Chapter 29: Additional Health Conditions

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Chapter 29 Additional Health Conditions
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Role of the Immune System

• Collection of disease fighting cells that
  neutralizes foreign substances
• Illness results when immune system does not
  neutralize foreign substances (antigens)
• Cell-mediated response, humoral immune response
  (B-cells that produce antibodies), or nonspecific
  immune response (inflammation)
• Auto-immune response against the body leads to
  damage of bodys own tissues

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Viral Infections

• Rhinovirus (Common Cold)
• Etiology
• Over 100 different rhinoviruses
• Transmitted by either direct or indirect contact
  (cough, sneeze, speaking, touching contaminated
  article)

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• Sign and Symptoms
• Begins w/ scratchy, sore throat, stopped-up nose,
  watery discharge and sneezing
• Second batch may produce thick yellow nasal
  discharge, watering eyes, mild fever, sore
  throat, headache, malaise, myalgia, dry cough
• Secondary - laryngitis, tracheitis, acute
  bronchitis, sinusitis, and otis media
• Management
• Symptomatic treatment (may last 5-10 days)
• Non-prescription cold medications
• Eat a balanced diet, consume 64 oz. of water
• Avoid emotional stress and extreme fatigue

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• Influenza (Flu)
• Etiology
• Caused by myoviruses (A, B, C)
• Type A is most common
• Virus enters through cell genetic material
• Sign and Symptoms
• Fever (102-103 degrees F), chills, cough,
  headache, malaise, and inflamed respiratory
  mucous membrane w/ coryza
• General aches and pains, headache becomes worse
• Weakness, sweating, fatigue may persist for many
  days
• Management
• Bed rest and supportive care
• Symptomatic care should be avoided by those under
  age 18 ( Reyes syndrome)
• Steam inhalation, cough medicines, and gargles

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• Infectious Mononucleosis
• Etiology
• Epstein-Barr virus (member of herpes group) that
  has incubation period of 4-6 weeks
• Transmitted through saliva
• Sign and Symptoms
• First 3-5 days -severe fatigue, headache, loss of
  appetite and myalgia
• Days 5-15 - fever, swollen lymph nodes and sore
  throat (50 will experience enlarged spleen)
• Possible jaundice, skin rash, puffy eyelids
• Management
• Supportive symptomatic treatment
• Acetaminophen for headache, fever and malaise
• Resume training after 3 weeks after onset if
  spleen not markedly enlarged/painful, athlete is
  afebrile, liver function is normal, and
  pharyngitis is resolved

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• Rubella (German Measles)
• Etiology
• Highly contagious viral disease (childhood
  disease)
• Results 13-24 days after exposure
• May cause developmental difficulties for fetus in
  pregnant females
• Sign and Symptoms
• Temperature elevation, sore throat, drowsiness,
  swollen lymph glands and red spots on palate
• Rash
• Management
• Prevent by early childhood immunization
• Measles, mumps, rubella vaccine (MMR)

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• Rubeola (Measles)
• Etiology
• Childhood disease
• Incubation time of 10 days following exposure
• Sign and Symptoms
• Sneezing, nasal congestion, coughing, malaise,
  photophobia, spots in mouth, conjunctivitis, and
  elevated fever (rash appears - causes itching)
• Management
• Inoculation w/ MMR vaccine at 12-15 months and
  4-6 years of age
• Bed rest, isolation in dark room and use of
  antipyretic and anti-itching medication

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• Mumps (Parotitis)
• Etiology
• Contagious viral disease that results in
  inflammation of parotid and salivary glands
• Appear in 12-25 days following exposure
• Sign and Symptoms
• Malaise, headache, chills and moderate fever
• Pain in neck - swelling of glands may last up to
  7 days
• Pain w/ jaw motion and swallowing increased or
  decreased saliva production
• Management
• Varicella-zoster immune globulin w/in 96 hours of
  exposure will prevent clinical symptoms in normal
  healthy children
• Acyclovir meds should be administered to
  adolescents and adults w/ in 24 hours of exposure
• Anti-itching medications to prevent scratching

