Sports Medicine

1. Sports Medicine How does sports medicine address the demands of specific athletes?

2. Children and young athletes • Almost half of admissions to hospital for young people are sports-related. • Issues such as • medical conditions, • overuse injuries, • thermoregulation and • appropriateness of resistance training must be considered to ensure safe participation.

3. Medical conditions • Asthma (is a chronic inflammatory condition of the airways, in which the bronchioles (branches of the airways) contract and restrict the amount of oxygen exchanged within the lungs. • While asthma in children and young people has decreased in Australia over time, it is still an important and at times life-threatening health issue that coaches need to address. • The Australian Institute of Health and Welfare reported that, in 2004–05, asthma was more prevalent among males aged 0–14 years, but from the age of 15 was more prevalent among females.

4. People with asthma can still participate in sport, but should have an Asthma Action Plan, or management plan, that has been created with their doctor to control and monitor asthma episodes • A child or young person may suddenly develop asthma-like symptoms during physical activity. • exercise-induced asthma. • Endurance sports, such as long-distance running, are more likely to trigger exercise-induced asthma than stop/start sports such as tennis. • ventolin puffer

5. step 1 Sit the young person upright, remain calm and provide reassurance. Do not leave them alone Give 4 puffs of a reliever puffer (Airomir, Asmol, Epaq or Ventolin), one puff at a time, preferably through a spacer device. - take 4 breaths from the spacer after each puff. step 2

6. step 3 Wait 4 minutes. step 4 If there is little or no improvement, repeat steps 2 and 3. If there is still little or no improvement, or the condition suddenly deteriorates,or you become concerned, call an ambulance immediately (Dial 000). Continue to repeat steps 2 and 3 while waiting for the ambulance.

7. Diabetes • The incidence of diabetes among children and young athletes has increased over time. • Why? • Type 1 diabetes is most common in children and young people, and occurs when the body is unable to produce insulin. • type 2 diabetes has also increased significantly due to obesity levels in children

8. The body uses glucose to fuel working muscles and if a person’s body is unable to produce this glucose they may start to feel unwell. • If the sugar levels of a person with diabetes are not maintained during exercise, they may have a hypoglycaemic episode, or a hyperglycaemic episode. • Either of these can lead to loss of consciousness.

9. A hypoglycaemic episode occurs when blood glucose levels fall below their normal range. • Symptoms: • increased heart rate • Sweating • shaking • anxiety and confusion • dizziness • possible altered state of consciousness. • Treatment • fast-acting carbohydrates, such as jelly beans, fruit juice or a soft drink • additional carbohydrates, such as a slice of bread, banana or sweet biscuits.

10. A hyperglycaemic episode occurs when blood glucose levels are elevated above their normal range. This happens slowly and is usually hard to detect. • Symptoms: • thirst • vomiting • excessive urination • rapid breathing • rapid but weak pulse • drowsiness. • Management • medical advice.

11. Exercise can assist children and young people to manage their diabetes. • Exercise helps maintain blood glucose levels and can help decrease the dosages of insulin required. • A long-term benefit of exercise is weight loss, which can lead to a reduced risk of type 2 diabetes. • Children and young athletes with diabetes can participate successfully in physical activity, providing they have taken extra measures to ensure their blood glucose levels are maintained.

12. Epilepsy • When normal electrochemical activity in the brain is disturbed, a seizure (sometimes known also as a fit) occurs. • Children and young people with epilepsy can participate in physical activity, as the modern medications available reduce the likelihood of seizures.

13. Management • Do not try and restrain the person. • Let the seizure occur, but move any objects away that may cause more harm. • Once the seizure has finished, place the person in the lateral position • Loosen any tight clothing and reassure the person that everything will be fine. • If the seizure lasts longer than 5 minutes, call an ambulance.

14. Overuse injuries • Overuse injuries are on the increase in children and young athletes, and occur when repetitive stress is placed on a body part (bone, tendon or muscle) without enough recovery time for the body to heal and repair. • These types of injuries can be related to improper technique, poorly fitted protective equipment, training errors, limited recovery time, and muscle weakness and imbalance. • shin splints, • stress fractures, • tendonitis • tennis elbow.

15. Stress fractures • caused by repeated stress on a bone due to an activity such as continual running. • develop due to a sudden increase in intensity of training, when the body is unable to cope with the repeated stress on the bone. How are they avoided?

