Female athlete triad syndrome in the high school athlete

Female sports participation at the high school level has significantly increased since the 1970s. Physical activity in females has numerous positive benefits, including improved body image and overall health. Unfortunately, a select population of exercising females may experience symptoms related to the “female athlete triad,” which refers to the interrelationships among energy availability, menstrual function, and bone mineral density. Clinically, these conditions can manifest as disordered eating behaviors, menstrual irregularity, and stress fractures. Athletes with conditions related to the triad are distributed along a spectrum between optimal health and disease and may not experience all conditions simultaneously.Previous research related to the triad has primarily focused on collegiate and elite athletes. However, mounting evidence demonstrates that the triad is present in the high school population. High school athletes should be assessed for triad components at preparticipation physicals. In addition, parents, coaches, and health care professionals should be educated and informed about the female athlete triad syndrome. In the presence of triad symptoms, further evaluation and treatment by a multidisciplinary team is strongly recommended for the athlete.     

Weight control in the athlete

Altering body composition either through reducing body fat or increasing muscle mass is a frequent and very important concern of large numbers of young athletes. When efforts to induce these body changes are approached with sound principles of nutrition and training, the resulting changes in body composition can make the desired contribution to health and fitness as well as contributing to increasing the athlete's performance potential. Any attempt to alter body composition must be planned over a significant time period, making it essential to initiate the program several weeks prior to the competing season. Significant increases or decreases in any body tissue component cannot be safely accomplished in a brief period. Supervision by a physician or another legitimate health professional is highly recommended to protect the motivated athlete from the abuses of faddists, quacks, and nutrition charlatans. The proper educational information regarding the ineffectiveness and hazards of drug use by the athlete are also to be dealt with. Having achieved a desired body composition, the athlete will recognize an achieved weight as his or her desired competing weight. Monitoring body weight two or three times weekly during the season will identify any involuntary changes in body weight that, if continued, will inevitably compromise athletic performance.     

Thoracolumbar injuries in the athlete

Acute thoracolumbar injury in the athlete can be a disabling condition that requires thorough evaluation and treatment. Although most thoracolumbar spine injuries are benign myofascial strains that respond well to nonsurgical management, the spectrum of injuries is broad and includes fractures and bony instability, ligamentous instability, and neurologic compromise. Evaluation of thoracolumbar injuries requires a rapid and focused evaluation at the time of injury to rule out catastrophic and neurologically threatening injuries; a detailed history and physical examination carried out at a later point in time should be paired with appropriate imaging studies. Initial radiographs may be combined with dynamic radiography, bone scanning, computed tomography, or magnetic resonance imaging to delineate the structural extent of injury. Acute treatment may be required and initiated at the time of injury; further treatment should be carried out once the nature and extent of the injury is fully understood. Nonoperative treatment is successful in most of the injuries. Operative treatment is applied in selected cases of structural instability or neurologic compromise.     

Back injuries in the athlete

In summary, the approach to the athlete with low back pain must include an emphasis on aggressive nonoperative intervention, education, and rehabilitation. A diligent attempt must be made to establish a correct diagnosis, though this may be difficult at first. A firm diagnosis allows individualized treatment that meets the strenuous needs of the athlete. Work-up should be standardized to avoid missing what will appear obvious in retrospect. Unlike most of the general patient population, athletes are unlikely to tolerate a long period of "wait and see" therapy. It is necessary to have qualified allied health personnel who can perform a full spectrum to have qualified allied health personnel who can perform a full spectrum of exercise, mobilization, and modality therapies. Return to competition should be gradual but steady, as previous performance levels can usually be obtained following lumbar injuries.     

Performance measurement and percent body fat in the high school athlete

Standards for performance have been derived from the preseason assessment of the high school athlete. The performance of 3,174 athletes during five performance tests was measured. The tests included dips, sit-ups, and pull-ups, in addition to grip strength measurement and vertical jump capability. Measurements were converted to the amount of work done or force developed. Nondimensional ratios were determined using the tables and empirical equations presented in this paper. These quantities were then compared to the percent body fat. The average performance of the athletes as determined by the testing procedures described herein decreases dramatically as the body fat increases above 10% in males and 19% in females.     

Incidence of training-related injuries among marathon runners

A questionnaire was sent to all 960 entrants in a major city marathon race to obtain information on training-related injuries. A total of 497 replies were received; of these 287 (58%) had incurred some form of injury during preparation for the race. Seventy-one of these individuals reported more than one injury. Almost all injuries affected the lower limb, with 113 cases (32%) involving pain or disability in the knee. More than half the injured runners (158, 55%) sought no professional advice; approximately half (146, 51%) received no treatment other than rest, which was not generally considered a form of therapy. Only 18 runners (6%) reported no improvement in their condition, while 143 individuals (51%) reported a full recovery. Injury incurred during training was thought by 98 runners (35%) to have had an adverse effect on their racing performance. These results suggest that runners preparing to compete in marathon races can expect their training to be interrupted by injury.     

