Gender Differences in Sports Medicine: Difference between revisions
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== Female Athlete Triad == | == Female Athlete Triad == | ||
What is it?<br> The Female Triad is a spectrum disorder where there is an altered relationship between energy availability, menstrual function, and bone mineral density<ref name="1">Gibbs, Williams, &amp;amp;amp; De Souza. 2013. Prevalence of individual and combined components of the female athlete triad. Medicine&amp;amp;amp; Science in Sports &amp;amp;amp; Exercise, 45(5), 985-996.</ref>. This means that there the person has low amount of energy available in their body, and this depletion of energy is effecting the different body systems. The female triad is considered a spectrum disorder because there are a variety of possible presentations, and girls don’t need to possess all three symptoms to be at risk for health complications<ref name="1" />. | What is it?<br> The Female Triad is a spectrum disorder where there is an altered relationship between energy availability, menstrual function, and bone mineral density<ref name="1">Gibbs, Williams, &amp;amp;amp;amp; De Souza. 2013. Prevalence of individual and combined components of the female athlete triad. Medicine&amp;amp;amp;amp; Science in Sports &amp;amp;amp;amp; Exercise, 45(5), 985-996.</ref>. This means that there the person has low amount of energy available in their body, and this depletion of energy is effecting the different body systems. The female triad is considered a spectrum disorder because there are a variety of possible presentations, and girls don’t need to possess all three symptoms to be at risk for health complications<ref name="1" />. | ||
Who is at risk?<br>This condition is commonly seen in female athletes who participate in sports that emphasize leanness and the sport also uses high amounts of energy (ballet, gymnastics, diving, figure skating, and running) (ACSM, 2011). Women athletes at the high school, college, and elite levels are the most at risk. The prevalence within those athletes is 1-16% with all 3 symptoms, 27% for two components, and up to 60% with one symptom of the female triad <ref name="1" />. | Who is at risk?<br>This condition is commonly seen in female athletes who participate in sports that emphasize leanness and the sport also uses high amounts of energy (ballet, gymnastics, diving, figure skating, and running) (ACSM, 2011). Women athletes at the high school, college, and elite levels are the most at risk. The prevalence within those athletes is 1-16% with all 3 symptoms, 27% for two components, and up to 60% with one symptom of the female triad <ref name="1" />. | ||
Energy Availability <br> The main cause of the female triad is a lack of energy availability. This occurs when a person does not have enough caloric intake based on their energy expenditure. It is not always linked to an eating disorder, but it can be a common cause of the decrease in energy intake<ref name="1" />. Having a decrease in energy availability can be caused by restricting food intake, self-induced vomiting, consumption of appetite suppressants, use of laxities or diuretics, or excessive exercise demands<ref name="1" /> | Energy Availability <br> The main cause of the female triad is a lack of energy availability. This occurs when a person does not have enough caloric intake based on their energy expenditure. It is not always linked to an eating disorder, but it can be a common cause of the decrease in energy intake<ref name="1" />. Having a decrease in energy availability can be caused by restricting food intake, self-induced vomiting, consumption of appetite suppressants, use of laxities or diuretics, or excessive exercise demands<ref name="1" /><ref name="2">American College of Sports Medicine. 2011. The female athlete triad.</ref>. This can be a deadly circumstance because health is greatly impaired when there is not enough energy present for physiologic functions<ref name="1" />. The results of a decrease in energy can be seen in a decrease ability to recover from injury, decreased bone density, impaired menstrual function and fertility, and an increased risk for cardiovascular diseases<ref name="1" />. | ||
Menstrual Function/Amenorrhea <br> A common side effect of the female triad is abnormal menstrual function. Women are expected to have a menstrual cycle every 28 days (+/- 7 days) for healthy a reproductive system and fertility<ref name="1" />. Amenorrhea is defined as a circumstance of an absence of menstruation by the age of 16, missing three consecutive periods, or having intervals of greater than 35 days | Menstrual Function/Amenorrhea <br> A common side effect of the female triad is abnormal menstrual function. Women are expected to have a menstrual cycle every 28 days (+/- 7 days) for healthy a reproductive system and fertility<ref name="1" />. Amenorrhea is defined as a circumstance of an absence of menstruation by the age of 16, missing three consecutive periods, or having intervals of greater than 35 days<ref name="2" />. Females should consult a physician if any of these circumstances are noticed. Inadequate caloric intake in relation to exercise level puts females at risk for menstrual abnormalities because of a decrease in estrogen levels via the hypothalamic pituitary-ovarian axis<ref name="1" /><ref name="2" />. | ||
Decreased Bone Mineral Density/ Osteoporosis <br> The last factor and side effect of the female triad is osteoporosis. The decrease in estrogen levels, hormonal imbalances, and nutritional deficiencies can cause a low bone mass, putting females at risk of the bones becoming weaker | Decreased Bone Mineral Density/ Osteoporosis <br> The last factor and side effect of the female triad is osteoporosis. The decrease in estrogen levels, hormonal imbalances, and nutritional deficiencies can cause a low bone mass, putting females at risk of the bones becoming weaker<ref name="2" />. This places the female at risk for stress fractures<ref name="1" />. Estrogen is a protective hormone for bone by limiting the osteoclast activity, so a decrease in estrogen allowed the osteoclasts to be more active leading to a decrease in bone mineral density<ref name="1" />. Athletes typically should have higher bone mineral density because of Wolff’s Law and the increased demands of the bone, so a decrease in bone mineral density should be a sign of an abnormality. When a female athlete has recurrent or multiple fractures, a bone scan or DEXA should be performed to evaluate the density of their bones<ref name="1" />. | ||
