CQ 2 How does sports medicine
address the demands of specific
athletes?
Term
Asthma
Definition
Asthma is a medical condition that affects the airways. Asthma
is characterized by inflammation of the airways leading to
contraction of the bronchioles (airway branches) limiting the
air flow both into and out of the lungs. The medical condition,
asthma, has various possible triggers including: dust, pollen,
pollution and exercise.
Diabetes
Diabetes is another medical condition frequently found in
children and young athletes. There are two (2) types of
diabetes. Type two (2) diabetes, is a medication condition
caused by lifestyle, often brought on through physical
inactivity and poor diet. It is characterized by a breakdown in
the efficiency of insulin activity resulting in high levels of
insulin (which is responsible for the transport of glucose from
the blood into our tissue cells) and glucose in the blood. Type
one (1) diabetes is also known as insulin dependent and early
onset diabetes, is a medical condition caused by an
autoimmune disorder. Type one (1) diabetes is when the body
no longer produces insulin resulting in a build up of glucose in
the blood. Type one (1) diabetes is the medical condition more
prevalent amongst children and young athletes.
Epilepsy
Epilepsy is used to refer to a group of medical conditions
relating to disruption of normal brain activity that results in
seizures. A seizure is when the brain's nerve cells misfire and
generate sudden, uncontrolled bursts of electrical activity in
the brain. The orderly communication between nerve cells
becomes scrambled and our thoughts, feelings or movements
become momentarily confused or uncontrolled. Epileptic
seizures can be subtle with only momentary loss of
consciousness, or conspicuous causing sudden loss of body
control. Epilepsy is unpredictable and often scary to those
involved and observing.
Thermoregulation refers to the maintenance of a stable core
body temperature. Thermoregulation is vital for every athlete
as maintaining a safe body temperature avoids conditions
such as hyperthermia and hypothermia. A child’s body will
overheat 3-5 times faster than an adult.
Heart conditions is a broad term used to refer to a number
health issues including:
Thermoregulation
Heart conditions
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high blood pressure
Cardiovascular disease
Angina
survivors of heart attacks
heart valve disease (e.g. leaky valve) etc
Although heart conditions are generally on the decrease in
Australia, they are still prevalent, especially among aged
athletes. As such, it is important to know how heart conditions
impact the choice of sport available to the person who has one,
especially since exercise is a useful form of treatment for the
underlying causes of most heart conditions.
Bone Mineral
Density
https://pdhpe.net/sports-medicine/how-does-sports-medicine-add
ress-the-demands-of-specific-athletes/female-athletes/bone-dens
ity/
Female triad
https://pdhpe.net/sports-medicine/how-does-sports-medicine-add
ress-the-demands-of-specific-athletes/female-athletes/
2.1 Children and Young Athletes
Content
Videos
1. pdhpe.net - Children and Young Athletes – Medical Conditions here.
2. pdhpe.net - Children and Young Athletes – Part 2 here.
3. Children and increasing number of knee injuries
4. Strength training guidelines for 10-13 year olds
Reading
pdhpe.net
Cambridge pg 249-252
Condition / Issue
Effect on participation in
sport
Management
Implications for coaches
and trainers
Asthma
▪ Respiratory disease
affects 10% of the
population.
▪ Characterized by
breathing difficulty
where there is a
reduction in the width
of the airways leading
to the lungs, resulting
in less air being
available to them.
▪
Diabetes
▪ Conditions affecting
the body’s ability to
take glucose from the
bloodstream and use it
for energy.
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Some activities may
provoke attacks
Participation is
however beneficial
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Exercise may result in a
drop in blood sugar
(hypoglycemia)
Exercise is useful in the
management of
diabetes
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Epilepsy
▪ A condition
characterized by
seizures or alteration to
the level of
consciousness as a
result of a disruption to
brain function.
