University Health Services

INJURIES

Female Athlete Triad

The female athlete triad is a combination of three medical conditions: disordered eating, lack of menstrual periods (amenorrhea), and bone weakening (osteoporosis). The three conditions are linked because disordered eating leads to low body weight, which leads to abnormal hormonal cycles and amenorrhea. Without adequate estrogen levels, bones lose calcium, leading to weak bones and fractures. Normal estrogen levels are required for bones to use calcium to remain strong. Bone density loss due to osteoporosis is irreversible, even if menstruation and normal eating are resumed.

Disordered eating does not only include anorexia and bulimia, but also inadequate food intake with high levels of exercise. Female athletes involved in highly competitive sports, or activities that require maintenance of a certain body type, such as ballet or gymnastics, are at risk for female athlete triad. If you follow an intense exercise regimen, it’s important to meet your higher caloric needs. Preventing female athlete triad will decrease your risk of stress fractures, strengthen your immune system, increase your ability to recover from injury, prolong your athletic career, and encourage normal hormonal balance.

Women who might have the triad, or be at risk for developing it, are those who exercise compulsively more than an hour everyday, unable to skip a day or two. They often restrict the amounts and kinds of foods eaten, exercise without a set training goal, spend excessive time in the bathroom, are depressed, and have frequent unexplained injuries.

Heat Illness

Heat illness is the most common and preventable sports injury. As your body heat rises, sweating counters the increased temperature through evaporative cooling. A major factor contributing to heat illness is inadequate replacement of fluids lost through sweat and respiration. When you’re physically active, especially in high temperatures, it is imperative that you drink plenty of water (and possibly electrolytes). Do not wait until you are thirsty, because by the time you feel thirst your cells are already suffering the effects of dehydration. It’s a good idea to drink sports drinks during intense exercise lasting more than one hour in order to avoid hyponatremia (low blood sodium).

A good way to tell if you are well hydrated is to check the color of your urine, which should be clear and copious, or at least a pale shade of yellow. It’s best to drink 16 ounces of water within two hours before you exercise, 5-10 ounces every 20 minutes during physical activity, and 16 ounces for each pound of weight lost during the workout. You should replace fluids as you go rather than let needs accumulate to prevent damage to your body (and performance). If you’re exercising for more than one hour, be sure your replacement fluid contains sodium, like Gatorade, to avoid hyponatremia (a deficiency of sodium in the blood). When playing a competitive sport, experiment with the timing of pre-exercise fluid intake to allow sufficient time to empty your bladder prior to the athletic event.

Aside from drinking plenty of water, the best ways to prevent heat illness are to acclimate your body to warmer temperatures, exercise in the morning or evening when it’s cooler, wear light-colored clothing, and don’t change into a dry shirt immediately because soaked shirts do a better job cooling the body.

Knee pain

Knee pain is a common overuse injury often caused by patellofemoral pain syndrome – when the cartilage behind the kneecap gets roughened and irritated. Pain occurs when there is increased pressure between the femur (thigh bone) and patella (kneecap). Although some may be prone to such knee pain due to genetic factors, other causes include overuse, weak thigh muscles, obesity, flat feet, knock-knees, and worn out shoes.

In order to prevent knee problems, be sure to warm up, cool down, and stretch in the time surrounding workouts (especially after work-outs). It’s particularly important to keep your front and back thigh muscles flexible. Wear shoes appropriate to the sport you’re playing, and make sure they’re not worn out and that they have good arch supports.

If you suffer from a painful kneecap, avoid kneeling or sitting with your legs crossed. Don’t sleep on your stomach because this puts direct, constant pressure on the kneecaps. Instead, sleep on your back with a pillow under your knees or on your side with a pillow between the knees. If you like to use stairclimber machines, try taking smaller steps. Once you no longer suffer knee pain, try doing exercises such as straight-leg raises. Either sitting in a chair or lying down, hold your leg out straight and raise it off the ground to strengthen the quadricep muscle without irritating the patella. (Lunges and squats are good exercises, too, but could be damaging to the knees if done improperly).