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Respiratory Conditions

• Sinusitis
• Etiology
• Stems from upper respiratory infection caused by
  a variety of bacteria
• Sign and Symptoms
• Nasal mucous swell and block ostium of paranasal
  sinus
• Painful pressure occurring from accumulation of
  mucus
• Skin over sinus may be swollen and painful to the
  touch
• Headache and malaise purulent nasal discharge
• Management
• If infection is purulent, antibiotics may be
  warranted
• Steam inhalation and other nasal topical sprays
  w/ oxymetazalone can produce vasoconstriction and
  drainage

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• Tonsillitis
• Etiology
• Acute inflammation and bacterial infection of
  tonsil epithelium
• Sign and Symptoms
• Tonsil appear red, swollen, w/ yellow exudate in
  pits
• Pain w/ swallowing, high fever and chills,
  headache and neck pain
• Sinusitis, otitis media, tonsillar abscesses may
  also develop
• Management
• Culture to check for streptococcal bacteria and
  antibiotics for 10 days
• Gargling w/ saline water, liquid diet, and
  antipyretic medication
• Frequent bouts of tonsillitis may necessitate
  removal

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• Seasonal Atopic (Allergic) Rhinitis
• Hay fever, pollinosis from airborne pollens
• Etiology
• Reaction to pollen - airborne fungal spores
  (allergens) resulting in allergic antibodies
  causing the release of histamine
• Sign and Symptoms
• Eyes, throat, mouth and nose begin to itch,
  followed by watering eyes, sneezing and clear
  watery discharge
• Sinus type headache, emotional irritability,
  difficulty sleeping, red swollen eyes and nasal
  mucus membranes, and wheezing cough
• Management
• Oral antihistamines and decongestants

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• Pharyngitis (sore throat)
• Etiology
• Caused by virus or streptococcus bacteria
• Transmitted by direct contact of infected person
  or one who is a carrier
• Sign and Symptoms
• Pain w/ swallowing, fever, inflamed and swollen
  glands, malaise, weakness and anorexia
• Mucus membrane may be inflamed and covered w/
  purulent matter
• Management
• Throat culture
• Topical gargles and rest
• Antibiotic therapy for streptococcal infection

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• Acute Bronchitis
• Etiology
• Infectious winter disease that follows common
  cold or viral infection
• Fatigue, malnutrition or becoming chilled could
  be predisposing factors
• Sign and Symptoms
• Upper respiratory infection, nasal inflammation
  and profuse discharge, slight fever, sore throat
  and back muscle pains
• Fever lasts 3-5 days while cough can last 2-3
  weeks
• Yellow mucus indicates infection
• Pneumonia can complicate condition
• Management
• Avoid sleeping in cold environment, avoid
  exercise in extreme cold w/ protection
• Rest until fever subsides, drink 3-4 quarts of
  water daily, ingest antipyretic analgesic, cough
  suppressant, and antibiotic

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• Pneumonia
• Etiology
• Infection of alveoli and bronchioles from viral,
  bacterial or fungal microorganisms
• Irritation from chemicals, aspiration of vomitus
• Alveoli fill w/ exudate, inflammatory cells and
  fibrin
• Sign and Symptoms
• Bacterial will cause rapid onset
• High fever, chills, pain on inspiration,
  decreased breath sounds, rhonchi on auscultation,
  coughing of purulent, yellowish sputum
• Management
• Treat w/ antibiotics perform deep breathing
  exercises to removal of sputum through heavy
  coughing
• Analgesics and antipyretics may be useful for
  controlling pain and fever

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• Bronchial Asthma
• Etiology
• Caused by viral respiratory tract infection,
  emotional upset, changes in barometric pressure
  or temperature, exercise, inhalation of noxious
  odor or exposure to specific allergen
• Sign and Symptoms
• Spasm of smooth bronchial musculature, edema,
  inflammation of mucus membrane
• Difficulty breathing, may cause hyperventilation
  resulting in dizziness, coughing, wheezing,
  shortness of breath and fatigue