Condition / Issue
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Individual cases should
be assessed by a
doctor
If seizures are frequent
then collision sports
should be avoided
Some water sports may
not be appropriate,
while supervision will
be essential for others
Effect on participation in
sport
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Avoid potential triggers
Use gradual warm up
and cool down
Ensure preventative
medication is taken
where appropriate
Ensure adequate water
intake
Monitor progress
throughout
participation.
4–4–4
▪
Balance insulin through
use of injection and
food intake
Ensure a pre-game
meal is consumed to
increase blood glucose.
Maintain blood glucose
levels by consuming
glucose every hour or
so if exercise is
prolonged
Restrict or modify
participation in solo or
unsupervised sports
Ensure prescribed
medication is taken
Avoid fatigue and
extremes of body
temperature
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Management
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Ensure participants
have their required
medication
Know how to recognize
an attack
Know how to manage
an attack and have a
management plan in
place
Allow rests and access
to medication when
required.
Know how to recognize
hypoglycemia
Know how to manage
hypoglycemia and have
a management plan in
place
Provide rest breaks as
needed
Ensure there is
someone present who
knows how to manage
a seizure
Implications for coaches
and trainers
Overuse injuries
▪ Injuries caused by
repetitive actions
generating consistent
stress and force at a
particular bone, joint or
tendon.
▪ Children are at
particular risk because
their bones have not
fully developed.
▪ Stress fractures are the
most common.
▪
Thermoregulation
▪ Action of the
hypothalamus in the
brain responding to
changes in body temp
and initiating
appropriate
mechanisms to
maintain core temp.
▪ Children are more
susceptible to extremes
of temp as they are less
efficient at losing heat
through sweating – less
surface area to aid the
cooling down process.
Ie. Sweating is less
effective as the surface
area is much smaller
than that of an adult
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Development of stress
fractures will requires
immediate rest from
activity for 4-8 weeks
If growth plates are
damaged may affect
long term development
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Participation needs to
be kept to a reasonable
amount of time with
consideration of
climate
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Ensure that correct
technique and skill
execution are
developed
Modify the frequency,
duration and intensity
of training programs
and competitive
participation
Wear appropriate
clothing – light and
breathable in summer,
warm layered clothing
in winter
Ensure adequate water
is consumed
See management
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Consider weather
conditions when
scheduling training and
competition
Structure training
session and remind
kids to drink before,
during and after
exercise
Look out for warning
signs of heat stress
Thermoregulation
Case Study:
You have been selected to coach a junior representative soccer team. The competition is
scheduled for late spring and the venue is Darwin, where the temperatures are expected
to reach 35 degrees or more. The players normally compete in NSW during winter, with
temperatures around 20 degrees.
Consider the case study and outline what measures you would take to address issues of
thermoregulation for these athletes.
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Spray bottle to cool down participants
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Fan them with a shirt or towel
Keep them in the shade as much as possible
Take out anyone who is overly sweaty or exhausted or red
Keep plenty of cool water
Get them used to hot weather
Sunscreen
Pre hydration, hydration during the game and post hydration
1. What is resistance training?
Resistance means a force against something, therefore resistance training is training
against a force or resistance.
2. Do you think resistance training is safe for children and young adults? Justify your answer.
It can cause growth issues, and excessive weight at a young age can stunt growth.
children should use light weights and high repetitions to develop muscular endurance
rather than muscular strength.
3. What do you think are the 5 most important considerations for parents / coaches of young
people starting a resistance training program?
● They must follow directions and practice proper technique and form
● Must be supervised
● Use light weights
● Warm up and cool down
Benefits
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Training itself
doesn’t cause
injury or growth
problems if done
correctly.
Strength gains
Coordination
improves
Increased muscle
Provides an
opportunity to feel
successful
Body
image/self-esteem
benefits
Risks
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Management / Risk Reduction
Potential for injury from
weights that are too
high or from incorrect
technique
Strength specialization
(e.g. focusing on biceps
and pectorals) can
cause muscle
imbalances and affect
growth.
