FQ2: How does sports medicine address the demands of specific athletes?

Question 1

Children and young athletes - Medical conditions (asthma)

Answer 1

• medical condition that affects airways → characterised by inflammation of airways leading to contraction of the bronchioles limiting air flow in and out of lungs
• Triggers include: dust, pollen, pollution, exercise
  signs + symptoms: shortness of breath, wheezing, chest tightness, dry cough, pale/ sweaty skin
• Can be induced by exercise → more likely triggers in long duration physical activity than short + intense bursts of activity
• Strategies to reduce risk:
• avoid triggers, warmup/ cooldown (gradual use of lung muscles), take prev medication, type of ex e.g. swimming =good (humid/ low impact), monitor progress participating
• Management = reliever puffer, sit in comf position = 4 puffs of puffer (4 breaths per puff), wait 4 mins
• if no improvement = call 000 + repeat process until help arrives
• ensuring athletes have appropriate med + coaches have current first aid quals = crucial e.g. asthmatic must have inhaler present + coach must be aware of athlete’s asthma management plan =
  aware of triggers that may lead to attack while participating in sport = life could be jeopardised

Question 2

Children and young athletes - Medical conditions (diabetes)

Answer 2

• condition in which body does not produce or properly use insulin
• affects sports engagement as glucose = important energy source for ATP production during participation
• During exercise muscle cells are opened for glucose transport w/o the need for insulin → results in a decrease in blood glucose = problematic for diabetics
  Type 1: autoimmune disorder
  Type 2: breakdown in the efficiency of insulin
  signs + symptoms:
• Hypoglycaemia (low BS):
  → rapid pulse, profuse sweating, trembling/ dizziness
• Hyperglycaemia (high BS):
  → Drowsiness, thirst, rapid pulse
• Strategies to reduce risk:
• warmup/cooldown (hormone + glucose levels adjust gradually), test blood glucose levels before + during + after exercise, ex not occur if feeling unwell, foods containing simple carbs = if on insulin injections/medic, avoid strenuous activity
  Management
• hypo = insulin injections + access to sugary foods e.g. jellybeans + complex carbs before + after events, hyper = medic assistance, participate in regular PA (both types)

Question 3

Children and young athletes - Medical conditions (epilepsy)

Answer 3

• Disorder of CNS = which nerve cell activity in brain is disturbed causing a seizure
• when brain’s nerve cells misfire + generate sudden, uncontrolled burst of electrical activity in brain
• Causes brief alteration to level of consciousness
• thoughts, feelings, movements become momentarily confused or uncontrolled
• Signs + symptoms: tremors, convulsions, rigid, difficulty speaking, repeated blinking, petit/grand mals
  Strategies to reduce risk:
• physical activity
• ensure ex + sporting activities = in safe env e.g. water supervision, avoid overexertion /dehydration = hydration, seek medical adv before some sports e.g. contact/water, avoid triggers e.g. fatigue, dehydration etc, take med as prescribed
  Management:
• stay calm, clear area, time seizure, protect from injury, roll onto side = until finished, apply DRSABCD if become unconscious

Question 4

Children and young athletes - Overuse injuries (Stress fractures)

Answer 4

• Result from repetitive movements placing stress upon body parts
• Still growing + developing therefore more susceptible to overuse injuries (shin splints, stress fractures) = means children + young athletes require longer recovery periods + nutrition needs
• bones grow at faster rate than supporting ligaments
• SF: small sliver or crack in bone caused by repeated stress over time
• Instead of resulting from a single severe impact = result of accumulated trauma from repeated submaximal loading
• Often caused by: increasing amount of intensity/activity too quickly (high stress loads), change of playing surfaces, improper equip, poor technique + recovery + muscular strength
• Growth spurts cause issues in muscles (bones are weaker + muscles are then stretched from bone growth
• Injuries in both pre-adolescents + adolescents are usually related to growth imbalances among bones, muscles + tendons
• Fractures = common - more prone to falls + accidents - lack of experience
• Often result from small injuries e.g. muscle tears = not noticed, or not given enough time to fully recover - leaves weak - more chance of reinjury when stressed

Question 5

Children and young athletes - Overuse injuries (Stress fractures) = considerations + management

Answer 5

signs + symptoms
- acute pain in particular area
- gradual onset of pain
- pain increasing
- local swelling/tenderness
strategies to reduce risk:
- avoid overtraining,
- play no. of sports/variety of positions = avoid overuse of particular joints/muscles,
- avoid specialising at young age = ensure development + growth - holistic + balanced
- have appropriate rest periods after training + perf
- ensure full recovery from injuries both major + minor, before continuing activities
- ensure appropriate conditioning + stretching programs are undertaken
- ensure correct footwear
Management:
- supervised by qual health prof e.g. physio
- immediate rest lasting 4-8 weeks = depending on severity, frequent use of ice, use of corrective devices + exercise to improve body mechanics