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• Exercise-Induced Bronchial Obstruction (Asthma)
• Etiology
• Brought on by exercise w/ exact cause unknown
• Metabolic acidosis, post-exertional hypocapnia,
  stimulation of tracheal irritant receptor,
  adrenergic abnormalities, defective catecholamine
  metabolism and psychological factors, loss of
  heat and water, sinusitis can also trigger
• Sign and Symptoms
• Airway narrowing due to spasm and excess mucus
  production
• Tight chest, breathlessness, coughing, wheezing,
  nausea, hypertension, fatigue, headache, and
  redness of skin
• May occur w/in 3-8 minutes of exercise

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• EIA (continued)
• Management
• Regular exercise, appropriate warm-up and cool
  down, w/ intensity graduated
• Inhaled bronchodilators may be useful
• Exercise in warm, humid environment

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• Cystic Fibrosis
• Etiology
• Genetic disorder that can manifest as obstructive
  pulmonary disease, pancreatic deficiency,
  urogential dysfunction and increased electrolyte
  sweating
• Cause of severe lung disease w/ life expectancy
  of about 30 years
• Sign and Symptoms
• Bronchitis, pneumonia, respiratory failure,gall
  bladder disease, pancreatitis, diabetes and
  nutritional deficiencies
• High production of mucus
• Management
• Drug therapy to slow progress of disease
  (ibuprofen)
• Antibiotics to control pulmonary disease
• Consistent postural drainage to mobilize
  secretions
• High fluid intake to thin secretions and use of
  humidifier

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Muscular Disorders

• Duchenne Muscular Dystrophy
• Etiology
• Hereditary disease causing degeneration of
  skeletal muscle (gradual replacement of muscle w/
  adipose and connective tissue - decreases
  circulation and perpetuates condition)
• Sign and Symptoms
• In children, exhibited by frequent falls,
  difficulty standing
• Muscles tend to shorten as they atrophy, causing
  scoliosis and other postural abnormalities
• Management
• Cannot be cured consistent exercise can be used
  to retard atrophy
• Ambulation w/ braces until the individual is
  confined to a wheelchair
• Death generally occurs by age 20

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• Myasthenia Gravis
• Etiology
• Autoimmune disease where antibodies attack
  synaptic junctions
• Deficiency in acetylcholine producing early
  fatigue
• Often occurs in females age 20-40
• Sign and Symptoms
• Drooping of upper eyelids and double vision due
  to weakness in extraocular muscles
• Difficulty chewing and swallowing, weakness of
  extremities and general decrease in muscle
  endurance
• Management
• Treat w/ drugs that inhibit breakdown of
  acetylcholine
• Corticosteroids can be used to suppress immune
  system - reducing production of antibodies that
  destroy acetylcholine

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Nervous System Disorders

• Meningitis
• Etiology
• Inflammation of meninges surrounding spinal cord
  and brain
• Caused by infection brought on by meningococcus
  bacteria
• Sign and Symptoms
• High fever, stiff neck, intense headache,
  sensitivity to light and sound
• Progress to vomiting, convulsions and coma

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• Meningitis (continued)
• Management
• Cerebrospinal fluid must be analyzed for bacteria
  and WBCs.
• If bacteria is found isolation is necessary for
  24 hours (very contagious), antibiotics must be
  administered immediately
• Monitored closely in intensive care unit

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• Multiple Sclerosis
• Etiology
• Auto-immune inflammatory disease of CNS that
  causes deterioration and damage to myelin sheath,
  disrupting nerve conduction
• Sign and Symptoms
• Blurred vision, speech deficits, tremors, muscle
  weakness and numbness in extremities
• Tremor spasticity, neurotic behavior and mood
  swings
• May progress slowly or may be acute attack
  followed by partial or complete temporary
  remission
• Management
• Deal w/ symptoms as they occur
• Avoid over exertion, extreme temperatures, and
  stressful situations
• Establish exercise routine
• Drug therapy to slow progression