16. Thermoregulation • The process that allows the body to maintain its temperature. • Children and young athletes are at greater risk of heat illnesses. • Because their bodies’ physiological structures are still growing, they are not as efficient at regulating body temperature as adults.

17. Young athletes have: • a greater surface area to body ratio than adults, which makes them more susceptible to gaining heat from the environment or when exercising • higher thresholds before sweating due to immature sweat glands, therefore holding in heat longer • slow acclimatisation to hot weather, therefore holding heat in for longer the capacity to become dehydrated very quickly • a core body temperature that increases faster than that of adults. • Children and young athletes should not participate in physical activity if the temperature exceeds 34 degrees Celsius.

18. Management • encourage athletes to drink small amounts of water regularly to replace fluid lost through perspiration • ensure suitable and appropriate clothing is worn for the weather conditions, such as hats during hot weather and polo fleeces during cold weather • provide adequate rest breaks in shaded areas to reduce fluid loss.

19. Appropriateness of resistance training • Resistance training, when combined with aerobic training, can enhance a young athlete’s sporting performance. • When supervised with correct instructions, resistance training is both safe and beneficial. • An athlete’s physical and emotional wellbeing can be enhanced through resistance training, with improvements in: • strength • motor performance • injury protection • self-esteem • body image

20. Young athletes should use their own body weight for resistance training; over time, they can progress to weights. • Exercises such as push-ups, chin-ups, tricep dips and planks where using own body weight can provide a good foundation for weight training.

21. Designing a resistance program • start with light loads and high repetitions. • Increasing the number of sets performed and the number of exercises in the workout will enable strength development. • The size and type of weights used can be changed to further develop overall strength. • specifically for each individual athlete, to ensure there is no risk of injury. • Specific to the athlete’s sport, and relevant to the overall training program.

22. Adult and aged athletes • As Australia’s population continues to age, coaches need to the address the specific needs of adult and aged athletes, enabling these athletes to participate safely in physical activity. • Adult and aged athletes can continue being physically active throughout their life span, providing due care is taken. • Research suggests that physical activity for older people increases muscle capacity, stamina, balance, joint mobility, flexibility, agility and overall physical coordination. • Regular vigorous exercise decreases the riskof cardiovascular disease, osteoporosis, diabetes and some forms of cancer.

23. Guidelines for adult and aged athletes: • Assess the medical history of an older athlete. • Evaluate the reasons why the athlete is participating in the sport. • Adults and aged athletes participate for different reasons than do younger athletes. • Ensure longer warm-up and cool-down sessions. • Monitor and adjust intensity levels for workout sessions. • Provide longer recovery periods after each activity. • Encourage athletes to continually improve their fitness levels safely.

24. Heart conditions • As people age, the efficiency of their cardiovascular system declines. • A variety of heart conditions are more prevalent in older people, such as heart attacks, strokes and high blood pressure. • As the cardiovascular system becomes less efficient, its ability to pump blood from the heart is reduced. • The amount of oxygen transported around the body therefore decreases, which makes exercising a lot harder. The narrowing and increasing inflexibility of blood vessels place an added resistance on blood flow, and can raise blood pressure. • Lung tissue becomes less elastic, decreasing the body’s ability to take in the oxygen needed for working muscles.

25. Fractures/bone density • As people age, so too do their bones. Bones lose some of their density and become brittle (osteoporosis), so older people have a higher risk of a fracture if they fall. • Osteoporosis is more common in women, which is linked to changes in their hormone levels. • Weight training or weight bearing exercise such as walking increases bone density, particularly in older women. • Exercise also improves agility, balance and coordination, which all contribute to the prevention of falls. • People with low bone density should avoid contact sports where any knock or fall could increase the risk of injury. • Activities such as cycling, light weights, climbing stairs and gardening are safe and beneficial.

26. Flexibility/joint mobility • Those who participate in physical activity can help prevent their joints from seizing up, and maintain good flexibility for daily functioning. • reduced mobility can restrict participation in physical activity. • Keeping active and mobile will increase quality of life and reduce injuries. • Flexibility exercises for people who are mobile could include: • low-impact exercises • yoga • stretching • pilates • dance.

27. Female athletes • When coaching female athletes, there are various factors that need to be taken into consideration to ensure that they participate safely. • The physiological changes that occur to the female body during the life span put them at greater risk of iron and calcium deficiency.