Can affect blood
pressure in those with
hypertension
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Follow safety guidelines
Can start as early as 6 – if
done appropriately
Proper technique is vital
Start with body weight as
resistance
Higher reps with lower
weights
Avoid high weights
Training programs must be
properly structured, well
planned, age-appropriate
and specific to the
individual.
Focus on major muscle
groups
Medical evaluation before
commencement
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Pre-screening for
appropriate planning and
management of specific
health issues that may
impact
Low weights essential until
the correct technique is
learnt
Warm up and cool down
important
Avoid weight lifting and
powerlifting until physical
maturity is reached
Evaluate any injuries before
continuing
Must be supervised.
2.2 Adult and aged Athletes
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As a result of the aging process, functional capacity decreases. This decrease
might be due to disuse, medical conditions, or simply ‘wear and tear’ on the
body.Exercise programs aimed at developing strength, aerobic capacity, flexibility
and coordination can improve functional capacity. This may not make people live
longer, but it will improve their quality of life and independence.
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Any adults returning to sport needs to go through prescreening, when any
pre-existing injuries or medical conditions are identified physical activity
programs can be modified accordingly. Three of the major issues relevant to the
adult athlete include heart conditions, fractures and flexibility.
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FRACTURES AND BONE DENSITY
Bone density loss occurs in aged athletes. Women suffer greater bone density
loss than men and this also starts around 20 years earlier than in men. This loss in
bone density increases the risk of fractures in the elderly. This statistic is evident
throughout the entire population, with falls being the highest cause
of injury in the elderly.
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Osteoporosis is a condition that affects both women
and men. Bone becomes more brittle as a result of
low mineral content, especially calcium. Those adults who suffer from
osteoporosis are at even greater risk of bone fractures due to falls, collisions
and the impact of equipment.
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FLEXIBILITY AND JOINT MOBILITY
Flexibility decreases with age because of a loss in elasticity of tendons, ligaments
and muscles. Effort should be made to keep joints supple and
flexible so that full range of motion is possible. The goals of an exercise program
for the older athlete should be to improve quality of life by:
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increased aerobic endurance,
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increased strength,
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increased energy levels,
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increased balance and coordination,
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increased flexibility, and maintenance of weight.
2.3 Female Athletes
● When energy intake is significantly decreased:
A female’s body reduces energy expenditure in other processes. One way is by suppressing
menstrual function Or in younger females – delaying onset of menstruation Another way is by
slowing the turnover of bone Tissue Low energy availability also suppresses hormones that
promote bone formation Disruption of menstruation also results in a reduction in the production
of estrogen
● Iron Deficiency
What is the role of iron in the body?
- Carry oxygen to and carbon dioxide away from all the cells in your body. Supports the
actions of enzymes (especially for energy production)Plays an important role in the
functioning of the immune system.
The effects of iron deficiency on performance:
● Loss of endurance
● Chronic fatigue
● Low power
● Frequent injury
● Recurring illness / infections
● Loss of interest in exercise and irritability
● Poor appetite
Note: Many of these symptoms are also common to over-training, so
Misdiagnosis is common. The only sure way to diagnose a deficiency is a
blood test to determine iron status
Avoiding deficiency:
● RDI for women = 12-16 mg / day (compared to 7 mg / day for men)
● RDI for pregnant women = + 10-20mg
● Good sources of iron:
- Lean red meat
- Iron-fortified breakfast cereals
- Nuts and Legumes
Note: Caffeine reduces the ability of the body to absorb iron – vitamin C
increase it.
Exercise in Pregnancy
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Pregnancy used to signal the end of a woman’s sporting career but in recent years
many great female athletes have returned to their sport to compete at the highest levels
following the birth of a baby. Pregnancy is a natural condition rather than an illness and
unless you have complications, it should be possible to enjoy your sport or activity at
some level throughout most of your pregnancy.