Treatment:<br> If a female shows signs and symptoms of the female triad, they need to seek medical treatment. The treatment of this disorder is a comprehensive multi-disciplinary approach<ref name="1" />. The goal of treatment is to re-establish a menstrual cycle and enhance their bone mineral density<ref name="1" />. This is achieved by a change in diet, exercise training, and increasing the overall energy availability<ref name="1" />. The treatment is largely based on patient education, nutritional consults, and changing unhealthy behaviors. Medications can be prescribed if needed, oral contraceptives can help restore menstruation, transdermal estrogen helps restore hormone balances, and biophosphates can be used to help with the resultant osteoporosis<ref name="1" />. The female triad can be linked to depression, low self-esteem, and anxiety disorders, so further referrals may be needed for mental health<ref name="1" />. <br><br> | Treatment:<br> If a female shows signs and symptoms of the female triad, they need to seek medical treatment. The treatment of this disorder is a comprehensive multi-disciplinary approach<ref name="1" />. The goal of treatment is to re-establish a menstrual cycle and enhance their bone mineral density<ref name="1" />. This is achieved by a change in diet, exercise training, and increasing the overall energy availability<ref name="1" />. The treatment is largely based on patient education, nutritional consults, and changing unhealthy behaviors. Medications can be prescribed if needed, oral contraceptives can help restore menstruation, transdermal estrogen helps restore hormone balances, and biophosphates can be used to help with the resultant osteoporosis<ref name="1" />. The female triad can be linked to depression, low self-esteem, and anxiety disorders, so further referrals may be needed for mental health<ref name="1" />. <br><br> | ||
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Differences in Structure[edit | edit source]
Differences in Mechanics[edit | edit source]
Differences in Neuromotor Control[edit | edit source]
Metabolic Differences[edit | edit source]
There is increasing evidence of gender-related differences in risk factors and clinical manifestation of metabolic conditions. Gender related metabolic differences are important to understand for medical treatment of men and women. Conditions such as diabetes, fat storage, and cardiac disease have an understood gender related mechanism and are conditions that have differing effects on men and women (Kautzky-Willer & Handisurya, 2009). Impaired glucose and lipid metabolism as well as energy balance and body fat distribution have a great impact on overall health and can have a greater effect on women than man. This is important to understand for sport activities and particularly for sports training in men and women.
One of the biggest reasons for sports performance differences in men and women is glucose use and skeletal muscle fiber type. Women tend to have a greater proportion of Type 1 fibers and greater capillary density leading to the ability to hold off fatigue. This means better tissue perfusion and greater capacity for glucose and fatty acid oxidation. Men have a higher glycolytic capacity meaning they can burn through more glucose in the absence of oxygen, which lends itself to better performance for short-intense bursts of effort. This is related to a higher percentage of Type II fibers. This is one reason male athletes tend to be faster and stronger in athletic competition(Lindle et al., 1997).
Another major difference is attributable to men’s higher testosterone levels and women’s higher estrogen levels. Testosterone is attributed to higher amounts of muscle mass and the ability to build muscle. Estrogen has been associated with better metabolic health and increased muscle sensitivity to glucose. Studies show when compared to sedentary men, endurance-trained men have 3-5x as many estrogen receptors on mitochondria increasing the rate of glucose uptake into the muscle when activated. This also relates to men’s ability to excel at high performance events while women tend to convert fat to energy better and fatigue less(Kautzky-Willer & Handisurya, 2009).
Overall, efficiency of skeletal muscle energy use, fat storage, and sex hormones all play a role in men’s and women’s training.
Epidemiology[edit | edit source]
Occurrence of injuries is common place in sporting competition and other athletic/fitness events. Common injuries that can occur include ACL injury, generalized knee pain, ankle sprain, meniscus injury, stress fractures, low back pain, patellar tendinitis, MCL and LCL knee injury, lumbar spondylolysis, and muscle strains. Although there is no evidence to suggest that there are gender related differences in the type of injury to an athlete (only one gender getting a certain injury), there is evidence to suggest that the prevalence of certain injuries can be linked to gender (women injuring a structure more than men).
Research has found significantly higher proportion of females who engaged in basketball, volleyball, or skiing presented with an ACL injury, compared with their male counterparts. There is also a higher proportion of females than males among the track and field athletes who present with stress fractures (Iwamoto, Takeda, Sato, & Matsumoto, 2008). Aside from ACL injuries; prevalence of other types of sports injuries between genders is not well established or studied.
