Training For A 10 K
This week was the first sign of spring. The hot weather brought us out from our winter hibernation. For some of us who brave the winter running it was great to see all the runners come out of the woodwork and pound some pavement. With this warm weather and this new found enthusiasm, it is the best time to set some goals. This is the best way to maintain your enthusiasm and this spring fitness fling. What better way then to pick one or a few road races or fun runs that are so prevalent in the spring and summer. For those of you who have run 10 k's in the past this may just be a review, but for those of you who this is your first, welcome aboard. The thought of new runners accomplishing this very reachable goal makes me remember my first attempt at completing my first race almost 15 years ago.
The important thing is to trian properly and sensibly so that you can finnish your goal relatively easily and enjoyably. There are three important components to training for a 10k. The first component is equipement and oviously the most important thing is your shoes. Shoes have developed an incredible amoount over the last couple of decades thanks to millions of dollars of research by the shoe companies. In the old days buying a shoe was a lot easier as there were only a few pairs to choose from. Today three are many companies that make many types of shoes designed specifically for running. The important thing is to find a compfortable shoe that is designed for your body type and the amount you want to run. A knowledgable sales person in a reputable store is an invaluable asset to finding the right shoe for you.
Although this week was short and t-shirt weather there undoubtably will be a few more cool days when you will need the appropriate running gear . Pay close attention to your socks as they are the main protection between your feet and your shoes. The fuel for your increased running comes from the food you ingest. A healthy balanced diet with an emphasis on carbohydrates will provide the energy you require. Pay close attention to your fluid and electrolytes. Always remember to replenish your lost fluids. Drink extra water during the day(8 cups a day) to avoid a chronic state of dehydration. The last concept is the most important; the training. If you have not run before or it has been a long time since you have run, you should allow 2 1/2 to 3 months before a race. You may want to start to walk before you run.
I advise people to train on alternate days to allow your body one day to recover and help to avoid injury. Work up slowly in the first month so you are walking, walk/jog, or slow jogging for 35-45 minutes 3-4 times per week. At this time or shortly after you should be able to jog for 20-25 minutes without stopping. Maintain that pace for you week day runs. You then want to start increasing your weekend run. Every week end add about 5 minutes to your run until you are running about 10 K. The average person will finish a 10K between 48-60 minutes. The key thing is the motivation to reach a goal. Having a friend join you or joining a running club will help motivate you and increase your enjoyment. So what are you waiting for. Go out and buy those shoes, lace them up and see how much fun it is to experience the freedom of running. Think how good you will feel being so fit. Think of the exhileration you will feel when you cross that finish line.
I remember growing up and reading in the paper that a famous athlete had "" shin splints"" I was almost envious that I did not have this malady myself. It just sounded so cool that you had shin splints. The basic fact was that no one really knew what shin splints were. What really was a splint of the shin and why did it not occur in other parts of the body? I could almost envision the splints of bone coming off the shin. To this day there is still a mystique around shin splints. I have many patients who come to see me in the office and tell me they have shin splints. The problem is that there is no such medical injury as shin splints. ""Shin Splints"" in my mind is nothing more than a lay man's term for any pain they have between the knee and the ankle. There are many causes for this and I will explain them to you.
The classic so called shin splint is along the inside of the shin. The athlete will complain of pain from about half way down the shin to just above the ankle. Depending on the severity it will ache a bit with activity and somewhat after activity, to a more severe situation where the pain limits activity and causes the individual to limp. The following are the most common causes of shin splints. To treat the problem it is important to have a clear diagnosis. 1/ TENDINITIS: The major muscle that inserts into the inside of the shin is called the Tibialis Posterior muscle. It's function is to move the foot down and inwards. It also helps to maintain the arch of the foot. While some muscles attach to bone at one small area, the tibialis posterior spreads out to insert over a wide area on the inside of the shin. With certain forms of exercise (running, aerobics) the muscle is constantly being asked to move the foot.
There is then a constant pulling on that broad based insertion into the bone. The tendon( the part of the muscle which actually attaches to the bone) starts to break down and become inflamed. There are probably microscopic tears in the tendon which lead to the pain and the inflammation. If the situation is allowed to worsen there is more damage in the tendon leading to more pain, swelling, and limitation of activity. PERIOSTITIS: As the situation gets worse there is repeated pulling of the tendon on the bone. The lining of the bone where the tendon inserts is called the periostium. Eventually the periostium becomes inflamed. There is increased pain as compared to the tendinitis and the pain generally lasts longer after activity. The person may notice swelling and even some bruising over the area.