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INCREASE IN BODY WEIGHT (ON AVERAGE 10 -15 KG)
As pregnancy progresses weight increases and changes occur in weight distribution and
body shape. This results in the body’s center of gravity moving forward and the curvature
of the spine increasing. This increase in body size can make some activities more
uncomfortable (eg. jogging). These changes can also alter balance and coordination,
particularly in the second half of the pregnancy, and for this reason activities that require
a degree of balance or rapid change in direction may not be advisable.
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LOOSENING OF ALL LIGAMENTS
During pregnancy, joints will gradually loosen to prepare for birth. This may create an
increased risk of injury. Those particularly affected are the pelvic (sacro-iliac and pubic
symphysis) joints. Care should be taken with any activity that involves jumping, frequent
changes of direction and excessive stretching. Jerky ballistic movements should be
avoided. Strengthening exercises (particularly core strength exercises) may also
decrease the potential of injury to these joints.
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INCREASE IN RESTING HEART RATE
Due to the increase in resting heart rate and decrease in maximal heart rate during
pregnancy, it is not recommended using target heart rate to determine intensity of
exercise. In healthy pregnant women the intensity of exercise can be monitored by the
mother’s rating of perceived exertion (see Borg’s Rating of Perceived Exertion Scale).
Borg’s Rating of Perceived Exertion Scale
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DECREASE IN BLOOD PRESSURE
During the second trimester of pregnancy, the development of blood vessels to supply
the growing placenta will cause blood pressure to fall. From approximately the fourth
month, pregnant women should avoid rapid changes of position, both from lying to
standing and vice-versa, so as not to experience dizzy spells. Stopping suddenly should
also be avoided as cardiovascular adjustments take longer and may result in dizziness
or faintness. If undertaking aerobics, leg exercises done whilst lying on the back should
be avoided after the fourth month as the weight of the foetus can slow down the return of
blood to the heart. Try to modify these exercises as most can be done lying on the side.
Prolonged periods of motionless standing should also be avoided.
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INCREASE IN BLOOD VOLUME, HAEMOGLOBIN AND VO2 MAX
As pregnancy progresses, the body’s ability to transport oxygen improves. This
adaptation is designed to meet the needs of the growing foetus. This means that oxygen
supply to other parts of the body, including working muscles, also improves. These
cardiorespiratory adaptations are potentially advantageous for performance after the
baby is born. During pregnancy the advantages are offset by changes in weight, blood
pressure and ligaments, and by the need to ensure oxygen supply to the foetus. It is true
however, that physiological adjustments resulting from pregnancy will remain for some
weeks following the birth of the baby. There may therefore be improvements in
performance for those who manage to return to competition soon after the birth. For
most women, managing a new baby, breast-feeding and sleep deprivation, means this
potential ‘advantage’ may go unnoticed.
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PELVIC FLOOR
Damage to the pelvic floor muscles occurs during birth (vaginal delivery). The pelvic
floor muscles are also weakened during pregnancy, so it is extremely important to begin
conditioning the pelvic floor muscles from the start of the pregnancy. These exercises
(which can be prescribed by a physiotherapist) should continue throughout the
pregnancy and recommence as soon as is comfortable after the birth.
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ARE THERE ANY DANGERS OF EXERCISING DURING PREGNANCY?
There are theoretical concerns for the foetus and mother including risk of overheating,
impairment of oxygen and nutrient delivery to the foetus and possible risk of premature
labor.
● RISKS TO THE FOETUS
There are no studies to date that show an association between exercise and
adverse outcomes for the foetus. There are however some areas where
concerns have been raised;
i) Effects on birth weight - Most studies have not shown any
significant difference in babies’ birth weights for exercising and nonexercising pregnant women. However, one recent study showed women who
exercised intensely more than three times per week in their third trimester delivered significantly
smaller babies. Although these babies were all healthy at the time of delivery, there are
concerns about the long term health effects on low birth weight
babies. It is therefore recommended that exercise in the third trimester be limited to three
sessions or less and not be as intense as earlier in the pregnancy.
ii) Contact sports - There has been much theoretical concern about the risks to the foetus
whilst participating in ‘contact’ sports such as netball. There is currently no research to support
this concern. The current advice is that each woman should discuss her wishes with her doctor
and take into consideration the type of sport, pregnancy status and her history of participation in
that sport. For example, it would be most reasonable for a woman who has played netball all her
life and is pregnant in her first trimester, with no complications, to continue with this activity.
