Transcript Chapter 29: Additional Health Conditions

Chapter 29: General Medical
Conditions
Role of the Immune System
• Collection of disease fighting cells that
neutralizes foreign substances
– Illness results when immune system does not
neutralize foreign substances (antigens)
– Cell-mediated response, humoral immune
response (B-cells that produce antibodies), or
nonspecific immune response (inflammation)
• Auto-immune response against the body
leads to damage of body’s own tissues
Viral Infections
• Rhinovirus (Common Cold)
– Etiology
• Over 100 different rhinoviruses
• Transmitted by either direct or indirect contact
(cough, sneeze, speaking, touching contaminated
article)
– Sign and Symptoms
• Begins w/ scratchy, sore throat, stopped-up nose,
watery discharge and sneezing
• Second batch may produce thick yellow nasal
discharge, watering eyes, mild fever, sore throat,
headache, malaise, myalgia, dry cough
– Secondary - laryngitis, tracheitis, acute bronchitis,
sinusitis, and otitis media
– Management
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Symptomatic treatment (may last 5-10 days)
Non-prescription cold medications
Eat a balanced diet, consume 64 oz. of water
Avoid emotional stress and extreme fatigue
• Influenza (Flu)
– Etiology
• Caused by myoviruses (A, B, C)
– Type A is most common
– Virus enters through cell genetic material
– Sign and Symptoms
• Fever (102-103 degrees F), chills, cough, headache,
malaise, and inflamed respiratory mucous
membrane w/ coryza
• General aches and pains, headache becomes worse
• Weakness, sweating, fatigue may persist for many
days
– Management
• Bed rest and supportive care
• Symptomatic care (aspirin) should be avoided by
those under age 18 ( Reye’s syndrome)
• Steam inhalation, cough medicines, and gargles
• Infectious Mononucleosis
– Etiology
• Epstein-Barr virus (member of herpes group) that
has incubation period of 4-6 weeks
• Transmitted through saliva
– Sign and Symptoms
• First 3-5 days -severe fatigue, headache, loss of
appetite and myalgia
• Days 5-15 - fever, swollen lymph nodes and sore
throat (50% will experience enlarged spleen)
• Possible jaundice, skin rash, puffy eyelids
– Management
• Supportive symptomatic treatment
• Acetaminophen for headache, fever and malaise
• Resume training after 3 weeks after onset if spleen
not markedly enlarged/painful, athlete is afebrile,
liver function is normal, and pharyngitis is resolved
• Rubella (German Measles)
– Etiology
• Highly contagious viral disease (childhood disease)
• Results 13-24 days after exposure
• May cause developmental difficulties for fetus in
pregnant females
– Sign and Symptoms
• Temperature elevation, sore throat, drowsiness,
swollen lymph glands and red spots on palate
• Rash
– Management
• Prevent by early childhood immunization
– Measles, mumps, rubella vaccine (MMR)
• Rubeola (Measles)
– Etiology
• Childhood disease
• Incubation time of 10 days following exposure
– Sign and Symptoms
• Sneezing, nasal congestion, coughing, malaise,
photophobia, spots in mouth, conjunctivitis, and
elevated fever (rash appears - causes itching)
– Management
• Inoculation w/ MMR vaccine at 12-15 months and
4-6 years of age
• Bed rest, isolation in dark room and use of
antipyretic and anti-itching medication
• Mumps (Parotitis)
– Etiology
• Contagious viral disease that results in inflammation of
parotid and salivary glands
• Appear in 12-25 days following exposure
– Sign and Symptoms
• Malaise, headache, chills and moderate fever
• Pain in neck - swelling of glands may last up to 7 days
• Pain w/ jaw motion and swallowing; increased or
decreased saliva production
– Management
• Immunization with MMR should be done in children
• If mumps occur the patient should be isolated while
contagious, confined to bed and given soft diet