28. Eating disorders • When participating in physical activity, female athletes need to be aware of special dietary considerations. • Any athlete needs to ensure they consume adequate food to meet the increased energy demands on their body. • Sports such as gymnastics, dance, and beach volleyball may add extra pressure on females to look a certain way, be a certain weight or have a desired physique. • In order to obtain this physique, some female athletes take extreme dietary measures, restricting their food intake as they view themselves as being overweight (anorexia nervosa).

29. Causing a range of serious health risks, including: • loss of energy • irregular menstrual cycles which can lead to amenorrhea • weak bones which can lead to osteoporosis • abnormal heart rhythm • dehydration • starvation.

30. If an athlete does not restrict their food intake, but still seeks a certain body shape for a sport, they may choose to overeat or binge-eat, and then purge (vomit) or over exercise to lose the weight (bulimia). • Causing several serious health risks, such as: • loss of energy • dental erosion • damage to the oesophagus • low blood pressure • malnutrition.

31. Management • seek medical assistance • educating female athletes on healthy eating, particularly iron, calcium and energy needs • effectively dealing with athletic performance stress • developing positive self-esteem and self-image • encouraging personal best, rather than perfection.

32. Iron deficiency • Iron is an essential mineral needed for the formation of red blood cells that carry oxygen to working muscles • However, female athletes—and endurance athletes in particular— have an increased risk of having low iron levels due to training. • When iron stores are depleted, haemoglobin levels drop, and oxygen is unable to be transported around the body - anaemia. • This lack of oxygen to working tissues results in fatigue, tiredness and breathlessness,

33. The recommended dietary intake (RDI) of iron for an female aged 14–18 years is 15 milligrams per day; for women aged 19–50 years, it is 18 milligrams per day. • A higher intake of iron is recommended for an active female. • The following foods are rich in iron and will help with iron intake: • red meat (once or twice a week) • liver • tuna • dark green leafy vegetables, e.g. spinach, broccoli • beans • lentils • foods rich in vitamin C - to assist in greater iron absorption.

34. Bone density • Calcium plays a crucial role in the functioning of the female body. • It is responsible for muscle contractions, blood clotting, activating enzymes, transporting nutrients in and out of cells, regulating energy metabolism and building strong bones. • The strength of a person’s bones is linked to their calcium intake, exercise and diet.

35. The recommended dietary intake (RDI) for calcium for a female aged 14–18 years is 1300 milligrams per day; for women aged 19–50 years, it is 1000 milligrams. • To meet this RDI, females should consider including calcium-rich foods in their diets such as: • skim milk • salmon • yoghurt • tofu. • cheese

36. Maximum bone density occurs by the age of 30 years, and most of this bone mass is achieved during puberty. • Since the body cannot produce calcium itself, it is essential that the RDI of calcium is consumed at each life stage. • If insufficient calcium is consumed, bones become frail and brittle, leading to osteoporosis • Exercise can positively affect bone density levels. Weight-bearing or strength bearing exercises such as climbing stairs, weightlifting or walking can assist in the restructuring and strengthening of bone.

37. Pregnancy • Participation in physical activity during pregnancy has raised issues that coaches and players need to consider. • If a female has not been active before their pregnancy and would like to participate in physical activity, it is important they consult with their health professional before they begin. • Research suggests that physical activity during pregnancy is beneficial, not only for the mother but also the developing baby.

38. Benefits of exercise include: • reducing the risk of cardiovascular disease • reducing the risk of type 2 or gestational diabetes • reducing the risk of excessive weight gain • improving self-esteem, self-image and wellbeing • improving physiological functioning, which will meet the increase • demand of oxygen and energy required by the developing baby.

39. There are various sports which present a higher risk for female athletes during pregnancy, • Non-contact sports (i.e. any sport where there is no contact with another person). • In most cases, it is safe for pregnant woman to participate in non-contact sports for the duration of their pregnancy, e.g. swimming, walking.

40. Minimal contact sports (i.e. any sport where there is a small amount of contact with another person). • In most cases, these sports (e.g. doubles tennis, netball) are considered safe in the first trimester of pregnancy, however advice from a health professional is recommended if participation continues into the second trimester. • Contact and collision sports (i.e. any sport where two players have the possibility of colliding). • In most cases, these sports (e.g. football, hockey) are considered safe only in the first trimester.

41. Pregnant females need to be particularly careful in hot and humid weather to ensure they do not overheat. • They also need to take care of their muscles, as the hormonal changes during pregnancy lead to the ligaments becoming more relaxed. • The increase in weight and the growing belly can also lead to an increased risk of injuries to pregnant females participating in physical activity.