It appears lower extremity injuries are more directly correlated to gender. Research has suggested that sex hormones, dynamic neuromuscular imbalance, and anatomy play a role in the increased risk of injury in female athletes. It also appears that the effects of sex hormones on lower-extremity neuromuscular control patterns differ across the menstrual cycle phases in female athletes (Dedrick et al., 2008).
Female Athlete Triad[edit | edit source]
What is it?
The Female Triad is a spectrum disorder where there is an altered relationship between energy availability, menstrual function, and bone mineral densityCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. This means that there the person has low amount of energy available in their body, and this depletion of energy is effecting the different body systems. The female triad is considered a spectrum disorder because there are a variety of possible presentations, and girls don’t need to possess all three symptoms to be at risk for health complicationsCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Who is at risk?
This condition is commonly seen in female athletes who participate in sports that emphasize leanness and the sport also uses high amounts of energy (ballet, gymnastics, diving, figure skating, and running) (ACSM, 2011). Women athletes at the high school, college, and elite levels are the most at risk. The prevalence within those athletes is 1-16% with all 3 symptoms, 27% for two components, and up to 60% with one symptom of the female triad Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Energy Availability
The main cause of the female triad is a lack of energy availability. This occurs when a person does not have enough caloric intake based on their energy expenditure. It is not always linked to an eating disorder, but it can be a common cause of the decrease in energy intakeCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. Having a decrease in energy availability can be caused by restricting food intake, self-induced vomiting, consumption of appetite suppressants, use of laxities or diuretics, or excessive exercise demandsCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. This can be a deadly circumstance because health is greatly impaired when there is not enough energy present for physiologic functionsCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. The results of a decrease in energy can be seen in a decrease ability to recover from injury, decreased bone density, impaired menstrual function and fertility, and an increased risk for cardiovascular diseasesCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Menstrual Function/Amenorrhea
A common side effect of the female triad is abnormal menstrual function. Women are expected to have a menstrual cycle every 28 days (+/- 7 days) for healthy a reproductive system and fertilityCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. Amenorrhea is defined as a circumstance of an absence of menstruation by the age of 16, missing three consecutive periods, or having intervals of greater than 35 daysCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. Females should consult a physician if any of these circumstances are noticed. Inadequate caloric intake in relation to exercise level puts females at risk for menstrual abnormalities because of a decrease in estrogen levels via the hypothalamic pituitary-ovarian axisCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Decreased Bone Mineral Density/ Osteoporosis
The last factor and side effect of the female triad is osteoporosis. The decrease in estrogen levels, hormonal imbalances, and nutritional deficiencies can cause a low bone mass, putting females at risk of the bones becoming weakerCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. This places the female at risk for stress fracturesCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. Estrogen is a protective hormone for bone by limiting the osteoclast activity, so a decrease in estrogen allowed the osteoclasts to be more active leading to a decrease in bone mineral densityCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. Athletes typically should have higher bone mineral density because of Wolff’s Law and the increased demands of the bone, so a decrease in bone mineral density should be a sign of an abnormality. When a female athlete has recurrent or multiple fractures, a bone scan or DEXA should be performed to evaluate the density of their bonesCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Treatment:
If a female shows signs and symptoms of the female triad, they need to seek medical treatment. The treatment of this disorder is a comprehensive multi-disciplinary approachCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. The goal of treatment is to re-establish a menstrual cycle and enhance their bone mineral densityCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. This is achieved by a change in diet, exercise training, and increasing the overall energy availabilityCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. The treatment is largely based on patient education, nutritional consults, and changing unhealthy behaviors. Medications can be prescribed if needed, oral contraceptives can help restore menstruation, transdermal estrogen helps restore hormone balances, and biophosphates can be used to help with the resultant osteoporosisCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. The female triad can be linked to depression, low self-esteem, and anxiety disorders, so further referrals may be needed for mental healthCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Pregnancy and Sport[edit | edit source]
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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Kautzky-Willer, A. & Handisurya, A. (2009). Metabolic diseases and associated complications: sex and gender matter. European Journal of Clinical Investigation, 39(8), 631-648. doi: 10.1111/j.1365-2362.2009.02161.x
Iwamoto, J., Takeda, T., Sato, Y., & Matsumoto, H. (2008). Retrospective case evaluation of gender differences in sports injuries in a japanese sports medicine clinic. Gender Medicine, 5(4), 405-414. doi:10.1 016/j.genm.2008.1 0.002
Dedrick, G., S., Sizer, P., S., Merkle, J. N., Hounshell, T., R., Robert-McComb, J., J., Sawyer, S., F., Brismee, J., & James, C., R. (2008). Effect of sex hormones on neuromuscular control patterns during landing. Journal of Electromyography and Kinesiology, 18, 68-78. doi:10.1016/j.jelekin.2006.09.004
Lindle R., S., Metter, E., J., Lynch, N., A., Fleg, J., L., Fozard, J., L., Tobin, J., Roy, T., A., & Hurley, B., F., (1997). Age and gender comparisons of muscle strength in 654 women and men aged 20–93 years. Journal of Applied Physiology, 83 (5), 1581-1587. PMID: 9375323
