rehabilitation (70%, 53%), Family Medicine (67%, 48%), Internal Medicine (54%, 36%), Obstetrics and Gynecology (46%, 32%), Pediatrics (45%, 29%), Endocrinology (33%, 33%), and Other (33%, 33%). Comparing the initial survey results to the follow-up survey results, there was an increase from 37 to 72% of physicians who correctly identified that the presence of low BMI or recent weight loss is not a required component of the Triad or RED-S. Both the initial and follow-up survey revealed a continued misperception surrounding the use of hormonal contraception to resume menstrual cycles, with 33% of physicians on initial survey and 44% of physicians on follow-up survey incorrectly answering that question. CONCLUSIONS Multidisciplinary physicians have various levels of knowledge surrounding the Triad and RED-S, and there is a need for improved physician awareness, diagnosis, and treatment of the Triad and RED-S. Misperceptions exist surrounding the role of hormonal contraception in female athletes with the Triad and RED-S to regain and regulate menses.
Collapse
Affiliation(s)
- Alexandra E Warrick
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Suite 3850, Sacramento, CA, 95817, USA
| | - Brandon Hassid
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Suite 3850, Sacramento, CA, 95817, USA
| | - Brandon Coleman
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Suite 3850, Sacramento, CA, 95817, USA
| | - Catherine Cansino
- Department of Obstetrics and Gynecology, University of California Davis School of Medicine, 2521 Stockton Blvd, 4th floor, Sacramento, CA, 95817, USA
| | - Marcia Faustin
- Department of Family & Community Medicine, University of California Davis School of Medicine, 4860 Y street Suite 3850, Sacramento, CA, 95816, USA.
| |
Collapse
|
2
|
Hoenig T, Tenforde AS, Strahl A, Rolvien T, Hollander K. Does Magnetic Resonance Imaging Grading Correlate With Return to Sports After Bone Stress Injuries? A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:834-844. [PMID: 33720786 DOI: 10.1177/0363546521993807] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While some studies have failed to reveal any significant relationship between magnetic resonance imaging (MRI) grading and return to sports after bone stress injuries, others have reported either a linear or nonlinear relationship. PURPOSE To evaluate the prognostic value of MRI grading for time to return to sports and rate of return to sports after bone stress injuries. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic search was performed in PubMed, Web of Science, SPORTDiscus, and Google Scholar. Studies reporting return to sports data after bone stress injuries using MRI grading systems were included in this review. The risk of bias was evaluated using the Quality in Prognosis Studies tool. Meta-analyses were performed to summarize the mean time to return to sports. The Pearson correlation was used to determine the relationship between time to return to sports and MRI grade. A meta-analysis of proportions was conducted to determine the percentage of athletes who successfully returned to sports. RESULTS A total of 16 studies with 560 bone stress injuries met inclusion criteria. Higher MRI-based grading was associated with an increased time to return to sports (P < .00001). Pooled data revealed that higher MRI-based grading correlated with a longer time to return to sports (r = 0.554; P = .001). Combining all anatomic locations, the mean time to return to sports was 41.7 days (95% CI, 30.6-52.9), 70.1 days (95% CI, 46.9-93.3), 84.3 days (95% CI, 59.6-109.1), and 98.5 days (95% CI, 85.5-112.6) for grade 1, 2, 3, and 4 injuries, respectively. Trabecular-rich sites of injury (eg, pelvis, femoral neck, and calcaneus) took longer to heal than cortical-rich sites of injury (eg, tibia, metatarsal, and other long-bone sites of injury). Overall, more than 90% of all athletes successfully returned to sports. CONCLUSION The findings from this systematic review indicate that MRI grading may offer a prognostic value for time to return to sports after the nonsurgical treatment of bone stress injuries. Both MRI grade and location of injury suggest that individually adapted rehabilitation regimens and therapeutic decisions are required to optimize healing and a safe return to sports.