The shin will be more tender to touch and almost always the athlete will by this time have limited their activity due to the pain. When I examine these people they are more tender on the bone on the inside of the shin as opposed to the tendon which is just below the bone. A regular x-ray will not show a shin splint. Often we will do a bone scan to asses the severity of the problem. A bone scan is a special test where we inject a small amount of radioactive material into the same vein in the arm that we use when we are taking a blood test. The amount of radiation that the body is exposed to is similar to a regular x-ray. The material injected is absorbed by any bone which is going through increased activity(ie. inflammation, fracture) A machine is then passed over the shin two hours later after the material has had time to go though the body. It reads the amount of radioactive material and creates a picture of the shin. If there is only a tendinitis there will be no uptake in the bone, but if the bone is inflamed it will show up on the scan as a thick line along the inside of the shin bone.
Once the bone is inflamed we know that it will be a much longer period of recovery. STRESS FRACTURE: It is not uncommon to have a stress fracture of the shin. The pain is again on the inside of the shin. The pain is usually more severe and can be there all the time and even ache in bed at night. The pain is usually more localized but not always. A stress fracture can occur as an extension of the periostitis or can occur by itself without any previous shin pain. This is again diagnosed by doing a bone scan. A stress fracture will show up on the scan as a deeper and very localized spot as opposed to the diffuse uptake you see with the periostitis. COMPARTMENT SYNDROME: The fourth common problem leading to shin splints is a compartment syndrome. The muscles in the lower legs are enclosed in a tight sheath. As we exercise there is an increased blood flow to the muscles. If the sheath is too tight it will cut off the blood going to the muscle and causing the pain. The pain in the lower leg will be where the muscles are being affected. This is usually a dull pain which will always last for several hours to days after exercise. In the more severe cases the nerves will be affected leading to numbness or even weakness. These are the four most common causes of ""Shin Splints"", but there are many other causes of shin pain, The next article will talk about the treatment of shin splints.
Shin Splints: The Treatment
The last article discussed the main causes of shin splints. As explained then ""Shin Splints"" is merely a lay man's term for any pain between the knee and the ankle. Therefore to treat the shin splint you have to make the diagnosis and treat the actual problem. Last week I broke shin splints into four main problems. They are 1/ Tendinitis 2/ Periostitis 3/ Stress Fracture 4/ Compartment Syndrome The treatment will vary for each.
1/ and 2/ TENDINITIS AND PERIOSTITIS Since periostitis is an extension of the tendinitis the treatment is essentially the same. The main difference is that the periostitis is more severe and will take longer to get better. This is the classic shin splint type problem. So, when people say they have shin splints, this is most commonly what they have. The main thing is to determine what caused the problem and correct these problems.
A/ Overuse: Like most sports injuries the most common problem is doing too much, too soon. Whether you are running or doing aerobics you probably have increased the amount and/or the intensity of your exercise. To decrease your pain you must decrease the activity which is perpetuating the pain. This may mean exercising alternate days or exercising for a decreased duration or less intense. To maintain your fitness augment your program with other activities such as cycling or swimming which will not aggravate your pain.
B/ SHOES: The shoes may be worn out or simply the wrong shoes for you or for the activity you are doing. This is extremely important for those doing indoor activities as the shoes will break down without looking worn. A rule of thumb is to replace your athletic shoes every 6-9 months of regular exercise.
C/ MECHANICS: Your lower leg alignment may predispose you to putting more stress on the shin and leading to shin splints. An orthotic may be useful if your biomechanics are leading to your problem.
D/ MUSCLES: Muscle weakness or inflexibility may lead to increased stress on the tibialis posterior tendon which is the tendon which is most commonly inflamed. Previous injuries that may have occurred even many years previously may have left you with muscle weakness and or tightness which may only now causing you problems now that you applying increased stress to the area.
These have to be assessed and corrected. The initial treatment involves decreasing the inflammation. This is accomplished by the following:
A/ ICE regularly for 15 minutes 2-3 times a day and after activity
B/ ANTI-INFLAMMATORY MEDICATION may be prescribed by your physician.
