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Female Athlete Triad

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What are some differences between male and female athletes?

It is widely known that playing sports and getting enough exercise leads to positive benefits. Both male and female athletes alike experience healthier lifestyles than non-athletes, however Primary Care Orthopedist and Sports Medicine Specialist Dr. Jeff Sellman notes that there should also be a distinction made between male athletes and female athletes.

“It’s important to remember that males and females are quite different,” said Dr. Sellman. “Many of them play the same sports; often they play different sports. They are physiologically different. Their body chemistries are different, specifically from a metabolic and hormonal standpoint.”

What is the Female Athlete Triad?

When it comes to athletic health and performance, males and females do, in fact, operate quite differently. Females, specifically, experience a condition known as Female Athlete Triad. It’s a condition that is actually a combination of three other biological conditions.

“Female Athlete Triad is a condition that has been documented in literature and medicine for almost 40 years, but still not quite elucidated on how [three certain conditions] interact,” said Dr. Sellman. “[Female Athlete Triad] is three pillars, or three points of a triangle, that contribute to the overall health of a female athlete. That is caloric intake or energy expenditure which would be disordered eating; bone mineral density loss or osteoporosis or osteopenia; and amenorrhea which is a lack of the menstrual cycle.”

Could one variable influence another or could each condition develop separately from the others?

It’s important to note with the Triad, that certain symptoms or conditions do not always lead to the next sequential condition. For instance, disordered eating could directly lead to osteopenia in some female athletes. In other athletes, however, it could lead directly to amenorrhea.

“As the triangle would suggest, one condition can lead to another, but they all can actually come about on their own,” said Dr. Sellman. “The main basis of it, however, is that a lot of women, especially in sports, are body conscious such as in gymnastics, swimming and dance. They are aware of what they put in their bodies so often times they will restrict their calories or they will practice so much that they will expend too many calories. Without sufficient calories, women may lose a menstrual cycle and when that happens, they can lose the protective benefits of estrogen which are related to bone and other processes in the body.”

How would an athlete know if they had one or more conditions of the Triad?

Unlike an orthopedic condition, it may seem hard to determine whether or not a female athlete is experiencing conditions within the Female Athlete Triad. Dr. Sellman and other Primary Care Orthopedist and Sports Medicine Specialists at Florida Orthopaedic Institute are trained to look for non-orthopedic sports medicine issues like the Triad.

“We look to see if they have a history of shin splints, stress fractures or fractures in their feet,” said Dr. Sellman. “We commonly see this in ballet dancers. We ask them if they’ve had their menstrual cycle. If they have, we ask, “How many have you had in the last six months?” If you’ve had less than six or you’ve had very irregular cycles, then we will delve further into their eating habits. Often, what is interesting is that it’s not an actual eating disorder such as Bulimia. It’s rather a disordered eating where women are not taking in enough calories to meet the caloric expenditure. The last thing we always screen for is their birth control choices. When you are on a progesterone only birth control that can often lead to the pillars of the Female Athlete Triad.”

How are these conditions treated?

Again, unlike orthopedic conditions treatment options may not necessarily always involve the musculoskeletal system. Often, a mental health provider and other specialists may be called to work with the athlete in order to provide assistance.

“The treatment process is multi-disciplinary and multi-factorial,” said Dr. Sellman. “We have to get to the roots and elucidate what is actually going on. Maybe we need a mental health provider to talk about the disordered eating and body image. Talk to a nutritionist to see what exactly is being taken in. If necessary, a bone mineral density scan if, in fact, it is indicated that there are repeated shin splints.”

Dr. Jeff Sellman is a Primary Care Orthopedist and Sports Medicine Specialist at Florida Orthopaedic Institute.

Youth Sport Specialization: What is it and What are the Risks?

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What is Sport Specialization?

In general, most might say that in order for an athlete to be considered ‘elite’ in a sport, they must start young and focus on that sport and that sport alone. Recent students, however, are showing otherwise. Currently, there is an increasing trend in young athletes (youth and high school) participating in what professionals call ‘sport specialization’. George Eldayrie, M.D., primary care orthopedist and sports medicine specialist at Florida Orthopaedic Institute, weighed in on the definition.

“When we talk about it in a broad sense, in the sports medicine world, there are different aspects of sport specialization,” said Dr. Eldayrie. “The biggest issue is kids specializing a little too early. We define that as when a kid is pushed into doing, or chooses on their own to do, just one particular sport or one position. Usually before the age of 12 is when they are considered specialized.”

What are the dangers?

