Health Risks in Young Female Athletes While sport promotes health in many ways, there are some risks associated with athletic activities, particularly when they are done in the extreme amount necessary for competition. Elite and competitive athletes must take caution to ensure that they are nurturing their body and protecting both short and long term health. Health cannot be taken for granted; if it is, injuries or illness may result. The most common risks to young active women's health are as follows:
Over training
Over training is when the body becomes less able to train for long periods of time. This is a result of working out more than the body can tolerate and/or working out without adequate rest. Rest is a necessary part of training to allow the body to recover and heal; without proper rest to distressed muscles which are constantly overused, the body and mind suffer great stress. Signs of over training include muscle soreness lasting longer than 2 days, illness, injuries, fatigue, anxiety, poor sleep, weight loss, losing your period, and even depression.
Nutrition
Young women in particular need to meet their nutritional quotas for protein, carbohydrates, and fats. Vitamins including B vitamins, and minerals including calcium and iron are also very important. (At least half of women today are not getting enough calcium, for example, and low calcium can lead to fractures.) Proper nutrition leads to peak performance during both training and competition due to maximum bone strength, muscle strength, power, and mental function. Proper nutrition can also prevent injury and assists effective healing.
Competition
Most injuries occur during competition. During games and meets, an athlete puts everything into her sport, pushing herself past fatigue, even forgetting to drink fluids, eat snacks, or recognize pain. All this can lead to increased injuries, and can even lead to more serious problems with the body's functioning. In trying to "give it her all", an athlete can lose her form, putting herself at further injury risk. If she forgets to drink or eat during competition, she may become faint or dizzy, which can lead to falls. Severe dehydration (not having enough to drink) can even lead to heat stroke, which is an extremely serious medical condition.
Body Image
Body image is the term used for a woman's feelings of her shape and size. Unfortunately, sometimes girls feel that they are actually bigger than they are, especially if they are muscular, which will cause them to weigh more. Other athletes and girls feel pressured to have the "perfect body." (newsflash: there is no perfect body!!!) This leads to eating disorders. Studies show that athletes have a better body image of themselves than non-athletes, yet athletes are also much more serious about controlling their diets. Certain sports such as figure skating, gymnastics, swimming, diving and long distance running encourage girls to be thin. Sometimes an athlete's competitive nature and drive for success, when applied to weight management, can be to an extreme. The problem is, medical studies reveal that being very thin is NOT healthier, and can even be risky to health. These health risks can occur not only now, but also later in life.
Teen Athlete Risks detrimental to bone health
Bone Health is an expanding area of medical attention as doctors are more regularly treating and preventing osteoporosis(thinning of the bones.) While most osteoporosis does occur later in life (after menopause), it can also occur in young women. The following substances, which are also unhealthy in other ways, are very bad for bone health.
Steroids
Steroids, taken by mouth or by injection, are both illegal and dangerous. Steroids are used by some bodybuilders, power lifters, and speed athletes to improve muscle bulk and endurance; because they have masculine side effects, they are not used as often by female athletes as by male athletes. Their side effects are not worth it; besides being banned from the Olympics and many other competitive events, steroids cause weak bones, male body development including body hair, deep voice, and loss of breasts, and have dangerous, permanent effects on body organs.
Alcohol
Alcohol use also prevents bone development, and poses health risks to the liver and nerves. Even more dangerous effects of alcohol include increased falls and injuries, along with serious car accidents. These can result in irreversible mind and body damage.
Tobacco
Tobacco results in poor bone health and is a significant cancer risk. It increases all types of cancer, notably lung (smoking) and mouth and throat (chewing). Also, tobacco use increases breast cancer risk. Smoking slows body healing and damages the nerves which control muscle firing and balance.
Dieting
Restricting calorie intake can be very detrimental to not only performance and training, but muscle and bone strength. Without proper nutrients, or enough calories, the body cannot function at its best. This also puts undue stress on a body taking away from the ability to be healthy and fit.