C/ PHYSIOTHERAPY is perhaps the most important element to reduce the inflammation and to work on the strength and flexibility to prevent future problems. As the pain diminishes the athlete is guided on a careful return to their activity. The goal is to get them back to their full activity and avoid a recurrence of the problem.
2/ STRESS FRACTURES A stress fracture is in fact a real fracture. It is a fatigue fracture which there is only a crack on the surface of the bone. It is like taking a soft piece of metal and bending it back and forth. At the point where the metal bends there is the most stress and it eventually cracks. If you continue to stress the metal it will break right through.
Although rare, this can happen to bone as well. Therefore, like any fracture it has to heal with new bone formation. You have to rest the bone to allow it to heal. You do not have to wear a cast, but you can not do any impact sports for around six weeks. You can though keep fit with cycling or swimming.
As with the tendinitis/periostitis you must correct any predisposing factors before you begin to exercise. For the first six weeks you must start very slowly to increase your impact activity as your body tolerates. It usually takes a further six weeks to get back to your previous exercise amount.
4/ COMPARTMENT SYNDROME As discussed last week this is pain caused by sheaths around the muscles of the lower leg being basically too tight. This is definitively diagnosed by inserting special needles into the muscles which can measure the pressure in the muscle. If you have a compartment syndrome the pressures will rise higher than normal and stay higher for a longer period of time than normal.
These will sometimes calm down by rest, stretching, and correcting any problems that may exist such as biomechanical problems. Ultimately, if the sheaths are just too tight and the pain persists, the only treatment is to surgically cut the sheaths to release the muscle. The bottom line is that if you have persistent shin pain than see your physician to determine the causes and to guide you on a treatment regime to cure your problem.
In -line skating or rollerblading is no doubt the fastest growing sport on wheels. While roller-skating on the traditional four wide base wheels never appealed to the masses, in-line skates have flourished. You just have to look at the streets every spring to see the large increase in the number of skaters. This is not only here in Canada where skating is second nature but I see the same phenomena in the warm southern United States. There are now two main ways that in-line skates are used. They are used just for skating which is a great way to get aerobic exercise and for roller hockey. Roller hockey is now so popular that there is actually a professional league in North America. As with any activity there are risks, particularly with a sport on wheels where your speed is faster and your control is less.
This is especially relevant since so much of roller blading is done by children who are less aware of the risks to their body. A recent study was done in Tampa by Emergency Room Physicians. The average age of those injured was 30 with the range being from age 6 to 57. Of the injured skaters 37% were skating for the first time, and 26% had skated less than 10 times. The nature of the injuries were quite severe with 30% requiring surgery and 27% more needing to have bones put back into place after being fractured or dislocated. The most common injury were wrist fractures with the second being ankle and boot top fractures. The more common skin abrasions and mild ankle sprains were not seen in this study as they usually do not go to see the doctor. The cause of the injuries were varied.
The majority at 57% were because of falls. 22% were due to collisions with other skaters, and 21% were due to skating across a defect in the pavement. Although high speeds were first suspected as the major cause of the falls, only 30% were as a result of a high speed fall. The majority were while the skater was standing still or moving at slow speeds. Protective gear was worn by only 1/3 of the injured skaters and while they did still see wrist fractures with skaters wearing wrist guards, skaters without wrist guards were 2.5 times more likely to sustain a serious wrist injury. There was one concussion reported, but the physicians did not report if that skater was wearing a helmet. The following are a list of safety factors which will help you to avoid injury and allow you to continue to get out on your blades.
1/PROTECTIVE GEAR: The best way to prevent injury is to wear protection. The two most important things are wrist guards and helmets. The most common injury is to the wrist and these can be very serious. Often surgery is required and the function of your wrist may never be the same. A head injury can be a lot more serious. Always wear a helmet when you are skating to help prevent a serious head injury. It can save your life. Knee guards are also helpful to prevent the common knee abrasions you get with falling.
2/LESSONS: A good lesson will help you master the technique a lot sooner. The skating motion is very similar to ice skating but the stopping motions are very different. This is generally where people get into trouble. You also can not turn and rotate as quickly as on ice skates. Also, there are no downhills on ice. Once you learn a few basic skills your chance of falling and injuring yourself is less.