Question 6

Children and young athletes - Thermoregulation

Answer 6

• refers to the maintenance of a stable core body temp
• VITAL to avoid conditions e.g. hyper + hypothermia
• Dehydration during sport = heat exhaustion +
  impair perf
• Not as well developed as it is for adults - have underdeveloped sweat glands = sweat less than adults - sweating = cooling of body = more likely to become overheated
• have a greater surface area of skin in relation to adults = more likely lose heat more readily in cold envs
• Have less muscular development than adults = less able to generate heat through muscular activity
• children have less metabolically efficient systems to produce sweat, + have trouble dispersing heat
• Children’s acclimatisation to heat is slower - greater risk on hot, humid days
  Signs + symptoms: profuse sweating, dizziness, fatigue
  Strategies to reduce risk:
• ensuring regular rehydrating while playing (multiple drink breaks), moving game times to early in the day = enhance perf in hot + humid conditions
• provide shade + ex duration 30mins or less in extreme conditions
• appropriate clothing
• By making adjustments to children’s participation in sport, risk of heat-related illnesses occurring = reduced + children’s perf in sport is optimised as
  fatigue related to heat is minimised
  Management = overheat = give cold, cold = give heat

Question 7

Children and young athletes - Appropriateness of resistance training

Answer 7

• topic of debate
• No more dangerous than many other form of PA
• no evidence that RT slows growth → but = not recommended
• More likely to have a positive effect on child’s growth
• RT will not affect the growth plates of a young athlete
• Strength program = an integral part of an overall program designed to improve skill + fitness
  strategies to reduce risk:
• Encourage: use of a safe program (appropriate if closely/strict supervision e.g. physio/PT + correct tech is taught = injury)
• follow appropriate guidelines
• Weight-bearing ex is most appropriate (eg push-ups, sit-ups), while a supervised program of using light weights + large nos of reps may also be suitable
• whole body focus (no strength specialisation = can lead to imbalances = injury)
• Care must be taken = to ensure progress is gradual
  + takes into consideration age + size of athlete
• need warm-up
• If precautions are not taken then growth plates in bones may be damaged permanently + participation in sport for rest of life will be limited

Question 8

Adults and aged athletes - Heart conditions

Answer 8

• As people age, efficiency of the CV system declines
• variety of heart conditions = more prevalent in older people e.g. heart attacks, strokes + high BP
• As CV system becomes less efficient, its ability to pump blood from heart is reduced → amount of oxygen transported around body decreases = makes exercising a lot harder
• Exercise can help improve CV system
  Participation options:
  → cannot participate in sports that require a high intensity → advised to participate in sports/physical activities that can be done using low intensities such as: Golf, cycling, tennis, dancing, walks, lawn bowls + aerobics
  → provide an opportunity to develop r/s, improve mental health + independence
  → provide a form of CV training w/o placing excess stress on heart + muscles surrounding arteries
  Considerations when participating:
• Ppl w/ heart conditions e.g. high BP = should be required to obtain a medical clearance from doctor before commencing an exercise program e.g. complete a stress test
• These indivis = should then begin chosen sport gradually + choose suitable activities to match personal capabilities - intensity = must be moderate
• Aerobic-type exercises e.g. walking, cycling, swimming +
  modified strength training programs (30 mins, 3x a week) = some of best options for people w/ heart conditions
• need proper 5-7 min warm-up + cool-down

Question 9

Adults and aged athletes - Fractures/bone density

Answer 9

• Fractures = more likely to occur in ppl w/ poor bone density → PBD can lead to osteoporosis (more common in women –> low estrogen levels = menopause) → brittle bones (more likely to injure)
• Predisposition to PBD + fractures include: genetics, female, early menopause, inadequate diet, poor PA
• Fractures + BD = greatly influenced by diet e.g. need nutrients e.g. calcium, vitamin D, sodium = good bone health
• PA increases bone mass + makes bones stronger
• Ex assists in delay
  of post-menopausal BD loss in older women in particular, thus reducing onset of
  osteoporosis
  Considerations
• Inactivity should be avoided → encourages calcium discharge from bone = weaker
• Ex’s that also improve physical fitness, balance, strength, coordination + flexibility = beneficial as contribute to prevention of falls
  Participation options:
• PBD should avoid contact sports/sports that involve powerful changes in direction that place large stress on bones (low impact) e.g. martial arts, rugby league,
• Options available for AAA w/ BD issues: cycling, walking, golf, tennis, swimming
• Weight training (low range) or weight bearing ex eg. walking → causes a physiological adaptation - increased bone strength through increased BD
• modified strength training programs = resistance training = very beneficial for BD + when performed w/ proper supervision + correct technique poses minimal risk
• If a fracture is present: don’t participate in any sport that uses injured bone /may cause bone to be further injured
• sport options assist in areas of balance, strength, coordination + flexibility = result in improved bone strength, thus avoiding further fractures