Collapse
Affiliation(s)
- Tim Hoenig
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Adam S Tenforde
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts, USA
| | - André Strahl
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Tim Rolvien
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Karsten Hollander
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts, USA.,MSH Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
| |
Collapse
|
3
|
McSweeney SC, Grävare Silbernagel K, Gruber AH, Heiderscheit BC, Krabak BJ, Rauh MJ, Tenforde AS, Wearing SC, Zech A, Hollander K. Adolescent Running Biomechanics - Implications for Injury Prevention and Rehabilitation. Front Sports Act Living 2021; 3:689846. [PMID: 34514384 PMCID: PMC8432296 DOI: 10.3389/fspor.2021.689846] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/23/2021] [Indexed: 12/28/2022] Open
Abstract
Global participation in running continues to increase, especially amongst adolescents. Consequently, the number of running-related injuries (RRI) in adolescents is rising. Emerging evidence now suggests that overuse type injuries involving growing bone (e.g., bone stress injuries) and soft tissues (e.g., tendinopathies) predominate in adolescents that participate in running-related sports. Associations between running biomechanics and overuse injuries have been widely studied in adults, however, relatively little research has comparatively targeted running biomechanics in adolescents. Moreover, available literature on injury prevention and rehabilitation for adolescent runners is limited, and there is a tendency to generalize adult literature to adolescent populations despite pertinent considerations regarding growth-related changes unique to these athletes. This perspective article provides commentary and expert opinion surrounding the state of knowledge and future directions for research in adolescent running biomechanics, injury prevention and supplemental training.
Collapse
Affiliation(s)
- Simon C McSweeney
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Allison H Gruber
- Department of Kinesiology, School of Public Health - Bloomington, Indiana University, Bloomington, IN, United States
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, United States
| | - Brian J Krabak
- Department of Rehabilitation, Orthopedics and Sports Medicine, University of Washington and Seattle Childrens Hospital, Seattle, WA, United States
| | - Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA, United States
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Scott C Wearing
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Astrid Zech
- Department of Human Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University Jena, Jena, Germany
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Faculty of Medicine, MSH Medical School Hamburg, Hamburg, Germany
| |
Collapse
|
4
|
Wallwiener LM, Kapfer B, Seifert-Klauss V. Knochengesundheit und Hochleistungssport. GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-021-00400-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ZusammenfassungRegelmäßige körperliche Betätigung trägt zu einer gesunden Knochendichte bei, Leistungssportlerinnen in einigen Sportarten weisen jedoch eine erhöhte Prävalenz erniedrigter Knochendichte sowie vermehrt Stressfrakturen auf. Häufig liegt dem ein relatives Energiedefizit (RED), verbunden mit hoher mechanischer Belastung und intensivem Trainingsalltag, zugrunde. Das Vorliegen eines RED im Sport ist oft unterdiagnostiziert, daher hat sich eine systematische multidisziplinäre Zusammenarbeit unter Zuhilfenahme standardisierter Tests, z. B. des RED‑S CAT (Relative Energy Deficiency in Sport Clinical Assessment Tool) als hilfreich erwiesen. Therapieansätze zielen primär auf eine Behebung der negativen Energiebilanz der Patientin als auch auf psychotherapeutische Interventionen ab. Darüber hinaus kann in schweren Fällen eine medikamentöse Therapie zur Unterstützung sowohl einer ausgeglichenen hormonellen Situation als auch des Knochenstoffwechsels notwendig sein.
Collapse
|
5
|
de Borja C, Holtzman B, McCall LM, Carson TL, Moretti LJ, Farnsworth N, Ackerman KE. Specific dietary practices in female athletes and their association with positive screening for disordered eating. J Eat Disord 2021; 9:50. [PMID: 33865448 PMCID: PMC8052728 DOI: 10.1186/s40337-021-00407-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/07/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To determine if following specific diets was associated with reporting behaviors that are consistent with disordered eating compared to non-diet-adherent athletes. We hypothesized that athletes adhering to specific diets were more likely to report disordered eating than those not following a diet. METHODS One thousand female athletes (15-30 years) completed a comprehensive survey about athletic health and wellness. Athletes were asked to specify their diet and completed 3 eating disorder screening tools: the Brief Eating Disorder in Athletes Questionnaire, the Eating Disorder Screen for Primary Care, and self-reported current or past history of eating disorder or disordered eating. Descriptive statistics were calculated for all study measures and chi-squared tests assessed relationships between athletes' dietary practices and their responses to eating disorder screening tools. Statistical significance was defined as p < 0.05. RESULTS Two hundred thirty-four of 1000 female athletes reported adherence to specific diets. 69 of the 234 diet-adhering athletes (29.5%) were excluded due to medically-indicated dietary practices or vague dietary descriptions. Of the 165 diet-adherent athletes, 113 (68.5%) screened positively to ≥1 of the 3 eating disorder screening tools. Specifically, athletes practicing a low-carbohydrate diet were more likely to report disordered eating vs. athletes without dietary restrictions (80% vs. 41.8%; p < 0.0001). CONCLUSION Specific diet adherence in female athletes may be associated with reporting behaviors that are consistent with disordered eating. Health practitioners should consider further questioning of athletes reporting specific diet adherence in order to enhance nutritional knowledge and help treat and prevent eating disorders or disordered eating.