• Analgesics and cold application should be used to
control swelling (heat may be used later)
• Varicella (Chicken Pox)
– Etiology
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Caused by varicella-zoster virus (herpes zoster)
May occur at any age (more common in children)
Incubation time is 13-17 days following exposure
Contagious for 11 days, including 5 days prior to
rash
– Signs and Symptoms
• Slight elevation in temperature followed by eruption
of rash
• Rash progresses (macule, papule, vesicles, and
crusts over for 2-3 days)
• Rash begins on back and chest
• May last 2-3 weeks
– Management
• Varicella-zoster immune globulin w/in 96 hours of
exposure will prevent clinical symptoms in normal
healthy children
• Acyclovir meds should be administered to
adolescents and adults w/ in 24 hours of exposure
• Anti-itching medications to prevent scratching
Respiratory Conditions
• Sinusitis
– Etiology
• Stems from upper respiratory infection caused by a
variety of bacteria
– Sign and Symptoms
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Nasal mucous swell and block ostium of paranasal sinus
Painful pressure occurring from accumulation of mucus
Skin over sinus may be swollen and painful to the touch
Headache and malaise; purulent nasal discharge
– Management
• If infection is purulent, antibiotics may be warranted
• Steam inhalation and other nasal topical sprays w/
oxymetazalone can produce vasoconstriction and
drainage
• Tonsillitis
– Etiology
• Acute inflammation and bacterial infection of tonsil
epithelium
– Sign and Symptoms
• Tonsil appear red, swollen, w/ yellow exudate in pits
• Pain w/ swallowing, high fever and chills, headache
and neck pain
• Sinusitis, otitis media, tonsillar abscesses may also
develop
– Management
• Culture to check for streptococcal bacteria and
antibiotics for 10 days
• Gargling w/ saline water, liquid diet, and antipyretic
medication
• Frequent bouts of tonsillitis may necessitate removal
• Seasonal Atopic (Allergic) Rhinitis
• Hay fever, pollinosis from airborne pollens
– Etiology
• Reaction to pollen - airborne fungal spores
(allergens) resulting in allergic antibodies causing
the release of histamine
– Sign and Symptoms
• Eyes, throat, mouth and nose begin to itch, followed
by watering eyes, sneezing and clear watery
discharge
• Sinus type headache, emotional irritability, difficulty
sleeping, red & swollen eyes and nasal mucus
membranes, and wheezing cough
– Management
• Oral antihistamines and decongestants
• Pharyngitis (sore throat)
– Etiology
• Caused by virus or streptococcus bacteria
• Transmitted by direct contact of infected person or
one who is a carrier
– Sign and Symptoms
• Pain w/ swallowing, fever, inflamed and swollen
glands, malaise, weakness and anorexia
• Mucus membrane may be inflamed and covered w/
purulent matter
– Management
• Throat culture
• Topical gargles and rest
• Antibiotic therapy for streptococcal infection
• Acute Bronchitis
– Etiology
• Infectious winter disease that follows common cold or
viral infection
• Fatigue, malnutrition or becoming chilled could be
predisposing factors
– Sign and Symptoms
• Upper respiratory infection, nasal inflammation and
profuse discharge, slight fever, sore throat and back
muscle pains
• Fever lasts 3-5 days while cough can last 2-3 weeks
• Yellow mucus indicates infection
• Pneumonia can complicate condition
– Management
• Avoid sleeping in cold environment, avoid exercise in
extreme cold w/ protection
• Rest until fever subsides, drink 3-4 quarts of water daily,
ingest antipyretic analgesic, cough suppressant, and
antibiotic
• Pneumonia
– Etiology
• Infection of alveoli and bronchioles from viral,
bacterial or fungal microorganisms
• Irritation from chemicals, aspiration of vomitus
• Alveoli fill w/ exudate, inflammatory cells and fibrin
– Sign and Symptoms