3/LOCATION: The best area is a smooth asphalt surface where there is little or no vehicle traffic. I get very scared seeing all those kids skating along those city streets. If you must skate on the streets be very careful to stay on the side and obey all traffic signs. Remember, most cars can not or will not see you. If you are skating in a crowded area with other skaters, joggers, and cyclists, skate with care as a lot of the injuries have occurred by collisions with other people. Be very careful even on small hills as this is where you have the least control. In-line skating is a great activity, but remember there are significant risks. Use common sense and skate within your limits.
""Hey Doc, Do I need to stretch? Is there any value in wasting my time stretching? You would be amazed how often people ask me these questions. Most people who are active if pressed will say that they should stretch, but how many will stretch properly, let alone stretch at all. Although the research is mixed in it's results, most people believe that a good stretching program will not only improve your performance as well as help prevent injury. If you are a runner and you want to improve your speed you can either increase your leg speed or lengthen your stride. If you want to lengthen your stride you will need the extra flexibility. The same applies to the upper body. To swim faster you can lengthen your stroke by improving your shoulder flexibility. By the same token , if you want to serve harder you will require the increased flexibility in your shoulder to increase the torque through the arm. The other important aspect is injury.
A warm flexible muscle is much harder to injure than a cold structure. This is evident in the acute stage where you might tear a hamstring if you are not warmed up. In the chronic situation the constant pull on a tendon at the end of an inflexible muscle can lead to tendinitis. For stretching to be effective it has to be done properly and on a regular basis. I see many patients who bemoan the fact that although they have tried they can't improve e their flexibility. The main reason is that they have not been taught to stretch properly. People ask if they should stretch before or after activity. Both are important. If you are doing an explosive type of event then it is important to stretch well before you start to prevent a tear in the muscle. If you are doing a slower event such as jogging it is important to start slowly and ease into your running speed over the first 5-10 minutes.
After you finish jogging you then should spend a longer period of stretching. The following are my rules of stretching.
RULE 1: Always warm up before you stretch. Never attempt to stretch a cold muscle as you might in fact injure the muscle when you are trying to prevent injury. Work out slowly with a slow jog or cycle until you have a light sweat. Large arm circles will warm up the upper body.
RULE 2: Stretching should never be painful. Stretch your muscle until you feel a slight tightness and then pull back slightly.
RULE 3: Never bounce. This again can injure the muscle/tendon unit. All stretches should be SLOW, STATIC stretches. I tell people that they should stretch at the speed of a glacier.
RULE 4: Hold your stretches for a significant amount of time. The most common problem with ineffective stretches is that they are not held long enough. People will hold their stretches for 5-10 seconds. At that point the muscle is reacting to the stretch and tightening up against you. Therefore the two forces equal out with no net result. You have to wait until the muscle relaxes to get a good stretch. A stretch should be held at least 30 seconds and repeated several times. The most flexible people in the world are ones that do Yoga and they hold their stretches for minutes at a time.
RULE 5: Play the edges. In a long stretch you will feel your muscle relaxing. Every 15 seconds slightly increase your stretch a slight amount. This is perhaps the best way to improve your flexibility.
RULE 6: Stretch regularly. Improving your flexibility is a cumulative task. Stretching must be done on a regular basis of 3-4 times a week for it to be effective.
RULE 7: If you have an injury, have individual unique needs or have problems improving your flexibility, then seek help. A good sports therapist can work with you with special techniques to help you improve you flexibility.
RULE 8: Never stretch an acutely injured muscle. If you tear a hamstring for example than stretching that torn muscle will only tear it more. You have to allow time for that muscle to heal before you begin to get back the flexibility. In summary, the ideal scenario is to warm up for 5-10 minutes and then stop and stretch. Then after your activity stretch for a longer more relaxed period of time. I like to allocate about 15-20 minutes for my stretching program. If you follow these rules I have no doubt that you will improve your flexibility and allow you to exercise not only safer but with improved performance.
