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4. MSK 1 Female Athlete Triad Flashcards

Female Athlete Triad

1
Q

What is energy availability?

A

Defined as the amount of energy available for physiological processes and activities of daily living after subtracting out the energy used for exercise training.

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2
Q

How is energy availability calculated?

A

(Energy intake – exercise energy expenditure) / kg lean body mass.

How much is ledt over after training

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3
Q

What hormonal disruption occurs due to an energy-deficient state?

A

Disrupts the secretion of gonadotropin-releasing hormone from the hypothalamus.

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4
Q

What are the two types of menstrual disturbances?

A
  • Subclinical
  • Clinical
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5
Q

What characterizes subclinical menstrual disturbances?

A

Occurs in the face of apparently regular cycles, encompass luteal phase defects and anovulation.

Subtle difference

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6
Q

What are examples of clinical menstrual disturbances?

A
  • Oligomenorrhea (36-90 days)
  • Amenorrhea

severe disturbance

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7
Q

What is functional hypothalamic amenorrhea?

A

Amenorrhea caused by an energy deficit resulting from a functional disorder of the hypothalamus.

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8
Q

What effect does low energy availability have on bone formation?

A

Suppression of insulin-like growth factor-1 and alteration of circulating concentrations of bone health metabolic hormones. Upregulation of bone reasorption

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9
Q

What is the impact of decreased serum concentrations of estrogen on bone health?

A

Causes an upregulation of bone resorption.

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10
Q

What are the characteristics of bone health in female athletes?

A
  • Lower trabecular number
  • Greater trabecular spacing

Greater at Distal tibia , total bone area not found in nonweightbearing areas lumbar spine radius

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11
Q

What is the significance of habitual exercise for bone strength?

A

May be partially protective against a reduction in bone strength.

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12
Q

What are the strongest predictors of bone structure in female athletes?

A
  • High impact loading
  • Odd impact loading
  • nonimpact
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13
Q

What is the relationship between menstrual status and bone health?

A

Menstrual status may not strongly influence bone health compared to loading modality.

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14
Q

What are primary contributors to bone mass and structure in female athletes?

A
  • Metabolic status
  • Body mass
  • menstrual function
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15
Q

What do amenorrheic athletes frequently present with?

A
  • Low areal BMD at lumbar spine
  • Reduced trabecular volumeric BMD
  • Reduced bone strength index at distal adius
  • Deterioration of trabecular microarchitecture at distal tibia
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16
Q

What role does age of menarche play in bone mineral density (BMD)?

A

Late menarche is one of the strongest predictors of low BMD.

Lean body mass is strongest predictor of area BMD

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17
Q

What factors increase the risk of stress fractures in athletes?

A

Current oligo/amenorrhea increases the likelihood of experiencing a stress fracture.

Actors associated with female athlete triad

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18
Q

What is necessary for complete recovery of bone health in athletes with the Triad?

A

Depends on whether primary or secondary amenorrhea occurred in adolescence or young adulthood.

EMD was not restored but bone area able to become comparable to healthy subjects

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19
Q

What is the most effective treatment for low bone mass in female athletes?

A

Nonpharmacological treatment including an increase in caloric intake and resistance training.

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20
Q

What are the recommended daily intakes of calcium and vitamin D for bone mineralization?

A
  • Calcium: 1,000–1,300 mg
  • Vitamin D: 600–1,000 IU
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21
Q

What is the effect of combined oral contraceptives on amenorrheic athletes?

A

Absence of a treatment effect.

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22
Q

What is the role of estrogen therapy in bone health?

A

Attenuated bone loss at the lumbar spine, but evidence is weak for the femoral neck.

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23
Q

What are the effects of recombinant human insulin-like growth factor-1?

A

Increased BMD by 1.8% in 9 months when combined with COC.

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24
Q

What is a potential concern with bisphosphonates as a treatment option?

A

Not recommended for women with reproductive potential or adolescent athletes due to growth impairment.

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25
Q

What is the noncontact ACL injury rate difference between female and male athletes?

A

Two to six times higher in female athletes.

Divergence in injury rates is evident immediately after puberty.

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26
Q

What is a common risk factor for patellofemoral pain in female athletes?

A

Knee valgus displacement as assessed by the box drop test.

Early sport specialization is also a risk factor.