Question 10

Adults and aged athletes - Flexibility/joint mobility

Answer 10

• As people age, their musculoskeletal system deteriorates, reducing mobility → tendons, ligaments + muscles lose elasticity
• Does not automatically change w/ age, does change according to use (less flexible if stop motions that require flexibility)
• Experience arthritis, aching joints + tight muscles
  Participation options:
• Can increase flexibility + JM by slowly increasing ROM at each joint through regular ex → ex should start at low intensities + speeds + can gradually increase as JM increases
• Not limited in choice BUT should slowly progress in intensity (e.g Yoga, Tai Chi → start low then progress levels)
• improved flexibility + JM = necessary for daily functioning, maintaining independence, increased QOL + reduced injuries = participation for longer
• Low-impact sport options: walking, cycling, swimming, tai-chi, aqua aerobics, yoga, pilates = all have positive effect on flexibility + JM in AAA programs that focus on safe stretching + improving RO movement in joints, increase balance + stability of AAA = reduction of fractures caused by falls

Question 11

Adults and aged athletes - EXAMPLE (from a response)

Answer 11

• It is important for AAA to be able to continue their participation in chosen sport - Many sporting orgs = recognising this + now provide modified comp arrangements for such athletes
• Examples include over 35 comps, ‘Golden Oldies’ tournaments + Masters games
• While these activities encourage + facilitate greater participation for AAA in sport, medical conditions e.g. heart conditions, BD + joint health/flexibility need to be incorporated into design of these comps
• Many of these therefore have modified equiP, rules + reduced physical contact

Question 12

Female athletes - eating disorders

Answer 12

• Eating disorders e.g. bulimia, anorexia nervosa
• Reasons for: peer influences, media, societal pressures/ expectations (to conform to certain body type), stereotypes eg. ‘appearance/aesthetic’ sports e.g. gymnastics + dance or ‘endurance’ sports e.g. long distance running, triathlons
• Need more nutrition to meet demands of sport → less nutrition can = malnutrition (deficiency of nutrients), lack of physiological adaptations, slow recovery + lethargy, affect skeletal health
• Also leads to starvation + dehydration = impaired performance → leads to serious health risks e.g. loss of energy (can’t sustain), irregular menstrual cycles, weak bones (lack of essential vitamins + minerals e.g. calcium = more susceptible to injuries), + abnormal heart rhythms (no steady heart → O2 to working muscles)
• Characterised by behaviour e.g. purging (ie. self vomit), binge-eating, starving, excessive dieting + ex, social withdrawal, weight changes, dizziness, fatigue
• Affect energy + nutrition available to female athlete → lack of energy + nutrition affects both bone health + menstrual cycle of athlete → can greatly affect perf
• Can impact: cellular maintenance, growth, repair + thermoregulation → all affect female athlete’s ability to adapt to training + perform
• Can result in iron deficiency + PBD
  Considerations:
• encourage a healthy, well-balanced diet rich in iron e.g. red meat, veg etc
• Increase education on signs and symptoms
• Observe training routines → take action on sus behaviours