Alternatively, a woman who has never down-hill skied and wants to attempt this for the first time
at 30 weeks pregnant would probably be advised not to participate.
iii) Overheating - Some animal studies have indicated that over-heating of the mother in the
first trimester may cause an increased risk of neural tube defects. Although humans have
different mechanisms of heat dissipation than the animals
studied, it is reasonable to suggest that it is not wise to exercise in the heat of the day and to
stay well- hydrated when exercising.
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RISKS TO THE MOTHER
Potential risks of increased injury due to changes in body shape and size, as well as
ligamentous laxity, have been discussed.
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BENEFITS FOR THE MOTHER
There are numerous potential benefits for women who exercise during pregnancy.
These include better weight control, improved mood and maintenance of fitness levels.
Exercise also helps prevent the onset of gestational diabetes (GDM) and is certainly an
important part of the management plan should GDM occur.
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HOW MUCH EXERCISE IS SAFE?
In general, healthy women who have uncomplicated pregnancies can continue their
previous exercise program after consultation with their doctor. It is also now considered
safe to START an exercise program during pregnancy. No studies have determined a
safe ‘upper’ limit of exercise but as pregnancy continues, increased size and fatigue
generally cause most women to lessen their participation. As previously stated, by the
third trimester no more than three sessions per week of vigorous exercise are
recommended. Moderate exercise (as determined by the perceived exertion scale) is
considered safe throughout pregnancy.
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WHEN SHOULD A PREGNANT WOMAN NOT EXERCISE
Exercise should be stopped if any abnormal symptoms occur such as pain,
contractions, vaginal bleeding, dizziness or unusual shortness of breath (see box below).
Exercise during pregnancy is not advised in a number of conditions including heart
disease (ischaemic or valvular), severe hypertension (high blood pressure), risk of
premature labour (incompetent cervix, multiple pregnancy, ruptured membranes), growth
retardation or pre-eclampsia. Any illness or complication of the pregnancy should be fully
assessed and discussed with your doctor before commencing or continuing an exercise
program.
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● WHEN CAN I RESUME EXERCISE AFTER THE BABY IS BORN?
After a normal vaginal delivery, gentle exercise including pelvic floor, abdominal
exercises and walking can be commenced when comfortable. More intense exercise
should be delayed for up to six weeks to allow for some resolution of the effects of
pregnancy and delivery, particularly on the pelvic floor muscles and pelvic joints. After
caesarean section, six weeks is the recommended time to return to exercise if the wound
is well healed. Exercise has not been shown to adversely affect lactation (breast feeding)
as long as fluid and caloric intake are maintained. Discomfort caused by full breasts and
sore nipples may make running and jumping uncomfortable. A supportive bra is
recommended. Exercising straight after a feed when breasts are less full can also help
prevent these symptoms. Athletes who are able to return quickly to a high level of
training will notice the beneficial physiological effects. You will be surprised how soon
you can resume your full fitness and skill level after the birth, but remember that it can
take up to six months for joint stability to be re-established.
● SHOULD I DISCUSS MY EXERCISE PROGRAM WITH MY DOCTOR?
Yes! It is essential that all women discuss their exercise plans with their doctor as each
pregnancy is different. A healthy uncomplicated pregnancy may have few restrictions
placed on the type and amount of exercise that can be done. Other situations may arise
that require exercise to be restricted or completely ceased. Accepting that pregnancy
and birth will interrupt sporting aspirations will reduce feelings of frustration and
resentment. Try to view this period positively, be flexible and be prepared to change
training programs and expectations. Remember the final outcome of a healthy child is
the aim for all concerned, whilst allowing the mother as much scope for choice and
healthy activity as possible.
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