Collapse
Affiliation(s)
- Celina de Borja
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Avenue - 6th Floor, Boston, MA, 02115, USA
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Bryan Holtzman
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Avenue - 6th Floor, Boston, MA, 02115, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren M McCall
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Avenue - 6th Floor, Boston, MA, 02115, USA
| | - Traci L Carson
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Laura J Moretti
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Avenue - 6th Floor, Boston, MA, 02115, USA
| | - Nicole Farnsworth
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Avenue - 6th Floor, Boston, MA, 02115, USA
| | - Kathryn E Ackerman
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Avenue - 6th Floor, Boston, MA, 02115, USA.
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
6
|
Abstract
Hintergrund Die labordiagnostische Untersuchung stellt eine wichtige Möglichkeit zur Beurteilung und Optimierung der Leistungs- und Regenerationsfähigkeit professioneller Athleten dar. Ferner ist sie für die Prävention, Diagnostik und Rehabilitation von Verletzungen und Überbelastungen von Bedeutung. Fragestellung Ziel dieser Arbeit ist die Darstellung muskuloskelettaler laborchemischer Parameter, die relevante Erkenntnisse für die medizinische Betreuung von Leistungssportlern liefern. Material und Methoden Literaturrecherche und narratives Review. Ergebnisse Die Bestimmung des Vitamin-D-, Calcium- und Knochenstoffwechsels stellt die laborchemische Basisdiagnostik im Rahmen der Beurteilung des Skelettstatus mit zusätzlichem präventivem Nutzen bezüglich muskuloskelettaler Verletzungen dar. Ferner können muskuläre Serummarker, z. B. Laktatdehydrogenase (LDH), Kreatinkinase (CK), Myoglobin und Aspartat-Aminotransferase (ASAT), helfen, eine metabolische Adaptation an das physische Training festzustellen und Aussagen über die muskuläre Arbeitslast und mögliche Schädigungen zu gewinnen. Die Energieverfügbarkeit kann durch eine entsprechende Bilanzierung sowie die laborchemische Bestimmung der Makro- und Mikronährstoffe eingeschätzt und optimiert werden. Schlussfolgerungen Die labordiagnostische Untersuchung besitzt in der Betreuung von Athleten eine sportartenübergreifende klinische Relevanz. Sie dient der Erreichung einer höchstmöglichen Leistungsfähigkeit sowie optimalen Prävention von Knochen- und Muskelverletzungen, wobei sämtliche Mangelzustände (z. B. Vitamin D) ausgeglichen werden sollten. Durch eine Periodisierung der laborchemischen Untersuchungen, mit zumindest zwei Labordiagnostiken im Jahr, und Aufstellung individueller Variabilitäts- und Referenzbereiche kann ferner eine bessere Beurteilbarkeit erreicht werden.