Shoulder injuries in the childhood athlete

Shoulder dysfunction in the young athlete usually is manifested differently than the adult counterpart. The physiology and biomechanics of a growing child and adolescents result in different injury patterns that require different and thoughtful approaches to diagnosis and treatment. Most of these conditions are served well by nonsurgical treatment modalities. Judicious use of surgical interventions, however, can significantly improve patient outcome and return them to their sport of interest. Postoperative rehabilitation, and proper training techniques are essential to ensure continued participation of the athlete.     

Acromioclavicular injuries in the throwing athlete

Acromioclavicular injuries in the overhead or throwing athlete are frequently encountered by team physicians. Treatment regimens vary greatly, depending on dominant versus nondominant arm, injury in-season or out-of-season, and the athlete's goals for future seasons. This article focuses on each of these unique issues with regards to acromioclavicular separations and fractures, acromioclavicular arthritis, and acromioclavicular osteolysis.     

Back injuries in the young athlete

The diagnosis of back pain in the young athlete should be specific and not attributed to nonspecific, mechanical causes. Risk factor identification and intervention are required. Treatment is then initiated in a specific pattern, addressing flexibility and muscular imbalances. Bracing is often used to allow healing of growth tissue. The lumbosacral orthosis may be molded in a lordotic posture to unload the disc or antilordotic posture to relieve the posterior column; however, customizing the lordosis to the individual biomechanics may be required. Spinal stabilization is initiated with therapy for strengthening isolated weaknesses and progressing to coactivation and proprioceptive techniques, such as the balance ball. Returning to competition is preceded with sport-specific training.     

Ankle injuries in the young athlete

Ankle injuries in the young athlete are quite different from those of an adult. Because the epiphyseal plates of the distal tibia and fibula are significantly weaker than surrounding ligaments, failure on stress occurs through the growth plates rather than through soft tissue. Growth-plate injuries can assume a distinct pattern based on the maturity of the physis. Leg length inequality and angular deformity are potential sequelae from significant injury to the ankle in the skeletally immature but, fortunately, occur infrequently. Soft-tissue injuries about the ankle are rare, but with advanced, rigorous training techniques a new pattern of overuse injuries appears to be emerging.     

Back injuries in the pediatric athlete

Pediatric and adolescent athletes presenting with back pain are much more likely to have a pathologic cause for their symptoms than are adult patients. For this reason, it is important for those caring for younger athletes to maintain a high index of suspicion for some of the more common pathologic causes of back pain in this population. Diagnostic evaluation should be undertaken more quickly in pediatric and adolescent athletes. Sports-related diagnoses that must be considered include disc-related back pain, atypical Scheuermann’s kyphosis, spondylolysis, and spondylolisthesis. Patients of this age may also present with conditions not associated with activity, including discitis, classic Scheuermann’s disease, rheumatologic disease, and spinal tumors. History and physical exam provide valuable information to help guide further diagnostic studies which, in turn, will determine necessary treatment. No definitive studies are available regarding the diagnosis and treatment of spondylolysis and spondylolisthesis. Health professionals need to consider the expertise of a local radiologist when deciding upon diagnostic imaging procedures. The athlete’s age and sport played can contribute to the appropriate treatment plan.     

Shoulder injuries in the throwing athlete

Shoulder injuries in the throwing athlete are becoming more frequent. Sports specialization at a younger age, playing multiple seasons, increased awareness of injury and injury prevention, advances in diagnosis, and surgical treatment all play a part in the increase in diagnosis of these injuries. Understanding the biomechanics of throwing and pathologies that are encountered in the throwing athlete can aid the clinician in successful diagnosis and nonoperative/operative treatment of the throwing athlete. This article discusses the relevant anatomy, biomechanics, and pathoanatomy of the throwing shoulder. Additionally, understanding the kinetic chain can assist in the nonoperative rehabilitation of the injured shoulder. Surgical reconstruction is indicated when nonoperative efforts have been exhausted and is directed based on the extent of the pathology to the capsuloligamentous structures, labrum, and rotator cuff.     

Overuse injuries in the young athlete

Overuse injuries are now well known to sports enthusiasts at any age or level of competition. The seeming explosion of overuse stress fractures of lower extremity bones in high-profile professional basketball players has brought about widespread media attention and a better understanding of the phenomenon of "overuse syndrome" by the public. However, the spectrum of overuse injuries in the child or adolescent athlete has only recently been recognized. These injuries can range from the permanent disability of osteochondritis dissecans of the elbow to the completely nonspecific "growing pains" of active youngsters.     

