Female Athlete and Sport during Pregnancy Flashcards
list the sex differences in CVS in women in comparison to men
Smaller heart
Faster heart rate
Lower blood volume, 15% less Haemoglobin, 6% fewer red blood cells
Lower VO2max (when compared with similarly trained male)
Lower peak bone mass
list skeletal differences b.w women in men
Smaller, shorter (not always!)
Wider pelvis
Larger Q angle
Tibia less bowed
Narrower shoulders
> Carrying angle at elbow
Higher % body fat
increased joint laxity
describe rate of injury of ACL injury
85 per 100 000 in people aged 16-39 years
describe frequency of ACL rupture in comparison to males vs female age 14-18
3X – 5X more common in young (14-18yrs) women vs. men
what percentage of ACL regardless of sex are non-contact injuries
80%
describe mechanism of injury of ACL injury in female athletes
upon landing (at foot strike during jump landing when knee is extended or in first 30degs flexion range), cutting or pivoting
Femoral internal rotation
Valgus
Anterior tibial translation
explain the landing mechanism of ACL injury in women
Eccentric Quads activity needed to stop knee flexion upon landing
higher relative MVC in Quads in women vs reduced hams activity, compared with EMG in men
increased anterior tibial translation puts ACL at risk
women tend to land with straighter knee - men land more flexed knee
common mechanism of injury of ACL injury
landing after jump
abrupt stopping
sudden direction change including rotary knee motion
describe extrinsic risk factors of ACL injury
high traction surface show interface
describe intrinsic risk factors of ACL injury
Previous ipsi ACL injury, age (<20), female,
biomechanics of landing,
low hamstring strength,
hormones affecting laxity (pre-ovulatory)
(narrow intercondylar notch width => smaller ACL?)
list the modifiable risk factors of ACL injury
Dynamic valgus,
Low flexion of hip and knee during landing,
Poor hip and trunk control,
Weakness of hamstrings and hip abductors (relative to knee extensors),
Delayed activation of hamstrings,
Proprioceptive deficits,
Muscle fatigue,
Poor general fitness
what are the most effective programmes for ACL injury prevention
Neuromuscular & Proprioceptive components to warm-up appear most effective
Balance work
Biomechanical focus on hip – knee – ankle alignment on landing correcting dynamic valgus
Strength training: Hams, gluts & core strengthening including Plyometrics
describe dosage and exercise prescription for ACL injury prevention programme introduced to female athletes
> 1 per week
Duration > 6/52 for effect
Pre-season
triads signs of relative energy deficiency sports
Irregular or absent menstrual cycles
Always feeling tired and fatigued
Problems sleeping
Stress fractures and frequent or recurrent injuries
Often restricting food intake
Constantly striving to be thin
risk factors of relative energy deficiency sports
history of menstrual irregularities and amenorrhoea
history of stress fractures
history of depression
personality factors (such as perfectionism and obsessiveness)
history of critical comments about eating or weight from parent, coach or teammate
history of dieting
pressure to lose weight
overtraining
associated factors of REDS
mood disturbances/fluctuations
cognitive dietary restraint
drive for thinness
reduced sleep quality
perfectionistic tendencies
Depressive symptoms and affective disorders
subjectively reported reduced well-being
Presentations of REDS
Low energy availability +/- Disordered eating
Altered menstrual function
Abnormalities of bone mineralisation
physical signs of anorexia
BW </= 85% norm
Emaciation but thinks overwt
Amenorrhoea
Hypotension
Bradycardia
Lanugo hair
Dry skin, hair, nails
physical signs of bulimia
Binging & purging cycles > 2x per week
Parotid gland hypertrophy
Teeth staining/caries
Pharyngeal oedema
Conjunctival petechiae
how does hypoestrogenism affect bone density
leads to a loss of spinal bone mineral density due to changes in calcium balance and altered bone turnover in response to hormonal disturbance
increased risk of stress #
screening questions for RED-S
Have you ever had a menstrual period?
How old were you when you had your first menstrual period?
When was your most recent menstrual period?
How many periods have you had in the past 12 months?
Are you presently taking any female hormones (oestrogen, progesterone, birth control pills)?
Do you worry about your weight?
Are you trying to or has anyone recommended that you gain or lose weight?
Are you on a special diet or do you avoid certain types of foods or food groups?
Have you ever had an eating disorder?
Have you ever had a stress fracture?
Have you ever been told you have low bone density
(osteopenia or osteoporosis)?
what would be classified as a high risk RED-S patient
has serious eating disorder
other serious medical conditions related to low energy availability
use of extreme weight loss techniques leading to dehydration induced hemodynamic instability and other life threatening conditions
severe ECG abnormalities
what would be classified as a moderate risk RED-S patient
prolonged abnormally low body fat % measured using DXA or anthropometry
substantial weight loss
attenuation of expected growth and development in adolescent athlete
abnormal menstrual cycle
no menarche by 15
reduced BMD
what would be classified as a low risk RED-S patient
appropriate physique managed w/o undue stress or unhealthy diet strategies
healthy functioning endocrine system
healthy bone mineral density