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• Amyotropic Lateral Sclerosis (Lou Gehrigs
  Disease)
• Etiology
• Sclerosis of lateral regions of spinal cord along
  w/ degeneration of motor neurons and significant
  atrophy
• Sign and Symptoms
• Difficulty in speaking, swallowing and use of
  hands
• Sensory and intellectual function remain intact
• Rapid progression of atrophy resulting in
  paralysis
• Management
• No cure
• Even after incapacitation, normal intellectual
  function remains inability to communicate
  feelings and ideas

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• Reflex Sympathetic Dystrophy
• Etiology
• Abnormal excessive response of sympathetic
  portion of autonomic nervous system following
  injury
• Sign and Symptoms
• Commonly seen in hands and feet following
  immobilization of injured part (change to bone,
  connective tissue, blood vessels and nerves)
• Develop extreme hypersensitivity to touch,
  redness, sweating, burning pain, swelling w/
  palpable tightness and shining skin atrophy
• Possible psychologic depression

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• Reflex Sympathetic Dystrophy (continued)
• Management
• Early recognition and intervention is critical
• Must direct sympathetic response (nerve block)
• AROM exercise through pain free range, use
  modalities to modify pain and reduce swelling
• Anti-depressant drugs may be necessary for
  chronic conditions

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Blood and Lymph Disorders

• Iron Deficiency Anemia
• Etiology
• Prevalent in menstruating women and males age
  7-14
• Three things occur during anemia
• Small erythrocytes
• Decreased hemoglobin
• Low ferritin concentration (compound that
  contains 23 iron)
• GI loss of iron in runners is common
• Aspirin and NSAIDs may cause GI bleeding and
  iron loss
• Menstruation accounts for most iron lost in women
• Vegetarian athletes may also be deficient in
  intake relative to iron loss

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• Sign and Symptoms
• First stage of deficiency, performance declines
• Athlete may feel burning thighs and nausea from
  becoming anaerobic
• Ice cravings are common
• Serum ferritin levels must be assessed
• Mean corpuscular volume and relative size of
  erythrocytes must be checked
• Management
• Eat a proper diet including more red meat or dark
  poultry avoid coffee and tea (hamper iron
  absorption)
• Consume vitamin C (enhance absorption)
• Take supplements (dependent on degree of anemia)

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• Runners Anemia (hemolysis)
• Etiology
• Caused by impact of foot as it strikes the
  surface
• Impact destroys normal erythrocytes w/in vascular
  system
• Sign and Symptoms
• Mildly enlarge cells, increase in circulatory
  reticulocytes and decreased haptoglobin (bound to
  hemoglobin)
• Varies according to training
• Management
• Run on soft surfaces, wear well cushioned shoes
  and run w/ light feet

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• Sickle-Cell Anemia
• Etiology
• Hereditary hemolytic anemia - RBCs are sickle or
  crescent shaped (irregular hemoglobin)
• Less ability to carry oxygen, limited ability to
  pass through vessels, causing clustering and
  clogging of vessels (thrombi)
• Severe cases can result in death if embolus
  develops and travels to lungs
• Exercise factors - 1)acidosis, 2) hyperthermia,
  3)dehydration, 4) severe hypoxemia
• Can be brought on by high altitudes

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• Sickle Cell Anemia (continued)
• Sign and Symptoms
• Fever, pallor, muscle weakness, pain in limbs
• Pain in upper right quadrant indicating possible
  splenic infarction
• Headaches and convulsions are also possible
• Management
• Provide anticoagulants and analgesics for pain

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• Hemophilia
• Etiology
• Hereditary disease caused by absence of clotting
  factors
• Prolonged coagulation time, failure of blood to
  clot and abnormal bleeding
• Sign and Symptoms
• Physical exertion can cause bleeding into muscles
  and joints -- may be extremely painful
• Joints may become immobilized
• Management
• If bleeding occurs, athlete should be taken to a
  medical care facility
• No cure
• Clotting factors have been developed to control
  bleeding for several days
• Avoid trauma and wear medical alert bracelet