• Bacteria will cause rapid onset
• High fever, chills, pain on inspiration, decreased breath
sounds, rhonchi on auscultation, coughing of purulent,
yellowish sputum
– Management
• Treat w/ antibiotics; perform deep breathing exercises
to removal of sputum through heavy coughing
• Analgesics and antipyretics may be useful for
controlling pain and fever
• Bronchial Asthma
– Etiology
• Caused by viral respiratory tract infection,
emotional upset, changes in barometric pressure or
temperature, exercise, inhalation of noxious odor or
exposure to specific allergen
– Sign and Symptoms
• Spasm of smooth bronchial musculature, edema,
inflammation of mucus membrane
• Difficulty breathing, may cause hyperventilation
resulting in dizziness, coughing, wheezing,
shortness of breath and fatigue
• Exercise-Induced Bronchial Obstruction
(Asthma)
– Etiology
• Brought on by exercise w/ exact cause unknown
– Metabolic acidosis, post-exertional hypocapnia,
stimulation of tracheal irritant receptor, adrenergic
abnormalities, defective catecholamine metabolism and
psychological factors, loss of heat and water, sinusitis can
also trigger
– Sign and Symptoms
• Airway narrowing due to spasm and excess mucus
production
• Tight chest, breathlessness, coughing, wheezing,
nausea, hypertension, fatigue, headache, and redness
of skin
• May occur w/in 3-8 minutes of exercise
• EIA (continued)
– Management
• Regular exercise, appropriate warm-up and cool
down, w/ intensity graduated
• Inhaled bronchodilators may be useful
• Exercise in warm, humid environment
• Cystic Fibrosis
– Etiology
• Genetic disorder that can manifest as obstructive
pulmonary disease, pancreatic deficiency, urogential
dysfunction and increased electrolyte sweating
• Cause of severe lung disease w/ life expectancy of
about 30 years
– Sign and Symptoms
• Bronchitis, pneumonia, respiratory failure, gall
bladder disease, pancreatitis, diabetes and nutritional
deficiencies
• High production of mucus
– Management
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Drug therapy to slow progress of disease (ibuprofen)
Antibiotics to control pulmonary disease
Consistent postural drainage to mobilize secretions
High fluid intake to thin secretions and use of
humidifier
Muscular Disorders
• Duchenne Muscular Dystrophy
– Etiology
• Hereditary disease causing degeneration of skeletal
muscle (gradual replacement of muscle w/ adipose and
connective tissue - decreased circulation which
perpetuates condition)
– Sign and Symptoms
• In children, exhibited by frequent falls, difficulty
standing
• Muscles tend to shorten as they atrophy, causing
scoliosis and other postural abnormalities
– Management
• Cannot be cured; consistent exercise can be used to
retard atrophy
• Ambulation w/ braces until the individual is confined to
a wheelchair
• Death generally occurs by age 20
• Myasthenia Gravis
– Etiology
• Autoimmune disease where antibodies attack synaptic
junctions
• Deficiency in acetylcholine producing early fatigue
• Often occurs in females age 20-40
– Sign and Symptoms
• Drooping of upper eyelids and double vision due to
weakness in extraocular muscles
• Difficulty chewing and swallowing, weakness of
extremities and general decrease in muscle endurance
– Management
• Treat w/ drugs that inhibit breakdown of acetylcholine
• Corticosteroids can be used to suppress immune system
- reducing production of antibodies that destroy
acetylcholine
Nervous System Disorders
• Meningitis
– Etiology
• Inflammation of meninges surrounding spinal cord
and brain
• Caused by infection brought on by meningococcus
bacteria
– Sign and Symptoms
• High fever, stiff neck, intense headache, sensitivity
to light and sound
• Progress to vomiting, convulsions and coma
• Meningitis (continued)
– Management
• Cerebrospinal fluid must be analyzed for bacteria
and WBC’s.