Sports Injuries In The Immature Athlete
A lot of the athletes I see are young athletes who are in their formative years. Children these days are specializing at an earlier age and spending more hours doing a specific sport or activity to obtain proficiency in their sport at an earlier age. Years ago children were encouraged to do a variety of sports, and while this is still true, there is a lot of pressure on kids who are particularly good at a sport to specialize and do only the one sport. Coaches and parents will even discourage or not allow the children to do other sports as it might affect their main sport. They are also doing certain sports year round as apposed to seasonal participation. This increased activity has lead to an increase injury rate in these children. Aristotle in 200 BC warned that "" Olympic victors were those individuals who did not overtrain in earlier years."" Not only is their an increased physical stress on the children's bodies, but there is also the increased pressure and psychological stress.
We have heard many stories of teenage elite athletes who burn out at a young age. In medical school we are often told that children are not just young adults. They have problems that are unique to them being children. Young athletes are prone to a myriad of physical, nutritional, and hormonal problems. The child's immature skeletal system react differently than an adults. In acute injuries the bones are the weakest structures as opposed to the ligaments. So, while an adult might sprain an ankle, the child will fracture a bone with the same mechanism of injury. In the overuse injuries the growth plate in the child will take most of the stress while the adult will develop tendinitis. Common injuries that you might of heard of to the growth plates are Osgoode Schlatters Disease in the knee and Little League Elbow. It is a rare gymnast who does not develop growth plate pain in their heels. Their are also different physiological differences which have to be taken into account when developing the child's training programs. A child's aerobic capacity is not as developed before puberty.
Co-ordination is also less developed. Until the hormones of puberty start to increase muscle development will be limited. Nonetheless a child can still increase their strength with a weight program consisting of low weights and high repetition. The following are tips for avoiding injury in the young athlete.
TIP 1: The same motif of "" No Pain-No Gain"" should definitely not be followed in the child or developing adult. The child must be taught to listen to their bodies an feel comfortable to relate their pain and discomfort to their coach and parent without the fear that they will be ignored or made fun of.
TIP 2: A child's amount of activity must be carefully monitored so as not to put too much stress on the skeletal system. A runner's mileage should be limited. Quality as opposed to quantity of the work outs should be stressed. A baseball pitcher should be limited to the number of pitches thrown a week and the same should apply to a tennis player.
TIP 3: Training should be in cycles as opposed to steady training. Specific peaking periods should be mixed with rest sessions to allow the body to adapt.
TIP 4: Weight training should be limited to low weight high repetitions and maximal weight lifts and strength contests should be avoided until the bones are mature.
TIP 5: Young athletes are most prone to growth plate injuries during and just after growth spurts. Training should be adapted accordingly.
TIP 6: Female athletes who have delayed menarche with or without nutritional problems need close medical care.
TIP 7: Certain sports put unusual stress on certain body parts which they were not designed for. For example a gymnast will use the wrist as a weight bearing joint. Too much stress on that joint for something it was not designed for will damage the joint and leave that individual with life long problems.
TIP 8: Contact sports should be delayed until after age 14 where puberty has evened out. At an earlier age you can get up to 100 lbs. discrepancy between children which can not only lead to serious injury but also discourage the smaller child from even participating. In summary, the objective is to limit the risk of injury while developing skills and maintaining enjoyment in the sport. Open communication and sensible training programs are the key.
Exercising To Eternity
How much would you pay for a potion that would not only let you live lomger, but have a better quality of life. An elixer that you can virtually take for life. Well, we do not have this elixer, but exercise has been proven to be the closest thing we have that a person can do for themselves for life. As people age they often are concerned about exercising. I am often asked if an individual is too old for a certain operative procedure or even old enough to come and see me on the sports clinic. Almost nothing upsets me more. Age is only a matter of mind. People can keep active their whole life. Many of us have seen the older barefoot water skier on that Castrol television add. I have many patients that are well into their 80's who are still competitive in their respective sports.
Our sports clinics have many people rehabilitating their injuries to get back on the tennis court or golf course. I am often asked if exercise is harmful to their health. I often hear people say that you shouldn't run as it will destroy your joints. Their are two studies that have been undertaken to look at this. A follow up study looked at Harvard University graduates. They compared the track team to the swimming team many years after they graduated. They found in fact that the swimmers had a 5% higher incidence in their knees. A larger study was done in Framingham, Massachusetts. This is a huge study done on the inhabitants of this town over the last 39 years to look at many trends in their lives as it relates to health.