Doctors and medical professionals alike are now conducting studies that show that young athletes specializing in one sport may actually be hindering their own performance. Experts are attributing an increased risk of injury to the lack of diversity in movements. In sports like tennis, baseball and even cross-country, the repetitive motions tend to neglect beneficial stress on other muscles and often leads to overuse injuries.

“If a kid is doing one particular sport or activity too much, they are at risk for overuse injuries and certain types of issues related to how their bones are growing,” said Dr. Eldayrie. “Most kids do better when they are involved in multiple different sports. Those athletes end up doing better in the long run. They become a little more athletic. They develop skills. They stress other joints and parts of their body to help adapt for other types of athletic success.”

Why is it so prevalent?

Across the board, sports medicine specialists say that youth sport specialization comes down to two main factors: culture and parenting. With an increasing glorification of professional sports, both athletes and their parents are hoping to achieve those same levels of success.

“Sports are such a huge part of the American culture,” Dr. Eldayrie said. “Eighty percent of kids who reach an elite level of sports think that they are going to go professional. Realistically, less than one percent of athletes are going to go professional.”

He continued, “I think there’s a movement where we are really pushing our kids a little too much and starting them a little too early. There is nothing wrong with that. It’s great to put your kid in a sport; there’s so many benefits to that, but it’s worthwhile to spice it up [and experiment with different sports].”

How can it be prevented?

Dr. Eldayrie is confident that data and further research will decrease the amount of youth athletes specializing in sports which, in turn, will lead to a decrease in overuse injuries and related conditions.

“[Again,] specialization is not a huge problem when you reach the elite level, but it’s more so the developmental stage. It’s the ten-year old playing baseball twelve months out of the year. Show them the proof. Yes, these injuries are happening more frequently and there is data to support that athletes are doing better when they aren’t sport specialized so early. As we continue to gather data, hopefully mindsets will change.”

Dr. George E. Eldayrie
Primary Care Orthopedist and Sports Medicine Specialist

Common Conditions in Musicians

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Hand and Upper Extremity Injuries

Music has been around for quite some time. In fact, the first musical instrument is believed to be a flute carved from the bone of an extinct cave bear nearly forty-three thousand years ago. Since then, the art form has quickly expanded across the world, establishing itself as a staple of every culture. From children and adults to hobbyists and professionals, musicians have found an outlet into which their talent can flow. This talent, however, can often come with a price.

As with any activity, injuries can happen after a while. More specifically, overuse injuries happen, which are brought on by repetitive motion and actions. It’s important to understand the potential setbacks that a musician may face and the methods used towards preventing injury. Whether you’re a guitarist playing your favorite riff, a pianist gliding up and down the keyboard or a drummer bashing on the kit, most musicians end up experiencing some sort of injury from constant playing.

de Quervain’s Tendonitis

First dorsal compartment tendonitis, also known as de Quervain’s Tendonitis, is a condition caused by irritation or inflammation of the wrist tendons at the base of the thumb. The inflammation causes swelling to the tunnel or sheath surrounding the tendon, further causing pain to the thumb and wrist. Someone with de Quervain’s Tendonitis may not be able to make a fist or grasp objects without some form of pain. Treatment includes splints, anti-inflammatories, rest and corticosteroid injections. Surgery may also be recommended.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a condition caused by increased pressure on the median nerve at the wrist. The pressure eventually affects the nerve function, resulting in tingling, numbness and pain felt in the hand and fingers. Loss of strength, forearm tenderness and pain during the night may also be experienced. Guitarists and pianists are two types of musicians who commonly experience this condition. Treatment includes splints, anti-inflammatories, rest, corticosteroid injections and physical therapy. Surgery may also be recommended.

Bursitis

Musicians are also susceptible to bursitis, a condition that happens when there is swelling in the bursa. Bursae are thin, fluid-filled sacs that cushion the bone from tendons and muscles. Usually caused by a formal injury, repetitive motions are also known to cause bursitis. While bursae are found all throughout the body, musicians commonly experience bursitis in their shoulders and elbows. Treatment includes splints, anti-inflammatories, rest, corticosteroid injections and physical therapy. Surgery may also be recommended, although rare.

Cubital Tunnel Syndrome

Cubital Tunnel Syndrome occurs when pressure is placed on the ulnar nerve. This pressure often causes pain, swelling or weakness in the hand. Tingling or numbness of the ring and pinky fingers are also noticed. If the nerve is compressed for prolonged periods of time, muscle wasting in the hand can occur. Treatment includes splints, anti-inflammatories and physical therapy. Surgery may also be recommended.  

These are just some of the conditions among a laundry list of injuries that musicians can be affected by. If you are experiencing pain similar to the above or think that you may have a similar condition, you should contact your hand and upper extremity physicians at Florida Orthopaedic Institute.