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• Lymphangitis (blood poisoning)
• Etiology
• Inflammation of lymphatic channels
• Caused by streptococcal bacteria
• Sign and Symptoms
• Usually occurs in extremities
• Deep reddening of the skin, warmth,
  lymphandentitis and raised border over affected
  area (particularly in case of infection)
• Chills and high fever w/ moderate pain and
  swelling
• Management
• Patient should be hospitalized and vital signs
  monitored
• Following evaluation warm compresses should be
  applied to the extremity
• Antibiotic administration and fluid intake
  (restore fluid balance)

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Diabetes Mellitus

• Most common forms are Type I (insulin-dependent
  diabetes mellitus) and Type II (non-insulin-depend
  ent diabetes mellitus)
• Etiology
• Result of interaction between physical and
  environmental factors
• Involves a complete or partial decrease in
  insulin secretion

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• Sign and Symptoms
• IDDM is most commonly seen in childhood with
  sudden symptoms of frequent urination, constant
  thirst, weight loss, constant hunger, tiredness,
  weakness, itchy dry skin and blurred vision
• NIDDM occurs later in life and is usually
  associated with being overweight
• Body either does not produce enough insulin or
  resist insulin that is being produced
• Management
• Monitor and control glucose levels
• Diet, doses of insulin
• Vigorous exercise increases peripheral insulin
  action and enhances glucose tolerance
• ATC must be aware that extreme temperatures and
  unpredictable activity levels may require the
  administration of rapid-acting carbohydrates

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• Diabetic Coma
• Etiology
• Loss of sodium, potassium and ketone bodies
  through excessive urination (ketoacidosis)
• Sign and Symptoms
• Labored breathing, fruity smelling breath (due to
  acetone), nausea, vomiting, thirst, dry mucous
  membranes, flushed skin, mental confusion or
  unconsciousness followed by coma.
• Management
• Early detection is critical as this is a
  life-threatening condition
• Insulin injections may help to prevent coma

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• Insulin Shock
• Etiology
• Occurs when the body has too much insulin and too
  little blood sugar
• Sign and Symptoms
• Tingling in mouth, hands, or other parts of the
  body, physical weakness, headaches, abdominal
  pain
• Normal or shallow respiration, rapid heart rate,
  tremors along with irritability and drowsiness
• Management
• Adhere to a carefully planned diet including
  snacks before exercise

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Seizure Disorders

• Defined as recurrent paroxysmal disorder of
  cerebral function characterized by periods of
  altered consciousness, motor activity, sensory
  phenomena or inappropriate behavior caused by
  abnormal cerebral neuron discharge
• Etiology
• For some forms of epilepsy there is genetic
  predisposition
• Brain injury or altered brain metabolism

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• Sign and Symptoms
• Periods of altered consciousness, motor activity,
  sensory phenomena or inappropriate behavior
  caused
• May last 5-15 seconds (petit mal seizure) or
  longer (grand mal seizure)
• Include unconsciousness and uncontrolled
  tonic-clonic muscle contractions
• Management
• Individuals that experience daily or weekly
  seizures should be prohibited from participating
  in collision sports (blow resulting in
  unconsciousness could result in serious injury)
• Must be careful with activities involving changes
  in pressure
• Can be managed with medication

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Hypertension

• Etiology
• Primary hypertension accounts for 90 of all
  cases with no other disease association
• Secondary hypertension is associated with kidney
  disorder, overactive adrenal glands,
  hormone-producing tumor, narrowing of aorta,
  pregnancy and medications
• Long term cases increase the chances of premature
  mortality and morbidity due to coronary artery
  disease, congestive heart failure and stroke

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• Sign and Symptoms
• Primary hypertension is generally asymptomatic
  until complications arise
• May cause dizziness, flushed appearance,
  headache, fatigue, epistaxis and nervousness
• Management
• Thorough examination must be performed to
  determine type of hypertension
• Primary hypertension can be controlled through
  lifestyle changes (diet, exercise, weight loss)
• When conditions associated with secondary
  hypertension are cured, blood pressure commonly
  returns to normal