• If bacteria is found isolation is necessary for 24
hours (very contagious), antibiotics must be
administered immediately
• Monitored closely in intensive care unit
• Multiple Sclerosis
– Etiology
• Auto-immune inflammatory disease of CNS that causes
deterioration and damage to myelin sheath, disrupting
nerve conduction
– Sign and Symptoms
• Blurred vision, speech deficits, tremors, muscle
weakness and numbness in extremities
• Tremor spasticity, neurotic behavior and mood swings
• May progress slowly or may be acute attack followed
by partial or complete temporary remission
– Management
• Deal w/ symptoms as they occur
• Avoid over exertion, extreme temperatures, and stressful
situations
• Establish exercise routine
• Drug therapy to slow progression
• Amyotropic Lateral Sclerosis (Lou Gehrig’s
Disease)
– Etiology
• Sclerosis of lateral regions of spinal cord along w/
degeneration of motor neurons and significant atrophy
– Sign and Symptoms
• Difficulty in speaking, swallowing and use of hands
• Sensory and intellectual function remain intact
• Rapid progression of atrophy resulting in paralysis
– Management
• No cure
• Even after incapacitation, normal intellectual function
remains; inability to communicate feelings and ideas
• Reflex Sympathetic Dystrophy
– Etiology
• Abnormal excessive response of sympathetic
portion of autonomic nervous system following
injury
– Sign and Symptoms
• Commonly seen in hands and feet following
immobilization of injured part (change to bone,
connective tissue, blood vessels and nerves)
• Develop extreme hypersensitivity to touch, redness,
sweating, burning pain, swelling w/ palpable
tightness and shining skin; atrophy
• Possible psychologic depression
• Reflex Sympathetic Dystrophy (continued)
– Management
• Early recognition and intervention is critical
• Must direct treatment at disrupting abnormal
sympathetic response
• Use of sympathetic ganglion nerve block is critical
• AROM exercise through pain free range, use
modalities to modify pain and reduce swelling
• Anti-depressant drugs may be necessary for chronic
conditions
Blood and Lymph Disorders
• Iron Deficiency Anemia
– Etiology
• Prevalent in menstruating women and males age 7-14
• Three things occur during anemia
– Small erythrocytes
– Decreased hemoglobin
– Low ferritin concentration (compound that contains 23% iron)
• GI loss of iron in runners is common
• Aspirin and NSAID’s may cause GI bleeding and iron
loss
• Menstruation accounts for most iron lost in women
• Vegetarian athletes may also be deficient in intake
relative to iron loss
– Sign and Symptoms
• First stage of deficiency, performance declines
• Athlete may feel burning thighs and nausea from
becoming anaerobic
• Ice cravings are common
• Serum ferritin levels must be assessed
• Mean corpuscular volume and relative size of
erythrocytes must be checked
– Management
• Eat a proper diet including more red meat or dark
poultry; avoid coffee and tea (hamper iron
absorption)
• Consume vitamin C (enhance absorption)
• Take supplements (dependent on degree of anemia)
• Runners’ Anemia (hemolysis)
– Etiology
• Caused by impact of foot as it strikes the surface
• Impact destroys normal erythrocytes w/in vascular
system
– Sign and Symptoms
• Mildly enlarge cells, increase in circulatory
reticulocytes and decreased haptoglobin (bound to
hemoglobin)
• Varies according to training
– Management
• Run on soft surfaces, wear well cushioned shoes and
run w/ light feet
• Sickle-Cell Anemia
– Etiology
• Hereditary hemolytic anemia - RBC’s are sickle or
crescent shaped (irregular hemoglobin)
• Less ability to carry oxygen, limited ability to pass
through vessels, causing clustering and clogging of
vessels (thrombi)
• Severe cases can result in death if embolus develops and
travels to lungs
• Exercise factors that can cause sickle cell anemai 1)acidosis, 2) hyperthermia, 3)dehydration, 4) severe
hypoxemia
• Can be brought on by high altitudes
• Sickle Cell Anemia (continued)
– Sign and Symptoms
• Fever, pallor, muscle weakness, pain in limbs
• Pain in upper right quadrant indicating possible
splenic infarction
• Headaches and convulsions are also possible
– Management
• Provide anticoagulants and analgesics for pain
• Hemophilia
– Etiology
• Hereditary disease caused by absence of clotting
factors
• Prolonged coagulation time, failure of blood to clot
and abnormal bleeding
– Sign and Symptoms
• Physical exertion can cause bleeding into muscles