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27
Q

What are the most common shoulder injuries in female athletes?

A

Impingement/rotator cuff, labral tears, and glenohumeral instability.

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28
Q

In which anatomical areas do bone stress injuries commonly occur in female athletes?

A

Foot, tibia, fibula, femur, pelvis, and sacrum.

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29
Q

What physiological factors contribute to bone stress injuries in female athletes?

A

Repetitive and overload stress, previous BSI, LEA, poor nutrition, menstrual dysfunction, low BMD, low BMI, low body weight, and disordered eating.

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30
Q

True or False: The risk of concussion is higher in female athletes than male athletes.

A

True.

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31
Q

What factors contribute to low bone mass and osteoporosis in female athletes?

A

Low energy availability, disordered eating, and menstrual dysfunction.

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32
Q

What is peak bone mass largely dependent on?

A

Genetic factors, weight bearing/loading exercise, lean body mass, reproductive hormone status, adequate energy intake, and bone-building nutrients.

Peak bone mass is attained between ages 20 and 30.

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33
Q

What is the Z score range for low bone mass according to ACSM?

A

Between -1.0 SD and -2.0.

Advantageous to identify athletes during first year of amenorrhea

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34
Q

What is the definition of osteoporosis in terms of Z scores?

A

Z-scores of -2.0 and below.

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35
Q

What are some medications that should not be tried due to safety effects on pregnancy in premenopausal women?

A

Bisphosphonates, teriparatide, selective estrogen receptor modulators, and denosumab.

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36
Q

Fill in the blank: The ‘SCOFF’ questionnaire is used for _______.

A

screening for eating disorders.

Other outcomes include eating disorder inventory EDI and LEA in females questionnaire LEAF – Q

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37
Q

What are the components of the female athlete triad?

A

LEA With or without DE/ED, menstrual dysfunction, and low BMD.

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38
Q

What is the term that defines a syndrome occurring in both female and male athletes related to energy deficiency?

A

Relative Energy Deficiency in Sports (RED-S).

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39
Q

What are some benefits of exercise during pregnancy?

A

Avoidance of excessive weight gain, improved balance, decreased back pain, improved well-being, energy levels, sleep patterns, improved labor symptoms, and lower risk of cesarean section.

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40
Q

What musculoskeletal changes occur during pregnancy?

A

Ligamentous laxity, displacement of the center of gravity, changes in spinal posture, anterior rotation of the pelvis, and abduction of the shoulders.

Resizing a pregnancy at 60 to 70% VO2 max does not raise core temperature greater than 38°C. VO2 max increases following pregnancy and moderate to high exercise

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41
Q

Exercising in pregnancy at 60%–70% V˙ O2 max does not raise core temperature greater than _______.

A

38°C.

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42
Q

What are the three major etiologic contributions to the gender disparity observed in ACL injury rates?

A
  • Anatomical
  • Hormonal
  • Neuromuscular
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43
Q

Increased valgus motion and valgus moments at the knee joint during which phase are key predictors of ACL injury in females?

A

Impact phase of jump-landing tasks

44
Q

How much greater were the knee abduction angles at initial contact (IC) in female knees that went on to ACL injury?

A

8.4° greater

45
Q

What was the difference in maximum knee flexion angle at landing between injured and uninjured athletes?

A

10.5° less in injured

46
Q

What percentage increase in vertical ground reaction force (GRF) was observed in the injured cohort?

A

20%

47
Q

What is the correlation between knee flexion (quadriceps) moment and peak force in uninjured athletes?

A

Significant correlation exists

48
Q

What was the difference in peak external hip flexion moment between the ACL-injured group and uninjured group?

A

Greater in the ACL-injured group

49
Q

What predictive specificity and sensitivity does the knee abduction moment have for ACL injury status?

A

73% specificity and 78% sensitivity

50
Q

True or False: Significant leg-to-leg differences in knee load were observed in injured females.

A

True

51
Q

Fill in the blank: Muscular power has been shown to increase up to _______ in females with 6 weeks of training.

A

44%

52
Q

What is the impact of knee abduction angle at landing for ACL-injured athletes compared to uninjured athletes?

A

8° greater in ACL-injured athletes

53
Q

Are athletes at a higher risk of suffering an ACL injury during a game or practice?

