Female Athlete and Sport during Pregnancy

Question 1

list the sex differences in CVS in women in comparison to men

Answer 1

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

Question 2

list skeletal differences b.w women in men

Answer 2

Smaller, shorter (not always!)
Wider pelvis
Larger Q angle
Tibia less bowed
Narrower shoulders
> Carrying angle at elbow
Higher % body fat
increased joint laxity

Question 3

describe rate of injury of ACL injury

Answer 3

85 per 100 000 in people aged 16-39 years

Question 4

describe frequency of ACL rupture in comparison to males vs female age 14-18

Answer 4

3X – 5X more common in young (14-18yrs) women vs. men

Question 5

what percentage of ACL regardless of sex are non-contact injuries

Answer 5

80%

Question 6

describe mechanism of injury of ACL injury in female athletes

Answer 6

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

Question 7

explain the landing mechanism of ACL injury in women

Answer 7

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

Question 8

common mechanism of injury of ACL injury

Answer 8

landing after jump
abrupt stopping
sudden direction change including rotary knee motion

Question 9

describe extrinsic risk factors of ACL injury

Answer 9

high traction surface show interface

Question 10

describe intrinsic risk factors of ACL injury

Answer 10

Previous ipsi ACL injury, age (<20), female,
biomechanics of landing,
low hamstring strength,
hormones affecting laxity (pre-ovulatory)
(narrow intercondylar notch width => smaller ACL?)

Question 11

list the modifiable risk factors of ACL injury

Answer 11

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

Question 12

what are the most effective programmes for ACL injury prevention

Answer 12

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

Question 13

describe dosage and exercise prescription for ACL injury prevention programme introduced to female athletes

Answer 13

> 1 per week
Duration > 6/52 for effect
Pre-season

Question 14

triads signs of relative energy deficiency sports

Answer 14

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

Question 15

risk factors of relative energy deficiency sports

Answer 15

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

Question 16

associated factors of REDS

Answer 16

mood disturbances/fluctuations
cognitive dietary restraint
drive for thinness
reduced sleep quality
perfectionistic tendencies
Depressive symptoms and affective disorders
subjectively reported reduced well-being

Question 17

Presentations of REDS

Answer 17

Low energy availability +/- Disordered eating
Altered menstrual function
Abnormalities of bone mineralisation

Question 18

physical signs of anorexia

Answer 18

BW </= 85% norm
Emaciation but thinks overwt
Amenorrhoea
Hypotension
Bradycardia
Lanugo hair
Dry skin, hair, nails

Question 19

physical signs of bulimia

Answer 19

Binging & purging cycles > 2x per week
Parotid gland hypertrophy
Teeth staining/caries
Pharyngeal oedema
Conjunctival petechiae

Question 20

how does hypoestrogenism affect bone density

Answer 20

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 #

Question 21

screening questions for RED-S

Answer 21

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)?

Question 22

what would be classified as a high risk RED-S patient

Answer 22

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

Question 23

what would be classified as a moderate risk RED-S patient

Answer 23

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

Question 24

what would be classified as a low risk RED-S patient

Answer 24

appropriate physique managed w/o undue stress or unhealthy diet strategies
healthy functioning endocrine system
healthy bone mineral density

Question 25

treatment for MDT

Answer 25

Prevention - reduction of risk factors
adequate caloric intake to match demand
adequate Ca intake and Vit D
alter training schedule -optimal loading
birth control

Question 26

effects of treatment of RED-S

Answer 26

energy status - increase energy status, stimulate anabolic hormones and bone formation
increase status will reverse conservation adaptations
menstrual status - increase reproductive hormones, increase estrogen exerts anti resorptive effect on bone
bone mineral density - increased estrogen inhibits bone resorption, increased energy status will stimulate anabolic hormones and bone formation