and joints -- may be extremely painful
• Joints may become immobilized
– Management
• If bleeding occurs, athlete should be taken to a
medical care facility
• No cure
• Clotting factors have been developed to control
bleeding for several days
• Avoid trauma and wear medical alert bracelet
• Lymphangitis
– Etiology
• Inflammation of lymphatic channels
• Caused by streptococcal bacteria
– Sign and Symptoms
• Usually occurs in extremities
• Deep reddening of the skin, warmth, lymphandentitis
and raised border over affected area (particularly in
case of infection)
• Chills and high fever w/ moderate pain and swelling
– Management
• Patient should be hospitalized and vital signs monitored
• Following evaluation warm compresses should be
applied to the extremity
• Antibiotic administration and fluid intake (restore fluid
balance) is encouraged
Diabetes Mellitus
– Most common forms are Type I (insulindependent diabetes mellitus) and Type II (noninsulin-dependent diabetes mellitus)
– Etiology
• Result of interaction between physical and
environmental factors
• Involves a complete or partial decrease in insulin
secretion
– Sign and Symptoms
• IDDM is most commonly seen in childhood with
sudden symptoms of frequent urination, constant
thirst, weight loss, constant hunger, tiredness,
weakness, itchy dry skin and blurred vision
• NIDDM occurs later in life and is usually associated
with being overweight
• Body either does not produce enough insulin or
resists insulin that is being produced
– Management
• Monitor and control glucose levels
• Diet, doses of insulin
• Vigorous exercise increases peripheral insulin action
and enhances glucose tolerance
• ATC must be aware that extreme temperatures and
unpredictable activity levels may require the
administration of rapid-acting carbohydrates
• Diabetic Coma
– Etiology
• Loss of sodium, potassium and ketone bodies
through excessive urination (ketoacidosis)
– Sign and Symptoms
• Labored breathing, fruity smelling breath (due to
acetone), nausea, vomiting, thirst, dry mucous
membranes, flushed skin, mental confusion or
unconsciousness followed by coma.
– Management
• Early detection is critical as this is a life-threatening
condition
• Insulin injections may help to prevent coma
• Insulin Shock
– Etiology
• Occurs when the body has too much insulin and too
little blood sugar
– Sign and Symptoms
• Tingling in mouth, hands, or other parts of the body,
physical weakness, headaches, abdominal pain
• Normal or shallow respiration, rapid heart rate,
tremors along with irritability and drowsiness
– Management
• Adhere to a carefully planned diet including snacks
before exercise
Seizure Disorders
– Defined as recurrent paroxysmal disorder of
cerebral function characterized by periods of
altered consciousness, motor activity, sensory
phenomena or inappropriate behavior caused by
abnormal cerebral neuron discharge
– Etiology
• For some forms of epilepsy there is genetic
predisposition
• Brain injury or altered brain metabolism
– Sign and Symptoms
• Periods of altered consciousness, motor activity,
sensory phenomena or inappropriate behavior
caused
• May last 5-15 seconds (petit mal seizure) or longer
(grand mal seizure)
• Includes unconsciousness and uncontrolled tonicclonic muscle contractions
– Management
• Individuals that experience daily or weekly seizures
should be prohibited from participating in collision
sports (blow resulting in unconsciousness could
result in serious injury)
• Must be careful with activities involving changes in
pressure
• Can be managed with medication
Hypertension
– Etiology
• Primary hypertension accounts for 90% of all cases
with no other disease association
• Secondary hypertension is associated with kidney
disorder, overactive adrenal glands, hormoneproducing tumor, narrowing of aorta, pregnancy and
medications
• Long term cases increase the chances of premature
mortality and morbidity due to coronary artery
disease, congestive heart failure and stroke
– Sign and Symptoms
• Primary hypertension is generally asymptomatic
until complications arise
• May cause dizziness, flushed appearance, headache,
fatigue, epistaxis and nervousness
– Management
• Thorough examination must be performed to
determine type of hypertension and extent of
hypertension
• Medication is not recommended for those with prehypertension (120-139/80-89) unless linked with
other conditions
• If pre-hypertension is an issue lifestyle changes