A

During a game

54
Q

What factors may increase an athlete’s risk of ACL injury?

A

Level of competition, way of competing, or a combination of both

55
Q

True or False: Boots with a higher number of cleats may reduce the risk of ACL injuries.

A

False

The Fishel floor is also a risk in addition to cleats spikes

56
Q

What does functional bracing appear to protect?

A

ACL-deficient knee of alpine skiers

57
Q

What is the effect of bracing on an ACL graft?

A

Inconclusive and requires more study

58
Q

What anatomical risk factors can predispose an individual to ACL injury?

A

Abnormal posture and lower extremity alignment

59
Q

What are internal risk factors for ACL injuries

A

Anatomical risk factors such as abnormal posture and lower extremity alignment. Notch size and ACL geometry, Posterior tibial slope which increases Anterior tibial translation
Notch width measurement

60
Q

How does the ACL geometry differ between women and men?

A

ACL is geometrically smaller in women than in men when normalized by body mass index

Lower tensile stiffness less elongation at failure and lower energy absorption

61
Q

What is the correlation between posterior inferior tibial slope and anterior tibial translation?

A

Highly significant correlation

62
Q

What hormonal risk factors are associated with ACL injuries?

A

Greater tibiofemoral joint laxity, hormonal interactions

63
Q

What is the role of estrogen in ACL structure and properties?

A

Interactions with cyclic loading and other hormones appear to alter its effects

64
Q

During which phase of the menstrual cycle are women at a greater risk of ACL injury?

A

Preovulatory phase

65
Q

What percentage of ACL injuries are non-contact in nature?

A

Almost 80%

66
Q

What are common mechanisms of injury for non-contact ACL injuries?

A

Landing from a jump, cutting, or decelerating

67
Q

What components are probably important in the mechanism of injury for ACL?

A
  • Anterior translation
  • Dynamic valgus of the lower extremity
  • Low flexion due to increased quadriceps activity
68
Q

True or False: Women have more ‘quadriceps dominant’ neuromuscular patterns than men.

A

True

69
Q

What is recommended for athletes to avoid likely injury mechanisms?

A

Avoid knee valgus and land with more knee flexion

70
Q

What specific problem arises when reconstructing the ACL before puberty?

A

Potential risk of growth disturbances

71
Q

What rehabilitation practices are considered safe after ACL injuries?

A
  • Early weight bearing
  • Early mobilisation
  • Rehabilitation without braces
  • Early CKC exercises
72
Q

What should ACL reconstruction be based on?

A

Regaining function, range of motion, strength, and patient’s desire

73
Q

What percentage of patients will have radiographic osteoarthritis 15 years after an ACL injury?

A

50%

74
Q

What should a successful prevention program for ACL injuries include?

A
  • Strength and power exercises
  • Neuromuscular training
  • Plyometrics
  • Agility exercises
75
Q

What test should be used to identify players at risk for ACL injuries?

A

Drop vertical jump test

76
Q

What is the definition of REDs?

A

A syndrome of impaired physiological and/or psychological functioning caused by problematic low energy availability

Detrimental outcomes include decreased energy metabolism, reproductive function, musculoskeletal health, immunity, and cardiovascular health.

77
Q

What are the detrimental outcomes of REDs?

A
  • Decreases in energy metabolism
  • Reproductive function
  • Musculoskeletal health
  • Immunity
  • Glycogen synthesis
  • Cardiovascular and haematological health

These outcomes can lead to impaired well-being, increased injury risk, and decreased sports performance.

78
Q

What key scientific advance was highlighted since the 2018 REDs consensus statement?

A

Problematic LEA is the underlying aetiology of REDs

This includes the influence of moderating factors on athlete health and performance.

79
Q

What impact does low carbohydrate availability (LCA) have in the context of REDs?

A

Substantial reduction in carbohydrate ingestion leading to concurrent LCA

Low carb intake can negatively affect bone, immunity, and iron biomarkers.

80
Q

Are REDs and overtraining syndrome (OTS) similar?

A

True

Both syndromes involve the hypothalamic-pituitary-adrenal axis and feature overlapping symptoms. LEA is distinguishing factor of reds

81
Q

What is the time-course of LEA resulting in REDs?