The Female Athlete Triad
Described in 1992 by a task force of the American College of Sports Medicine, The Female Athlete Triad describes a syndrome which is becoming more and more recognized in not just serious athletes, but also women who work out a lot and restrict their calories. One of the greatest health risks are osteoporosis, which occurs much more frequently both while young, and later in life. Signs that an athlete may have the female athlete triad include thinness (body fat <18%), fatigue,stress fractures, and obsession with body measurements.
Eating Disorder
Most common eating disorders described are: Bulemia, bingeing and purging with vomiting or laxatives; Anorexia; eating little or nothing; and Anorexia Athletica, working out excessively to become thin.
Amenorrhea
This is the medical term for not having a period for more than 6 months. Most girls should be having regular (monthly) periods between the ages of 14 to 16. Not having a period is a sign that the body is not cycling estrogen as it should because there is too much stress. Estrogen is necessary, not only for reproductive health, but notably for bone strength. Amenorrhea can also be due to overtraining, physical stress, psychological stress, low calorie diets, low fat diets, and low protein diets. There are also some medical conditions that can cause this. Amenorrhea can lead to decreased bone density or strength after only 6 months!
Osteoporosis
Bones that are thin have decreased density and are subject to fracture. The term for this is osteoporosis, typically a disease of women over 55 or 60 who lose their estrogen in menopause. It can lead to fractures and pain, along with poor posture. Frighteningly, almost half of white women after menopause have osteoporosis, and recently, it has also become a disease in teens and young women, particularly girls who have eating disorders and amenorrhea, or those with poor nutrition such as low fat and low calcium in diets. Osteoporosis is diagnosed by having a bone density test, the most specific is called a DEXA scan, and is defined as density greater than 2.5 standard deviations below the mean for age. Another term, Osteopenia, is also a red flag, as it is a predictor of osteoporosis when bone density greater than 1 standard deviations below the age mean. Severe osteoporosis is a term used to define thin bones which have also had an insufficiency, or stress fracture. Osteoporosis can be prevented during the teen and young years, since the greatest density is reached from ages 12-25. This is when the foundation for the bones is deposited. If not deposited well, osteoporosis is much more likely to occur; it is also more likely in women who are thin, or had a history of eating disorders or amenorrhea early in life (the female athlete triad)!
Stress Fractures
These are fractures to bones in areas which take a lot of physical stress. Because the bones at these areas are thin due to the factors described above, they can develop cracks in them which cause pain. These cracks are stress fractures, and if not properly identified and healed, they can lead to full fractures which require casting or even surgery. This can also lead to chronic pain or weakness elsewhere in the body as the athlete puts stress on other areas instead. Risk of fractures, regardless of bone density, is increased after recent weight loss, low body weight, family history of stress fractures, and personal history of fracture. Smoking is one of the largest risks of fractures.
Leg
One of the most common sites of stress fractures are the lower leg (below the knee) or tibia. This can present as the pain of shin splints or also calf pain. This is common in runners or impact athletes.
Foot
Another common area for stress fractures to occur are in the foot, often at the metatarsals. These are also called "dancer's fractures" or also "March fractures."
Thigh
Stress fractures of the thigh, or femur bone are less common but quite serious as they can progress to hip fractures. This can seriously disable an athlete's career.
Pelvis
Pelvic stress fractures are a red flag for osteoporosis.
Forearm
Gymnasts and rowers, along with athletes who use their upper body frequently can get stress fractures of the radius or ulna, even of the hand.
Practical Guidelines for maximum health
Prevention is the best medicine. If an injury or heath problem can be avoided, this is the best way to live life and perform as an athlete. A once yearly doctor's evaluation, nutritional screening, and seasonal review of all essential body systems with your coach, trainer, or sports medicine professional can prevent loss of training or competition due to illness or injury. Unfortunately, often after an injury has occurred, it causes an area of weakness which will always need specific attention and strengthening.