One aspect was to look at their knees to look at the development of arthritis. Eight hundred and twenty women and 584 men were examined. The last follow up was in 1983-85 when the age of the participants were between 63-93. The study showed that about 18% of the people developed arthritis in their knees, but there was no correlation to the amount of physical activity. Although they did not find any correlation to people who had knee injuries, it is my belief that people with certain knee injuries are placing that knee under increased stress with weight bearing activities and they should modify their activity accordingly. The other fallacy I hear is that older people can not exercise because they lose their endurance and might die while exercising. Sudden death during exercise will be the topic of a future article, but high intensity exercise after age 40 adds no significant risk of coronary heart disease.
The benefit of regular exercise far out weighs the slight increased risk of heart problems during the actual exercise period. A recent study in Finland looked at the life expectancy of former world class athletes. The endurance athletes generally lived a healthy lifestyle and had an increased life expectancy by 2-4 years as compared to even their fellow healthy citizens. As you age starting at about age 40 their is a natural decline in your aerobic fitness. The key point is that regular exercise will help to maintain your aerobic capacity. If the same intensity is maintained then this reduction will be minimal. Weight training as an adjunct is important to help maintain muscle mass. Muscle mass seems to decline at a rate of about three pounds per decade unless weight training is done routinely in your program.
Bone density is also maintained reducing the risk of fractures which are more prevalent in the older age group, especially females as the bones weaken. The last important issue is health issues. Previous article have discussed the benefits of exercise as it relates to health. The most important elements are maintaining blood pressure and preventing heart disease. Now while we can not halt the aging process, regular exercise can sure help prevent disease and more importantly slow the aging process. It is the closest thing to the fountain of youth that we know about.
HIV In Sports Today
The most talked about disease in the last 10 years is AIDS. From something which we did not even know about 15 years ago, it is now one of the major killers in young people today. We initially thought that AIDS was very limited to certain population groups, but we now know that is simply not true. Once Magic Johnson announced that he had the HIV virus we realized that any of us or any of our opponents might be in fact exposed to the virus or in fact have the virus. This is of concern to athletes both as they live in today' s society and being involved in contact sports. There is a lot of misinformation of how the actual virus is transmitted. The majority of victims have obtained the virus from sexual contact. The next most common way is an infected person's bodily fluids enter another person's blood system.
In the past this usually occurred through blood transfusions. Today blood is screened to prevent this problem. Puncture wounds by infected used needles and other sharp objects have lead to transmission of the virus. The least common way to transmit the virus and the most relevant to those playing sports is another persons infected blood finding it's way into an open wound. Certain body fluids have been known to transmit the virus while others have not been implicated. Those that transmit the virus are blood, semen, breast milk, vaginal and cervical secretions. Those that have not shown at the present time not to transmit the virus include tears, saliva, sweat, urine, sputum, and respiratory droplets(sneeze). HIV is not transmitted through handshaking, skin contact, swimming pool water, toilet seats, food and drinking water. No known cases of HIV transmission have occurred through contact with contaminated surfaces such as wrestling mats, taping tables, sinks or other surfaces.
The question is is there a risk of acquiring HIV while playing sports. To date their is only one unconfirmed case of an athlete acquiring the virus while playing sports. This was in a soccer match where the two individuals were involved in a fight where there was quite a bit of blood involved in the fight. The greatest risk to the athlete is their risk off the playing field. The largest risk is through sexual contact. Athletes who are travelling to other parts of the world should be aware of which areas have a higher incidence of HIV and that other countries are not as careful with using clean needles or instruments or screening their blood products before transfusion. The Canadian Academy of Sport Medicine have set forth recommendations that are directly applicable to HIV. Here are some of them.
1/ Safe sex and abstinence from sex play the major role in deceasing HIV transmission.
2/ All needles and instruments that will pierce the skin should be sterile, used one time and not shared.
3/ Personal items such as razors, toothbrushes, and nail clippers that may pierce the skin should not be shared.
4/ Primary protection for bloody injuries include the use of appropriate protective equipment.