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Cancer

• Etiology
• Condition where cellular activity becomes
  abnormal and cells no longer perform normal
  function
• Cells do not multiply at increased rate but
  continue to develop ultimately taking over normal
  tissue
• Tumors may be benign or malignant
• Malignancies are classified based on the types of
  tissue they invade
• Variety of causes including, ultraviolet
  radiation, chemicals (tobacco), alcohol, fatty
  diet, combination of heredity and environmental
  factors

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• Sign and Symptoms
• Vary tremendously depending on type of cancer
• Warning signs include change in bowel and bladder
  habits, sore throat that does not heal, unusual
  bleeding or discharge, development of lump in
  breast or elsewhere, indigestion, change in wart
  or mole
• Management
• Early detection is critical
• Effective forms of treatment include surgery,
  radiation and chemotherapy

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Sexually Transmitted Infections (STIs)
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• Chlamydia
• Etiology
• Caused by bacterial organism
• Sign and Symptoms
• May result in pelvic inflammation and is
  important cause of infertility and ectopic
  pregnancy in females
• In males, inflammation occurs along with purulent
  discharge 7-28 days after intercourse
• Painful urination and traces of blood in urine,
  vaginal discharge
• Can cause conjunctivitis and pneumonia in
  newborns
• Management
• Identify infection and exact organism present
• Treat with antibiotics

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• Genital Herpes
• Etiology
• Caused by type 2 herpes simplex virus
• Sign and Symptoms
• Develops 4-7 days following sexual contact
• Begins to crust 14-17 days in primary genital
  herpes and 10 days in secondary
• Females may be asymptomatic while males will
  experience itching and soreness
• Development of lesions
• Management
• Herpes and pregnancy
• No cure just systemic medication (antiviral
  medications) to lessen early symptoms or the
  disease

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• Trichomoniasis
• Etiology
• Caused by the flagellate protozoan trichomonas
  vaginalis
• Sign and Symptoms
• Vaginal discharge that is greenish yellow and
  frothy
• Causes irritation of the vulva, perineum and
  thighs
• Painful urination
• Males tend to by asymptomatic but may experience
  purulent urethral discharge
• Management
• 2 grams of metronidazole cures up to 95 of cases
  in women
• Males require 500mg twice daily for 7 days
• Complete cure is required before engaging in
  intercourse

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• Genital Candidiasis
• Etiology
• Transmitted through sexual activity and appear as
  warts on the glans penis, vulva or anus
• Sign and Symptoms
• Cauliflower-like wart or can be singular
• Soft, moist pink or red swellings that develop
  cauliflower-like head
• May be mistaken as secondary syphilis or
  carcinoma
• Management
• When moist - 20-25 polophyllin
• Dry warts - may be frozen with liquid nitrogen

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• Gonorrhea (clap)
• Etiology
• Caused by organism infection - gonococcal
  bacteria which is spread through intercourse
• Sign and Symptoms
• In men - experience tingling of urethra followed
  by 2-3 hours of greenish yellow discharge and
  painful urination
• 60 of women are asymptomatic
• Females will experience vaginal discharge
• May result in sterility if not treated or
  arthritis
• Management
• Penicillin
• Avoid sexual contact until it is known that the
  disease is no longer active

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• Syphilis
• Etiology
• A spirochete bacteria is the organism related to
  syphilis and enters body through mucous membranes
  or skin lesions
• Sign and Symptoms
• 4 stages
• Incubation is usually 3-4 weeks but could be
  anywhere from 1-13 weeks painless chancre or
  ulcer forms that heal w/in 4-8 weeks (can occur
  on penis, urethra, vagina, cervix, mouth, hand,
  foot or around eye)
• Secondary stage occurs 6-12 weeks after initial
  infection and is characterized by a rash, lymph
  swelling, body aches, mild flu-like symptoms and
  possible hair loss
• Latent syphilis is characterized by no or few
  symptoms - but if untreated it may result in
  tertiary syphilis

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• Sign and Symptoms
• Late stage is characterized by deep penetration
  of spirochetes that damage skin, bone,
  cardiovascular system and nervous system
• Late stage may develop w/in 3-10 years of
  infection and cause neurosyphilis - muscle
  weakness, paralysis and various types of
  psychoses
• Management
• Penicillin is used for all stages
• Other drugs may be required due to increased
  resistance