should be made
• Individuals with stage 1 and 2 hypertension should
be medicated
Cancer
– Etiology
• Condition where cellular activity becomes abnormal
and cells no longer perform normal function
• Cells do not multiply at increased rate but continue
to develop ultimately taking over normal tissue
• Tumors may be benign or malignant
• Malignancies are classified based on the types of
tissue they invade
• Variety of causes including, ultraviolet radiation,
chemicals (tobacco), alcohol, fatty diet, combination
of heredity and environmental factors
– Sign and Symptoms
• Vary tremendously depending on type of cancer
• Warning signs include change in bowel and bladder
habits, sore throat that does not heal, unusual
bleeding or discharge, development of lump in
breast or elsewhere, indigestion, change in wart or
mole
– Management
• Early detection is critical
• Effective forms of treatment include surgery,
radiation and chemotherapy
Sexually Transmitted Infections
(STI’s)
• Chlamydia
– Etiology
• Caused by bacterial organism
– Sign and Symptoms
• May result in pelvic inflammation and is important
cause of infertility and ectopic pregnancy in females
• In males, inflammation occurs along with purulent
discharge 7-28 days after intercourse
• Painful urination and traces of blood in urine,
vaginal discharge
• Can cause conjunctivitis and pneumonia in
newborns
– Management
• Identify infection and exact organism present
• Treat with antibiotics
• Genital Herpes
– Etiology
• Caused by type 2 herpes simplex virus
– Sign and Symptoms
• Develops 4-7 days following sexual contact
• Begins to crust 14-17 days in primary genital herpes
and 10 days in secondary
• Females may be asymptomatic while males will
experience itching and soreness
• Development of lesions
– Management
• Herpes and pregnancy
• No cure just systemic medication (antiviral
medications) to lessen early symptoms of the
disease
• Trichomoniasis
– Etiology
• Caused by the flagellate protozoan trichomonas
vaginalis
– Sign and Symptoms
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•
•
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Vaginal discharge that is greenish yellow and frothy
Causes irritation of the vulva, perineum and thighs
Painful urination
Males tend to by asymptomatic but may experience
purulent urethral discharge
– Management
• 2 grams of metronidazole cures up to 95% of cases
in women
• Males require 500mg twice daily for 7 days
• Complete cure is required before engaging in
intercourse
• Genital Candidiasis
– Etiology
• Transmitted through sexual activity and appear as
warts on the glans penis, vulva or anus
– Sign and Symptoms
• Cauliflower-like wart or can be singular
• Soft, moist pink or red swellings that develop
cauliflower-like head
• May be mistaken as secondary syphilis or carcinoma
– Management
• When moist - 20-25% polophyllin
• Dry warts - may be frozen with liquid nitrogen
• Gonorrhea (clap)
– Etiology
• Caused by organism infection - gonococcal bacteria
which is spread through intercourse
– Sign and Symptoms
• In men - experience tingling of urethra followed by
2-3 hours of greenish yellow discharge and painful
urination
• 60% of women are asymptomatic
• Females will experience vaginal discharge
• May result in sterility if not treated or arthritis
– Management
• Penicillin
• Avoid sexual contact until it is known that the
disease is no longer active
• Syphilis
– Etiology
• A spirochete bacteria is the organism related to
syphilis and enters body through mucous
membranes or skin lesions
– Sign and Symptoms
• 4 stages
– Incubation is usually 3-4 weeks but could be anywhere
from 1-13 weeks; painless chancre or ulcer forms that
health w/in 4-8 weeks (can occur on penis, urethra, vagina,
cervix, mouth, hand, foot or around eye)
– Secondary stage occurs 6-12 weeks after initial infection
and is characterized by a rash, lymph swelling, body
aches, mild flu-like symptoms and possible hair loss
– Latent syphilis is characterized by no or few symptoms but if untreated it may result in tertiary syphilis
– Sign and Symptoms
– Late stage is characterized by deep penetration of
spirochetes that damage skin, bone, cardiovascular system
and nervous system
– Late stage may develop w/in 3-10 years of infection and
cause neurosyphilis - muscle weakness, paralysis and
various types of psychoses
– Management
• Penicillin is used for all stages
• Other drugs may be required due to increased
