Transcript Women*s Issues: ACL Injuries and Others

The Female Athlete Triad (FAT)
Mary Lloyd Ireland, M.D.
University of Kentucky
Dept. of Orthopaedic Surgery & Sports Medicine
Lexington, Kentucky USA
(859) 218-3061
www.ukhealthcare.uky.edu/sportsmedicine
The Female Athlete Triad
The Female Athlete Triad
Three related factors:
Disordered eating
Amenorrhea
Osteoporosis
Prevalence:
15-62%
3.4-66%
Unknown
High recurrence rate in anorexia: 30% relapse
• 10-18% mortality rate
Most likely you have seen a female athlete
with this triad.
PROPERTIES
On passing, 'Finish' button:
On failing, 'Finish' button:
Allow user to leave quiz:
User may view slides after quiz:
Goes to Next Slide
Goes to Slide
After user has completed quiz
After passing quiz
Body image is
important to all
ages
Thin is still in
Young females are
doing anabolic
steroids to look
“cut”
Did you know that Marilyn Monroe was. . .
5’4”, 140 lbs. and . . .
. . . that she pumped iron!
The Following Slide Contains an Excerpt
Courtesy of
American College of Sports Medicine
“The Female Athlete Triad”
American College of Sports Medicine
“The Female Athlete Triad”
The Next Slide Contains a
Short Preview of the New Video:
“Eating Disorders: More
Common Than You Think”
Sponsored by the James E. Ireland Foundation
Supported by the Women’s Sports Foundation
“Eating Disorders:
More Common Than You Think”
Sponsored by the James E. Ireland Foundation
Supported by the Women’s Sports Foundation
“Eating Disorders:
More Common Than You Think”
Funded by the James E. Ireland Foundation
http://james-e-ireland-foundation.com/
Scenes in the video were played by students from the
School for Creative and Performing Arts (SCAPA)
at
Lafayette High School
Lexington, Kentucky
1992 US Olympic Gymnastics Team eating
hamburgers at the White House
Epidemiology of FAT (Female Athlete Triad)
• 15% – 62% of college female athletes with
disordered eating
• 3.4% – 66% female athletes with amenorrhea
compared to 2% – 5% in the general female
population
• Amongst female athletes with menstrual
disturbance, prevalence of osteopenia or
osteoporosis ranges from 1.4% – 50%
Epidemiology of FAT (Female Athlete Triad)
• 425 female college athletes, 7 Universities
• 3.3% reported a diagnosis of anorexia nervosa
• 2.3% reported a diagnosis of bulimia nervosa
• 15.2% – 32.4% scored “at-risk” for EDO
• 31% reported menstrual irregularity
• 65.9% reported muscle injuries during collegiate career
• 34.3% reported bone injuries during collegiate career
(Beals, Manore. Int. J Sp. Nutr, 2002)
Disordered Eating
• At risk:
• Sports that focus on weight
(distance running, gymnastics, dancers, wrestlers)
• Chronic diseases related to caloric utilization
(diabetes)
• Food- or weight-focused professions
(models, culinary professionals)
• Disordered eating is fueled by the
misconceptions:
“Thinner is better”!
“If I’m thinner I’ll run faster, jump higher,
be more popular, be happier.”
PROPERTIES
On passing, 'Finish' button:
On failing, 'Finish' button:
Allow user to leave quiz:
User may view slides after quiz:
Goes to Next Slide
Goes to Slide
After user has completed quiz
After passing quiz
Description of Eating Disorders
• Abnormal eating patterns & cognitive distortions related
to food and weight
• Emotional/psychiatric
▪ Disturbed body image
▪ Preoccupation with becoming thinner
▪ Fear of becoming fat
• Disease affects:
▪ nutritional status
▪ medical health
▪ mental health
DSM IV: Anorexia Nervosa
• Restricting type
No regular binge eating or purging
• Binge-eating/purging type
Regular binge-eating or purging behavior
• self-induced vomiting, laxatives, diuretics, enemas
• Refusal to maintain body weight
• (< 85% expected); no weight gain during periods of growth
• Intense fear of gaining weight and becoming fat, even
though underweight
• Disturbance of body image, or denial of seriousness of
low body weight
• Amenorrhea (3 consecutive menses)
Food Behaviors – Anorexia Nervosa
• Counts calories/fat grams
• Restricts fat, protein and
•
•
•
•
other foods
Avoids red meat, other meats
Eats mostly vegetables
and fruit
Eats slowly
Cuts food into small pieces
• Denies hunger
• Throws food away
Anorexia Nervosa
• Co-morbidity
▪ 25% lifetime prevalence of
obsessive compulsive
disorder
▪ 50-75% prevalence of
dysrhythmia
• Prognosis
▪ 40 – 50% recover completely
▪ 30% improve
▪ 25% chronic course
▪ 10 – 15% mortality rate
DSM IV: Bulimia Nervosa
• Recurrent episodes of binge eating
• Amount of food larger than normal
• Sense of lack of control
• Inappropriate compensatory behaviors
• Self-induced vomiting, misuse of laxatives, diuretics, enemas
• Fasting or excessive exercise
• Behaviors occur 2x per week for 3 months
• Self-worth based on body size, shape, & weight
• Not occur exclusively during episodes of AN
• Purging type
• Regular self-induced vomiting or misuse of laxatives, diuretics
or enemas
• Non-purging type
• Inappropriate compensatory behaviors, such as fasting or
excessive exercise
• No self-induced vomiting, misuse of laxatives, diuretics or
enemas
Food Behaviors – Bulimia Nervosa
•
•
•
•
•
Somewhat aware of calories
Binges on calorie-dense, sweet foods
Eats fast, gulping food in large bites
Frequently hungry
Cannot waste food
• Co-morbidity
• Depression
• Substance abuse
• Many have history of sexual trauma
• Prognosis
• > 50% recover completely
• 25% retain some abnormal eating habits
• Few become anorectic
• 30% maintain a nonspecified eating disorder
DSM IV: Eating Disorder NOS
• AN, but regular menses
• AN, but normal weight; despite weight loss
• BN, but frequency < 2x/week or <3 months
• Inappropriate compensatory behavior after normal food
intake
• Chewing & spitting, not swallowing, large amounts of
food
• Binge eating disorder (BED): binges w/o purging
Menstrual Dysfunction
• Delayed menarche
• No secondary sexual characteristics by age 14
• No menses by the end of the 16th year
• Oligomenorrhea
• Cycle length > 35 days, < 90 days
• Secondary amenorrhea
• Cessation of menses for 90 days once
normal menses have been established
Orthopaedic Conditions More Common
in Females
Stress Fractures
High Risk Tensile Side
Low Risk Compression Side
Injury Patterns
• Cheerleading Injuries
• Who gets hurt?