Ensure adequate nutrition
A well balanced diet with plentiful fruits and vegetables, adequate protein and carbohydrates, and a smaller percentage of fat is best for optimum health and performance. The essential mineral which often needs to be supplemented in nearly all active females is Calcium for a total intake of 1200 mg a day. Other important nutrients include Iron and the B vitamins, although these are often consumed with an adequate diet. Vitamin D and Magnesium are also necessary for bone health, but are usually present in high enough doses in other foods. Phosphorus (in soda), caffeine, and sodium can negatively affect bone health, so moderation is recommended with these. A controversial nutrient, sodium is often necessary in very active athletes as, along with potassium, it regulates the muscle pump and is excreted in sweat. Therefore, most active women can eat salt without worry, as the negative bone effects are outweighed by the need in the muscles. Adequate calories, as discussed earlier, are necessary for maximum performance and protecting the menstrual cycle and overall structural health. Practical recommendation is a well balanced diet, a daily multivitamin, and 600 mg of calcium supplement will cover all a female athlete's nutritional needs. If she has food restrictions, is a "picky eater," is vegetarian, or trying to lose weight, a consult with a dietician or nutritionist is strongly recommended to ensure she is eating enough Calcium, Iron, protein, fat, calories, and vitamins and minerals.
Monitor for localized pain that persists
If pain occurs without a history of injury, it is likely due to overuse. Pain that lasts more than a few days, limits athletic or sport performance, or interferes with living activities should be evaluated by a doctor, as this could be a sign of more serious injury. Addressing possible injury early on is the key to optimum healing, and preventing it from getting worse. Also, pain in one area can cause pain elsewhere as the athlete tries to compensate for the pain and weakness using other body parts. Muscle soreness which lasts more than 2 days is a sign of overtraining, which can lead to other health risks.
Allow rest
Rest is important to let the body recover. An athlete should always take at least 1 day off a week to allow the muscles, joints, and physiological system to rebalance and function better. If an athlete is sick with a virus or bacterial infection, she should take off from practice. She should never practice or play with a fever (temperature greater than 100 degrees) with cough or chest symptoms, or if she feels weak or dizzy.
Medical screening
Health is our most precious resource. Without it there is no work, sport or play. Health must be evaluated yearly with an appropriate medical evaluation. If the doctor is not one who routinely screens athlete, an athletic trainer, physical therapist, or sports medicine professional who does should also review the athlete's musculoskeletal health. Coaches or another training team member should also evaluate each athlete's health and performance, eating patterns, and menstrual history seasonally.
Injury Prevention
Medical research has recently focused on the nature of injuries and also how to prevent them. Proper conditioning, training, and technique is a vital part of maximizing performance and minimizing pain and injury. Most injuries occur during games or competitions. Many injuries can be prevented with exercises such as jumping and landing training, balance drills, skill and technique training, and teaching the athlete to ask for assistance or evaluation when not feeling well. Training camps are invaluable, and preconditioning is essential, along with strength and flexibility training specific to the sport. Having available medical professionals who will communicate with the coach and player about recommendations and or restrictions is essential. After injury or surgery, physical therapy is often recommended to ensure that an injury is fully rehabilitated and recovery is optimum. If an athlete has had to take time off she should gradually return to training, based on the amount of time she was out and the reason for her absence, particularly if medical.
Education
Young athletes are wise, but even mature intelligent people cannot always recognize potential problems which relate to their own health. It is of utmost importance that coaches, trainers, parents, friends, health care professionals, and athletes themselves are aware of the possible health risks associated with overtraining, poor nutrition, absence of a period, or improper care of an injury. Communication is vital to maintaining not only optimum health but optimum performance. The Women's Sports Foundation has provided a venue for maintaining the best treatment for female athletes. Books which are recommended as health resources include The Athlete's Survival Guide by Carol Otis, MD, along with comprehensive medical resources include Medical and Orthopedic Issues of Active and Athletic Women by Rosemary Agostini,MD Women in Sport by Barbara Drinkwater, MD and Women's Sports Medicine and Rehabilitation by Nadya Swedan, MD.