resistance
Menstrual Irregularities and the
Female Reproductive System
• Physiology of the Menstrual Cycle
– Menarche
• Onset of menses and puberty normally occur
between ages 9-17
• Female becomes capable of reproduction
• May be delayed through strenuous sports training
– Menstruation
• 28 day cycle that consist of follicular and luteal
phases (each lasting ~14 days)
• Result of cyclic hormone pattern
– Follicle stimulating hormone stimulates
maturation of ovarian follicle while luteinizing
hormone (LH) stimulates development of corpus
luteum and encourages secretion of progesterone
and estrogens
– Control and inhibition of production of FSH
when follicle reaches maturity caused by
estrogenic steroids
– Progesterone will ultimately inhibit LH
– Before onset of new menstrual period, FSH
levels are already rising = maturation of new
follicle for next cycle
– Menstrual Cycle Irregularities
• Strenuous training may alter cycle (25-38 day long
cycles)
• Oligomenorrhea - diminished flow (refers to fewer
than 3-6 cycles per year)
• Amenorrhea is the complete cessation of the cycle
– Ovulation is seldom or not at all due to low levels of
estrogen circulation
• Amenorrhea
– Etiology
• Exercise related is often a hypothalamic dysfunction
• Gonadotropin-releasing hormone is often deficient
• Must rule out pregnancy, abnormal reproductive or
genital tract as well as ovarian failure and pituitary
tumors
– Sign and Symptoms
• Complete cessation of menstrual cycle
– Management
• Re-establishment of normal hormone levels
• Thorough medical examination, nutritional
counseling, reduction of exercise intensity and
emotional stress
• Estrogen replacement may be considered
• Dysmenorrhea
– Etiology
• Painful menstruation prevalent in active women
• May be caused by hormonal imbalance, ischemia of
the pelvic organs, endometriosis
• Most common menstrual disorder
– Sign and Symptoms
• Cramps, nausea, lower abdominal pain, headache,
occasionally emotional lability
– Management
• Mild to vigorous exercise that help to ameliorate
dysmenorrhea are usually prescribed
• Continued activity as long as performance levels do
not drop
The Female Athlete Triad
– Etiology
• Relationship between disordered eating, amenorrhea
and osteoporosis
• Often seen in females driven to meet standards of
sport or to meet a specific athletic image to attain
goals
– Sign and Symptoms
• Disordered eating - bulimia and anorexia
• Osteoporosis - premature bone loss in young
women, inadequate bone development
– Management
• Prevention is key; identify and educate
Bone Health
– Etiology
• Decrease in bone is seen commonly in older women
and is linked to declines in FSH, LH, progesterone,
and estrogen
• Athletic women with irregular menses
– Sign and Symptoms
• Increased risk of stress fractures
• Decreased bone mineral density
– Management
• Decrease training volume, increase total caloric
intake and increase calcium supplementation
• Estrogen replacement therapy
Contraceptives and Reproduction
• Oral contraceptives
– Should not be used to delay menstruation
during competition
• May result in nausea, vomiting, fluid retention,
amenorrhea, hypertension, double vision and
thrombophlebitis
– Use under supervision of a physician
– Low dose preparations (<50mg of estrogen)
provide little risk to healthy women
• Intrauterine devices
– Not recommended for adolescents that have not
given birth
Pregnancy
• Physical activity and competition can be engaged
in up to the 3rd month unless complications
present
• May even be able to continue up through the
seventh month
• Impact on performance
• No indication that exercise is harmful to the fetal
growth patterns
• Extreme exercise may result in low birth weight
• Should avoid activities that involve severe body
contact, jarring or falls
• Contraindications include
– Pregnancy induced hypertension
– Pre-term rupture of membranes
– Pre-term labor during the prior or current pregnancy or
both
– Incompetent cervix or cerclage
– Persistent second or third trimester bleeding
– Intrauterine growth retardation
• Ectopic Pregnancy
– Etiology
• Fertilized egg implants outside the uterine cavity
due to inflammation of fallopian tubes or
mechanical blockage
– Sign and Symptoms
• Amenorrhea, tenderness and soreness on affected
side, referred pain to shoulder, pallor, possible shock
and/or hemorrhaging
– Management
• Operative treatment is necessary to terminate
nonviable pregnancy and control hemorrhaging