Elbow injuries in the young athlete

Young athletes sustain fractures, dislocations, and overuse injuries to their elbows. Overuse injuries are particularly troublesome because they begin insidiously. The majority of elbow overuse injuries can be attributed to excessive baseball pitching and are part of the “Little League elbow” syndrome. Elbow overuse problems also occur in overhead racquet sports and in gymnastics. The key to diagnosis, treatment, and prevention is knowledge of the forces about the elbow, strengths of the growing tissues and sequelae to the elbow if injuries are left untreated. Although most of the conditions are managed nonsurgically, arthroscopic techniques are useful to correct those requiring surgical intervention.     

Upper extremity injuries in the adolescent athlete

There has been a significant increase in youth sports participation and athletic activities over the past 3 decades. With the increase in participation, there has been a commensurate rise in the number of sports-related injuries. A majority of these injuries are due to overuse as athletes frequently compete in multiple sports with year round competition and training. As higher demands are placed on these young athletes, the likelihood of injury during and individual's playing career continues to increase. This review will focus on both overuse and traumatic injuries of the upper extremity in the adolescent athlete. A significant emphasis will be placed on the evaluation and management of soft tissue and bony injuries in the overhead throwing athlete. The review will conclude with a discussion on common wrist and hand injuries seen in this population.     

Overview of injuries in the young athlete

It is estimated that 30 million children in the US participate in organised sports programmes. As more and more children participate in sports and recreational activities, there has been an increase in acute and overuse injuries. Emergency department visits are highest among the school-age to young adult population. Over one-third of school-age children will sustain an injury severe enough to be treated by a doctor or nurse. The yearly costs have been estimated to be as high as 1.8 billion US dollars. There are physical and physiological differences between children and adults that may cause children to be more vulnerable to injury. Factors that contribute to this difference in vulnerability include: children have a larger surface area to mass ratio, children have larger heads proportionately, children may be too small for protective equipment, growing cartilage may be more vulnerable to stresses and children may not have the complex motor skills needed for certain sports until after puberty. The most commonly injured areas of the body include the ankle and knee followed by the hand, wrist, elbow, shin and calf, head, neck and clavicle. Contusions and strains are the most common injuries sustained by young athletes. In early adolescence, apophysitis or strains at the apophyses are common. The most common sites are at the knee (Osgood-Schlatter disease), at the heel (Sever's disease) and at the elbow (Little League Elbow). Non-traumatic knee pain is one of the most common complaints in the young athlete. Patellar Femoral Pain Syndrome (PFPS) has a constellation of causes that include overuse, poor tracking of the patellar, malalignment problems of the legs and foot problems, such as pes planus. In the child, hip pathology can present as knee pain so a careful hip exam is important in the child presenting with an insidious onset of knee pain. Other common injuries in young athletes discussed include anterior cruciate ligament injuries, ankle sprains and ankle fractures. Prevention of sports and recreation-related injuries is the ideal. There are six potential ways to prevent injuries in general: (i) the pre-season physical examination; (ii) medical coverage at sporting events; (iii) proper coaching; (iv) adequate hydration; (v) proper officiating; and (vi) proper equipment and field/surface playing conditions.     

Acute soft-tissue injuries in the young athlete

Although the incidence of soft-tissue injury is high in the young athlete, one must be constantly aware of the tendency toward epiphyseal and apophyseal injuries in individuals with open growth plates. After the diagnosis of a soft-tissue injury (sprain, strain, or contusion) has been made, treatment must include an initial 24- to 48-hour period of RICE. Appropriate splinting may be required. Rehabilitation then proceeds aggressively, with early restoration of strength, flexibility, and joint range of motion. Prior to return to full athletic activity, the athlete should meet the criteria outlined in this article. Protective taping or bracing may be necessary upon return to full activity. The treatment of soft-tissue injuries should start with prophylaxis. All predisposing factors to the development of injury should be sought on preparticipation physical examinations and corrected prior to allowing the young athlete to compete. Using the program described as a guide to treating the injured athlete should result in early return to function with low recurrence rates of injury.     

Upper extremity injuries in the paediatric athlete

Injuries to the upper extremity in paediatric and adolescent athletes are increasingly being seen with expanded participation and higher competitive levels of youth sports. Injury patterns are unique to the growing musculoskeletal system and specific to the demands of the involved sport. Shoulder injuries include sternoclavicular joint injury, clavicle fracture, acromioclavicular joint injury, osteolysis of the distal clavicle, little league shoulder, proximal humerus fracture, glenohumeral instability and rotator cuff injury. Elbow injuries include supracondylar fracture, lateral condyle fracture, radial head/neck fracture, medial epicondyle avulsion, elbow dislocation and little league elbow. Wrist and hand injuries include distal radius fracture, distal radial physeal injury, triangular fibrocartilage tear, scaphoid fracture, wrist ligamentous injury thumb metacarpalphalangeal ulnar collateral ligament injury, proximal and distal interphalangeal joint injuries and finger fractures. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can prevent deformity/disability and return the youth athlete to sport.