• How?
• How bad?
• No NCAA tracking of injuries in
cheerleading
• Studies on cheerleading
injuries are needed
Fatalities and Catastrophic Injuries
– from
Cantu RC, Mueller FO,
“Fatalities and catastrophic injuries in high
school and college sports, 1982-1997,” in
The Physician and Sportsmedicine
1999;27(8): 35-48.
Fatalities and Catastrophic Injuries
Direct Fatalities
& Catastrophic Injuries
HIGH SCHOOL
Cheerleading
Gymnastics
Track
Swimming
Basketball
Softball
Field Hockey
Volleyball
TOTAL
Indirect Fatalities
HIGH SCHOOL
18
9
3
2
2
2
2
1
39
Basketball
Swimming
Track
Cheerleading
Soccer
Cross country
Volleyball
TOTAL
8
5
4
3
1
1
1
23
Fatalities and Catastrophic Injuries
Direct Fatalities
& Catastrophic Injuries
COLLEGE
Cheerleading
Gymnastics
Field Hockey
Downhill skiing
Lacrosse
TOTAL
Indirect Fatalities
COLLEGE
16
2
1
1
1
21
Tennis
Basketball
1
1
TOTAL
2
Prevention Strategies
• Coaches should:
• Supervise all practices
• Be safety certified
• Have an emergency plan
• Cheerleaders should:
• Have a preparticipation physical exam
• Be trained in gymnastics, spotting, conditioning
• Participate in stunts they have mastered
PROPERTIES
On passing, 'Finish' button:
On failing, 'Finish' button:
Allow user to leave quiz:
User may view slides after quiz:
Goes to Next Slide
Goes to Slide
After user has completed quiz
After passing quiz
Extreme pressure placed on athletes by
themselves and coaches
Do we push our teenage athletes too hard?
STOP Elbow Injuries in Youth Baseball:
Youth Sports Injury Prevention
Sports
Trauma and
Overuse
Prevention
Powerpoint
www.stopsportsinjuries.org/
STOP Cheerleading Injuries Tip Sheet
Psychology of Coaching
• Coaching
• Manhood: “Be the Man”
• Boys/men humiliation tactics by their coaches if
performing poorly
• Do not work on female athletes
– Kathy DeBoer, “Optimizing performance in team sports for
female athletes.” In Ireland & Nattiv, eds. The Female Athlete,
2002.
• The female athlete is very competitive – must
use methods to motivate and match world view
Joan Ryan,
Little Girls in
Pretty Boxes
Warner Books
(New York),
© 1995
The Positive
• High school girls who play sports are less likely to have
an unplanned pregnancy, less likely to be involved with
drugs, and more likely to graduate from high school.
• A teenager’s risk of breast cancer drops with as little as
2 hours of exercise a week.
PROPERTIES
On passing, 'Finish' button:
On failing, 'Finish' button:
Allow user to leave quiz:
User may view slides after quiz:
Goes to Next Slide
Goes to Slide
After user has completed quiz
After passing quiz
The Positive
• It is possible to help prevent osteoporosis by engaging
in weight bearing exercises that encourage an increase
in bone mass.
• Females involved in sports have been shown to have
higher self-esteem and lower incidences of depression.
• High school athletes have higher grades than their non-
athlete counterparts.
The Positive
• Females involved in sports have a more positive body
image and experience higher states of psychological
well-being than those who do not play sports.
• Sports teaches teamwork, goal-setting, the pursuit of
excellence and other achievement-based behaviors. It
has been shown these traits carry over to the workplace.
A WOMAN IS OFTEN MEASURED . . .
. . . by the things she cannot control. She is measured by the way
her body curves or doesn’t curve. By where she is flat or straight or
round. She is measured by 36-24-36 and inches and ages and
numbers, by all the outside things that don’t ever add up to who she
is on the inside. And so if a woman is to be measured, let her be
measured by the things she can control. By who she is and who she
is trying to become. Because as every woman knows,
measurements are only statistics and STATISTICS LIE.
― Nike: “Helping Athletes with Eating Disorders”
The End . . .
The Female Athlete Triad (FAT)
Mary Lloyd Ireland, M.D.
University of Kentucky
Dept. of Orthopaedic Surgery & Sports Medicine
Lexington, Kentucky USA
(859) 218-3061
www.ukhealthcare.uky.edu/sportsmedicine
Thank You!
In Closing
To insure credit for this module, please wait until
the next slide appears before closing out your
web browser