A
  • Short-term: a few days to weeks
  • Medium-term: weeks to months
  • Long-term: months to years

Acute mild periods of LEA do not always lead to adverse outcomes.

82
Q

What are potential mental health outcomes of REDs?

A
  • DE behaviours
  • Eating disorders
  • Mood disturbances
  • Anxiety related to injury

DE behaviors can perpetuate under-fuelling and may be exacerbated by various social factors.

83
Q

What are indicators of REDs in male athletes?

A
  • Low libido
  • Decreased morning erections

These are physiological consequences of LEA.

84
Q

What unique challenges do para athletes face concerning REDs?

A

Altered skeletal loading and reduced bone mineral density

This is particularly concerning for athletes with spinal cord injuries.

85
Q

What does the REDs Health Conceptual Model illustrate?

A

The effects of LEA exist on a continuum

Adaptable LEA is mild, while problematic LEA is associated with adverse outcomes.

86
Q

What are the clinical applications for assessing energy availability (EA)?

A

A continuum of zones ranging from low to high risk of harm

High EA for mass gain is ≥45 kcal/kg FFM/day, adequate EA is ~45 kcal/kg FFM/day, and reduced EA for fat loss is 30–45 kcal/kg FFM/day.

87
Q

What is primary prevention of REDs?

A

Education and tackling inadequate awareness of REDs

This includes improving knowledge among athletes, coaches, and medical teams.

88
Q

What is secondary prevention of REDs?

A

Early identification of symptoms using screening instruments

This may include health interviews and objective assessments of REDs biomarkers.

89
Q

What treatments are suggested for REDs?

A
  • Change in diet and exercise
  • Pharmaceutical: 17β-oestradiol transdermal patch with micronised progesterone

What is considered tertiary care: treatment

The latter has shown to increase bone mineral density Z-scores.

90
Q

What is the core body temperature range indicating heat illness in children?

A

100.4°F to 104.9°F

Children have reduced ability to adapt to heat. Thirst is not indicator of hydration

91
Q

Why is thirst not a reliable indicator of hydration in children?

A

Children do not develop an appropriate thirst response to heat

This means they may not drink enough fluids when needed.

92
Q

What type of injuries are more likely to occur in the prepubertal age group?

A

Overuse injuries involving the growth plate, stress fracture, female athlete triad, ACL injury

These injuries can lead to serious conditions affecting growth cartilage.

93
Q

Name one condition that can result from injured growth cartilage at apophyses.

A

Osgood-Schlatter disease

Other conditions include Sever disease and little leaguer’s elbow.

94
Q

What is the recommended progression for training in children?

A

Increase total training by no more than 10 percent per week

This gradual progression helps prevent injuries.

95
Q

What is important for injury prevention in young athletes?

A

Scheduled rest intervals

These intervals are crucial to allow for recovery.

96
Q

What type of training complements aerobic activity in all age groups?

A

Strength training

It is beneficial for enhancing overall physical fitness.

97
Q

What are high-risk stress fractures in adolescents?

A

Femoral neck, anterior cortex of the tibia, and proximal fifth metatarsal

These fractures require referral to a sports medicine specialist.

98
Q

What is the recommended duration and frequency of exercise for pregnant women?

A

At least 30 minutes per day on most days of the week

This is advised in the absence of medical complications.

99
Q

What intensity level should pregnant women aim for during exercise?

A

Moderate intensity. On scale of 6 - 20 rated “somewhat hard” of 12 - 14 on scale

This is equivalent to brisk walking.

100
Q

What should be monitored during exercise for pregnant women?

A

Hydration and nutrition and subjective feelings of heat stress

Proper hydration is crucial for safety.

101
Q

What type of exercise should be avoided during pregnancy?

A

Scuba diving

This is due to the risk of fetal decompression sickness.

102
Q

What is one benefit of regular physical activity for older adults?

A

Decreased all-cause mortality rates

Regular activity contributes to longevity and health.

103
Q

What is a key focus of physical activity in older adults?

A

Fall prevention

Reducing fall risk is crucial for maintaining independence.

104
Q

Recommendation for pregnant women who are sudden Terry before pregnancy who want to start exercising

A

Gradually progressed to 30 minutes per day

105
Q

By what age does normal menses occur

A

Women over age of 15 are expected to have normal menses that occur every 28+ or -7 days.

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