Collapse
|
7
|
Hollander K, Rahlf AL, Wilke J, Edler C, Steib S, Junge A, Zech A. Sex-Specific Differences in Running Injuries: A Systematic Review with Meta-Analysis and Meta-Regression. Sports Med 2021; 51:1011-1039. [PMID: 33433864 PMCID: PMC8053184 DOI: 10.1007/s40279-020-01412-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Running is a popular sport with high injury rates. Although risk factors have intensively been investigated, synthesized knowledge about the differences in injury rates of female and male runners is scarce. OBJECTIVE To systematically investigate the differences in injury rates and characteristics between female and male runners. METHODS Database searches (PubMed, Web of Science, PEDro, SPORTDiscus) were conducted according to PRISMA guidelines using the keywords "running AND injur*". Prospective studies reporting running related injury rates for both sexes were included. A random-effects meta-analysis was used to pool the risk ratios (RR) for the occurrence of injuries in female vs. male runners. Potential moderators (effect modifiers) were analysed using meta-regression. RESULTS After removal of duplicates, 12,215 articles were screened. Thirty-eight studies were included and the OR of 31 could be pooled in the quantitative analysis. The overall injury rate was 20.8 (95% CI 19.9-21.7) injuries per 100 female runners and 20.4 (95% CI 19.7-21.1) injuries per 100 male runners. Meta-analysis revealed no differences between sexes for overall injuries reported per 100 runners (RR 0.99, 95% CI 0.90-1.10, n = 24) and per hours or athlete exposure (RR 0.94, 95% CI 0.69-1.27, n = 6). Female sex was associated with a more frequent occurrence of bone stress injury (RR (for males) 0.52, 95% CI 0.36-0.76, n = 5) while male runners had higher risk for Achilles tendinopathies (RR 1. 86, 95% CI 1.25-2.79, n = 2). Meta-regression showed an association between a higher injury risk and competition distances of 10 km and shorter in female runners (RR 1.08, 95% CI 1.00-1.69). CONCLUSION Differences between female and male runners in specific injury diagnoses should be considered in the development of individualised and sex-specific prevention and rehabilitation strategies to manage running-related injuries.
Collapse
Affiliation(s)
- Karsten Hollander
- Medical School Hamburg, Hamburg, Germany.
- Department of Physical Medicine and Rehabilitation, Spaulding National Running Center, Harvard Medical School, Cambridge, MA, USA.
| | - Anna Lina Rahlf
- Department of Human Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University Jena, Jena, Germany
| | - Jan Wilke
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Christopher Edler
- Prevention, Rehabilitation and Interdisciplinary Sports Medicine, BG Trauma Hospital of Hamburg, Hamburg, Germany
| | - Simon Steib
- Department of Human Movement, Training and Active Aging, Institute of Sports and Sports Science, Heidelberg University, Heidelberg, Germany
| | - Astrid Junge
- Medical School Hamburg, Hamburg, Germany
- Swiss Concussion Center, Schulthess Klinik, Zürich, Switzerland
| | - Astrid Zech
- Department of Human Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University Jena, Jena, Germany
| |
Collapse
|
8
|
Wasserfurth P, Palmowski J, Hahn A, Krüger K. Reasons for and Consequences of Low Energy Availability in Female and Male Athletes: Social Environment, Adaptations, and Prevention. SPORTS MEDICINE - OPEN 2020; 6:44. [PMID: 32910256 PMCID: PMC7483688 DOI: 10.1186/s40798-020-00275-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/20/2020] [Indexed: 02/07/2023]
Abstract
Low energy availability (LEA) represents a state in which the body does not have enough energy left to support all physiological functions needed to maintain optimal health. When compared to the normal population, athletes are particularly at risk to experience LEA and the reasons for this are manifold. LEA may result from altered dietary behaviours that are caused by body dissatisfaction, the belief that a lower body weight will result in greater performance, or social pressure to look a certain way. Pressure can also be experienced from the coach, teammates, and in this day and age through social media platforms. While LEA has been extensively described in females and female athletes have started fighting against the pressure to be thin using their social media platforms, evidence shows that male athletes are at risk as well. Besides those obvious reasons for LEA, athletes engaging in sports with high energy expenditure (e.g. rowing or cycling) can unintentionally experience LEA; particularly, when the athletes' caloric intake is not matched with exercise intensity. Whether unintentional or not, LEA may have detrimental consequences on health and performance, because both short-term and long-term LEA induces a variety of maladaptations such as endocrine alterations, suppression of the reproductive axis, mental disorders, thyroid suppression, and altered metabolic responses. Therefore, the aim of this review is to increase the understanding of LEA, including the role of an athlete's social environment and the performance effects related to LEA.
Collapse
Affiliation(s)
- Paulina Wasserfurth
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Am Kleinen Felde 30, [PW1] 30167, Hannover, Germany
| | - Jana Palmowski
- Institute of Sports Science, Department of Exercise Physiology and Sports Therapy, Justus-Liebig University Giessen, Kugelberg 62, 35394, Giessen, Germany
| | - Andreas Hahn
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Am Kleinen Felde 30, [PW1] 30167, Hannover, Germany
| | - Karsten Krüger
- Institute of Sports Science, Department of Exercise Physiology and Sports Therapy, Justus-Liebig University Giessen, Kugelberg 62, 35394, Giessen, Germany.
| |
Collapse
|