5/ Dealing with a Bloody Wound: i/If bleeding occurs where other participants may be exposed to blood, the individual's participation must be interrupted until the bleeding is stopped. The wound must be both cleansed with antiseptic and securely covered. ii/All clothing soiled with blood must be replaced prior to the athlete resuming training or competition. Clothing soiled with blood and other bodily fluids must be washed in hot, soapy water. iii/All equipment and surfaces contaminated with blood or other bodily fluids should be cleaned with a solution of one part household bleach to nine parts water. The solution should be prepared daily. iv/While cleaning blood or other bodily fluid spills the following must be done: -wear waterproof gloves -wipe up fluids with paper towels or disposable cloths -disinfect the area as described in iii. -place all soiled material in a plastic bag for disposal -remove gloves and wash hands with soap and water
6/ Other wounds including abrasions and all skin lesions and rashes on athletes, coaches, and officials must be reviewed by medical personnel. All wounds, skin lesions, rashes must be confirmed as noninfectious and be securely covered prior to the athlete starting or continuing participation.
The Female Athlete Triad
YOUNG AMERICAN FEMALE GYMNAST DIES BECAUSE OF HER SPORT!!! This was a headline in this summer's paper. What happened to this once elite gold medalist that her sport caused her death. In a certain number of females especially the young elite athlete the desire to maintain a competitive edge has lead to a discrete, but potentially inter-related medical entities. This triad of DISORDERED EATING, AMENORHEA, and OSTEOPOROSIS is important because of the significant problems it can cause the individual resulting in even death in the worst case scenario. We see this although not exclusively in three main sporting type events .
They are: 1/ The appearance events such as figure skating and gymnastics. Subjective judging may force women to strive to maintain their thinness. This is also evident in the arts such as ballet. Studies have shown that 19-44% of ballet dancers have some form of these problems.
2/ Women who participate in endurance sports are often told that the thinner they are the faster they will be. 3/ Sports where the athlete has to make a weight class such as wrestling or martial arts. DISORDERED EATING A broad spectrum of eating patterns exists ranging from a mild preoccupation with food and body image to serious anorexia nervosa and bulemia. At some point the athletes health becomes a concern.
Frank anorexia nervosa and bulemia have specific criteria based on actual weight, body image, binging, and purging(vomiting or laxative abuse) AMENORRHEA Amenorhhea means absence of menstral bleeding. Primary amenorhhea applies to females who have never had a menstral period by age 16. Secondary amenorhhea is the absence of menstral periods in a women who has had established menstral periods.
Generally if you have not had a period for 3-6 months you fall into this category. Be aware that there are other causes for amenorhhea besides being an athlete and these should be investigated fully by a doctor before you blame your loss of menstration on you athletic involvement. OSTEOPOROSIS This refers to premature bone loss and/ or inadequate bone formation, resulting in low total bone mass.
In this scenario the loss of bone mass is due to the low level of female hormones associated with the amenorhhea. This can lead to increase in injury such as stress fractures in the short term and maybe more importantly, if you do not develop a good bone mass when you are growing you will be more prone to osteoporsis at a latter age and be more prone to hip and wrist fracture as well as spinal kyphosis, all of which have serious consequences.
Over 90% of athletes with this triad are adolescent girls and women. Due to a denial of the problem and an individuals desire to hide the problem exact statistics are hard to determine. The potential medical problems are numerous and the reason their is such a concern for this problem. In the most severe cases life is at risk from fluid and electrolyte problems or from suicide which is not uncommon.
Medical problems which can occur with this triad are in the short term increased injury, heart, gastrointestinal, and psychological problems. Long term problems are osteoporosis, fractures, scoliosis, altered reproductive function, cancer, and psychological problems. The key to helping this problem is prevention. The problem if not prevented totally must be recognized early and dealt with immediately. The important thing is to take the problem seriously.
Do not undermine the athletes perception of the problem as it is very real in their eyes. The problem will not go away on its own. What is important is to approach the problem realistically. Focus on the athletes perception and needs. The athlete must learn proper methods to train, eat and perform. The approach MUST be a team approach. Without having everyone involved the treatment is doomed.
The team should include the athlete herself, the physician, a registered dietician, a specialized psychologist or psychiatrist, the sports therapist, the coach and the parents. The most important thing is to have ALL team members involved. There must be a set policy and communication is the key. I personally never want to see this headline again.
The Toronto Sun also feels the same way and is now working on establishing a home(Sheena's House) for females with these problems. Ultimately, exercise for women is beneficial and something we want to encourage. It is the preoccupation with body image and thinness that is the problem. Our athletes must be taught proper training and nutritional techniques to obtain optimal performance.