Sports and exercise medicine

Sports and exercise medicine - technical

Topics covered:

Essentials

Physicians are increasingly confronted with medical problems related to sport.

Female athlete triad—consists of disordered eating, amenorrhoea, and osteoporosis, which are most commonly seen in those pursuing endurance sports or gymnastics. Clinical assessment includes a nutritional screen to assess calorie and calcium intake, measurement of serum tri-iodothyronine level (typically low) and of bone density, along with exclusion of other causes of amenorrhoea. The most effective treatment is to re-establish natural menstruation with a combination of reducing training intensity and increasing calorie intake, both of which the athlete may find hard to accept.

Overtraining syndrome—is characterized by performance deterioration refractory to normal regeneration strategies and often associated with loss of appetite, depression and anxiety, sleep disturbance, fatigue, upper respiratory tract infections, and a raised resting heart rate. Treatment requires rest to allow regeneration and recovery, but most athletes will only accept absolute rest for a few days, hence it is important to follow this up with a period of relative rest that allows very low intensity training after which exercise can be slowly increased, but it may take up to 12 weeks to achieve full recovery.

Medical complications in sport—these include (1) delayed-onset muscle soreness, rhabdomyolysis, and heat stroke; (2) exercise-induced gastrointestinal symptoms including reflux/heartburn, intestinal cramps, the urge to defecate, and diarrhoea (sometimes bloody); (3) exercise-related anaemia, which can be due to faecal blood loss, also intravascular haemolysis caused by high impact forces on the feet; (4) hyponatraemia—a well-recognized problem in the marathon and other endurance events; can be severe, leading to encephalopathy, pulmonary oedema, and death; primarily caused by excessive fluid intake during the event; it is vital to measure the serum sodium concentration of any collapsed or confused competitor at the end of a race.

Overuse injuries—these are the most common type of injury seen in sports medicine clinics. Diagnosis is usually relatively straightforward by history and examination, but it is important to determine the aetiological factors responsible for the injury (training methods, equipment, and biomechanical factors) to prevent recurrence.

Drugs and nutritional supplements—these are widely used in competitive sports. Anabolic agents include anabolic–androgenic steroids, human growth hormone, β2-agonists, and creatine. Stimulants include amphetamines, ephedrine, cocaine and caffeine. Other agents include β-blockers, diuretics, erythropoietin and blood doping, bicarbonate and β-hydoxy-β-methylbutyrate. Use of many of these agents is banned or restricted by sports governing bodies.

Introduction

Traditionally, sports medicine has concentrated on injuries that occur during exercise, and therefore has come under the umbrella of orthopaedics. However, with the pursuit of sporting excellence a range of different exercise-related medical disorders are now recognized. These are associated with intense levels of training and may have a detrimental effect on long-term health, as may drugs (and nutrients) that are frequently taken to enhance training and performance. Physicians are therefore increasingly being confronted with medical problems related to sport. This section will cover some of the medical disorders that occur with sport and physical training. It will also address the use of drugs and some of the common overuse injuries that occur with sport.

Developments in exercise physiology over the last 30 years have led to improved training regimes for athletes. A spin-off from this has been the recognition of the benefits of exercise in health promotion and disease management. Exercise prescription now forms an important part of some treatment programmes, with evidence for its use in the management of a range of disorders, including heart disease, diabetes, obesity, hypertension, osteoporosis, arthritis, back pain, chronic fatigue syndrome, and depression (for details see the relevant specific sections of this book).

Female athlete triad

History

Amenorrhoea in athletes was first recognized in the late 1970s. Before that it was unusual for women to train sufficiently hard to develop this syndrome. Since 1980, there has been a growth in the popularity of aerobic sports and in the number of endurance competitions for women, whose first Olympic marathon was in 1984 and first 10 000 m in 1988. The other important factor has been the fashion for thinness, which really began in the 1970s. These two changes in female behaviour are the main factors responsible for the development of this syndrome.

In the early 1980s it was thought that training intensity was the main underlying aetiological factor, but studies in the late 1980s indicate that many of these athletes also have disordered eating habits. It was also thought that the bone density of amenorrhoeic athletes would be normal, as the high levels of exercise would compensate for the low levels of oestrogen. However, studies from 1984 onwards have shown that amenorrhoeic athletes have low bone density. This female athlete triad therefore consists of disordered eating, amenorrhoea, and osteoporosis.

Continued here: Female athlete triad