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Menstrual Irregularities and the Female
Reproductive System

• Physiology of the Menstrual Cycle
• Menarche
• Onset of menses and puberty normally occur
  between ages 9-17
• Female becomes capable of reproduction
• May be delayed through strenuous sports training

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• Menstruation
• 28 day cycle that consist of follicular and
  luteal phases (each lasting 14 days)
• Result of cyclic hormone pattern
• Follicle stimulating hormone stimulates
  maturation of ovarian follicle while luteinizing
  stimulates development of corpus luteum and
  encourages secretion of progesterone and
  estrogens
• Progesterone will ultimately inhibit LH
• Menstrual Cycle Irregularities
• Strenuous training may alter cycle (25-38 day
  long cycles)
• Oligomenorrhea - diminished flow (refers to
  fewer than 3-6 cycles per year)

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• Amenorrhea
• Etiology
• Exercise related is often a hypothalamic
  dysfunction
• Gonadotropin-releasing hormone is often deficient
• Must rule out pregnancy, abnormal reproductive or
  genital tract as well as ovarian failure and
  pituitary tumors
• Sign and Symptoms
• Complete cessation of menstrual cycle
• Management
• Re-establishment of normal hormone levels
• Thorough medical examination, nutritional
  counseling, reduction of exercise intensity and
  emotional stress
• Estrogen replacement may be considered

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• Dysmenorrhea
• Etiology
• Painful menstruation prevalent in active women
• May be caused by hormonal imbalance, ischemia of
  the pelvic organs, endometriosis
• Most common menstrual disorder
• Sign and Symptoms
• Cramps, nausea, lower abdominal pain, headache,
  occasionally emotional lability
• Management
• Mild to vigorous exercise that help to ameliorate
  dysmenorrhea are usually prescribed
• Continued activity as long as performance levels
  do not drop

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The Female Athlete Triad

• Etiology
• Relationship between disordered eating,
  amenorrhea and osteoporosis
• Driven to meet standards of sport or to meet a
  specific athletic image to attain goals
• Sign and Symptoms
• Disordered eating - bulimia and anorexia
• Osteoporosis - premature bone loss in young
  women, inadequate bone development
• Management
• Prevention is key identify and educate

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Bone Health

• Etiology
• Decrease in bone is seen commonly in older women
  and is linked to declines in FSH, LH,
  progesterone, and estrogen
• Athletic women with irregular menses
• Sign and Symptoms
• Increased risk of stress fractures
• Decreased bone mineral density
• Management
• Decrease training volume, increase total caloric
  intake and increase calcium supplementation
• Estrogen replacement therapy

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Contraceptives and Reproduction

• Oral contraceptives
• Should not be used to delay menstruation during
  competition
• May result in nausea, vomiting, fluid retention,
  amenorrhea, hypertension, double vision and
  thrombophlebitis
• Use under supervision of a physician
• Low dose preparations (little risk to healthy women
• Intrauterine devices
• Not recommended for adolescents that have not
  given birth

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Pregnancy

• Physical activity and competition can be engaged
  in up to the 3rd month unless complications
  present
• May even be able to continue up through the
  seventh month
• Impact on performance
• No indication that exercise is harmful to the
  fetal growth patterns
• Extreme exercise may result in low birth weight

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• Should avoid activities that involve severe body
  contact, jarring or falls
• Contraindications include
• Pregnancy induced hypertension
• Pre-term rupture of membranes
• Pre-term labor during the prior or current
  pregnancy or both
• Incompetent cervix or cerclage
• Persistent second or third trimester bleeding
• Intrauterine growth retardation

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• Ectopic Pregnancy
• Etiology
• Fertilized egg implants outside the uterine
  cavity due to inflammation of fallopian tubes or
  mechanical blockage
• Sign and Symptoms
• Amenorrhea, tenderness and soreness on affected
  side, referred pain to shoulder, pallor, possible
  shock and/or hemorrhaging
• Management
• Operative treatment is necessary to terminate
  nonviable pregnancy and control hemorrhaging