Question 13

Female athletes - iron deficiency

Answer 13

• Iron = essential mineral needed for formation of red blood cells
• only small amounts of iron = required in body = plays an important role in
  transportation of O2
• W/o sufficient iron, no. of red blood cells is reduced,
  limiting oxygen-carrying capacity of blood + degree to which athlete is able to fully participate in PA + sport
• Result in: lethargy, fatigue, weakness, breathlessness, less haemoglobin in blood = limited O2 carrying capacity of blood = decreased perf, reduced rate of lactate clearance (lactic acid removed more slowly from muscles) = early fatigue
• Females need twice as much iron as males
• a lack of iron is common in females as usually consume less red meat + can lose iron during menstruation + eating disorders
• Exercise-induced anaemia is common in particular for female endurance athletes, = can be result of intense training where iron reserves are already heavily drained
• e.g. female triathlete who is anaemic = may not be able to meet participation demands as muscles will not be receiving adequate oxygen to synthesise ATP when working aerobically = prevents optimum perf
• Causes anaemia (abnormally low levels of haemoglobin) resulting in less oxygen being available to working muscles
• Iron = needed to allow haemoglobin to bind w/ O2 + transport it around body
• Iron deficiency, even w/o anaemia can lead to a reduced rate of lactate clearance (LC) = slower LC causes early fatigue
• Aerobic energy system + good delivery of oxygen = speed up recovery from lactic acid energy system
• Low iron levels = cannot deliver enough O2 to their muscles to sustain sports perf - rely too heavily on anaerobic energy systems - fatigue increased
• Lack of iron = affect training → won’t be sustained for long durations, also feel lethargic (tired), + less motivated to train at all
• Iron deficiency = female athlete less likely to participate in sport + when do will fatigue quickly + have a neg impact on perf
  Considerations:
• consume iron rich foods eg red meat (1-2 per week), tuna, eggs, dark green, leafy vegs eg. spinach, broccoli, nuts + legumes
• Consume vitamin c w/ iron e.g. orange, berries
• be aware of important mineral + maintain correct intake
• Manage athletes who are iron deficient

Question 14

Female athletes - Bone Density

Answer 14

• Measure of bone strength + bone mineral density (thickness/strength of bones)
• If insufficient calcium is consumed, bones become frail + brittle leading to osteoporosis (more common in females)
• associated w/ quantity of calcium in bones, ex + oestrogen levels
• Oestrogen (levels drop during menopause = lower mineral counts /results in low bone strength)
• Calcium = necessary for bone strength + also required in blood to allow muscles + nerves to function correctly
• Female athletes w/ eating disorders = not consume appropriate amounts of calcium + other minerals needed for skeletal health
• FA w/ bones low in calcium = more susceptible to structural weakening +
  bone fractures, as calcium loss leads to bones becoming brittle + frail = impact on participation as females = greater risk of injury = high intensity + contact sports = can cause fractures
• e.g. female basketballer w/ low BD who falls while playing may be at a higher risk of sustaining a fracture
• Injuries sustained as a result of low BD will take longer to heal + will prevent indivs from engaging in sports for an extended period of time
  Considerations:
• need to be aware of the effect of age + menopause on BD to ensure safety in sport participation
• Following menopause, women lose calcium faster than men + some may end up w/ osteoporosis = imperative females eat a well-balanced diet w/ calcium-enriched foods e.g. milk, cheese
• should focus on safety in activity = choose aerobic activities e.g. swimming, cycling, running + aerobics
• body cannot produce calcium = important that females include calcium-rich foods in diets to maintain BD e.g. milk, cheese, yoghurt, leafy green veg (proper diet)
• Weight-bearing or resistance training e.g. climbing stairs, weight-lifting or walking can assist in the strengthening + restructuring of bone

Question 15

Female athletes - Pregnancy

Answer 15

• Can continue current levels of training + comp = maintain healthy weight, flexibility, strength + cardio endurance - depends on indiv (normally participating - can do more)
• sustained, moderate ex creates no more stress to previously active, healthy women than stress of weight gain - moderation = key
• modifications may be needed to accommodate the physiological changes that occur during pregnancy
• Important to consider: athlete’s health status, stage of pregnancy, type of sport participating + risk of injury to themselves + developing baby
• Increased relaxin (hormone) (relaxes muscles + ligaments during birth) = careful of overstretching during sport - negative effect
• Shift in centre of gravity (loss of balance = affect perf e.g. dance, gymnastics), will make exercise a higher intensity because of extra weight - negative effect
• Haemoglobin levels + blood volume rise (ensure enough nutrients for baby, whilst still supporting mother) → greater O2 support = increased perf - positive effect
• Exercise is contraindicated in high-risk pregnancies eg. women who have experienced miscarriage, premature labour, high BP, IVF
• Benefits of continuing sport during uncomplicated pregnancy: weight control, improved mood/ wellbeing, maintain fitness levels, avoid gestational diabetes
• 1st trimester = can do more, - 2nd = a bit less, 3rd = should reduce
  Considerations:
• Avoid high contact sports (can cause miscarriage) + but are safe
• Avoid overheating + high intensities (baby needs blood + temp regulation/ vasodilation during ex takes blood away from baby/ don’t exercise in heat)
• Maintain adequate hydration
• Ex should be gradual w/ a thorough warmup/cooldown
• Be aware of signs to stop exercising eg pain, bleeding, nausea or headaches