Shin Splints

Shin splints is a common overuse injury that develops over time in athletes who pound their legs – runners, sprinters, figure skaters, gymnasts, etc. Pain occurs on the inside of the lower leg, where the soleus muscle of the calf attaches to the shinbone, or tibia. Running and other weight-bearing exercises exacerbate pain. In order to prevent shin splints, train on softer surfaces, such as grass or a treadmill, or engage in lower-impact workouts, such as swimming or cycling. Proper footwear is essential for runners to reduce the stress of impact. Ice is the best treatment for shin splints, and massage can help as well. Taping the shins can relieve pain, but should not be used to enable exercise on injured legs.

Stress Fractures

Stress fractures are tiny cracks in the bone, which occur when muscles are overexerted and lose the ability to absorb shock, which is then transferred to the bone. People who develop stress fractures are usually those engaged in repetitive weight-bearing activities, such as running, tennis, basketball, and gymnastics. Having flat feet, rigid arches, or osteoporosis will increase your risk of a stress fracture, which typically occurs in the lower leg or foot. To prevent such injury, build up the intensity and duration of your exercise routine gradually so your muscles have time to strengthen. Symptoms include pain that increases with time and is still painful after a few days. The pain increases with activity, and there may or may not be swelling. You should go to a doctor if the pain doesn’t go away after 2 days of rest.

Sprains

A sprain occurs when a ligament (the fibrous tissue that connects bones) is overstretched or torn, but there is no dislocation or fracture. The sprained joint will cause immediate pain, swelling, bruising, and warmth at the injured site. As the sprain heals, the damaged ligaments and connective tissue will be replaced by new fibrous tissue that is stronger, but not as flexible. This is why it’s important to move and stretch the injured site during the healing process, as long as it doesn’t cause pain. The joint may not fully recover for many weeks.

To treat sprains, follow R.I.C.E. (explained below), and make sure ankle sprains are elevated above heart level even during sleep. Standing or dangling the leg can lead to more swelling, throbbing, and pain. Do not treat acute sprains with heat, only ice.

The best pain reliever to take right after injury is Ibuprofen because it is also anti-inflammatory (decreases swelling). Acetaminophen (Tylenol) is not an anti-inflammatory and Aspirin will increase internal bleeding if taken within 24 hours of the injury. Crutches are useful if the leg cannot bear weight fully, but early walking is important to prevent tightening of the tendons that connect muscles to bones.

Strains

Strains are often the result of overuse or injury, when muscles or tendons are overstretched or overexerted. While sprains concern ligaments, strains affect tendons, the tissue that connects muscles to bones. Strains cause pain, tenderness, swelling, and bruising at the injured site. Because sprains and strains affect different types of tissue, you can have both types of injury at the same time. For example, an ankle sprain and a strain of the Achilles tendon.

Tendonitis (also spelled “tendinitis”)

Tendonitis is any inflammation or irritation of a tendon, which connects muscles to bone. The condition causes pain, tenderness, and stiffness near a joint, usually around the shoulders, elbows, and knees, and is commonly the result of injury or overuse. The pain of tendonitis is aggravated by movement, so rest, ice, and pain medication is usually the best treatment. In order to avoid tendonitis, don’t participate in activities that place abnormal amounts of stress on your tendons, such as running uphill. Also, try cross-training to limit and spread out high-impact workouts, such as running. [top]

TREATING SPRAINS, STRAINS, AND OTHER SPORTS INJURIES

• If the injury does not appear serious, stop what you’re doing and use R.I.C.E.:
   
  • Rest the injured area as much as possible for 24 to 48 hours.
  • Ice the injured area as soon as possible for 20 minutes on and 20 minutes off. After a couple hours you can reduce icing to 20 minutes 4 times a day.
  • Compression. Apply an elastic bandage to the area to control movement, but loosen it if you feel numbness, tingling, or increased pain.
  • Elevation. Raise the injured area above heart level.
• Full return to activity should be avoided until full range of motion no longer causes pain.

To make an appointment at UHS, call (609) 258-5357. [top]

GENERAL PREVENTION OF SPORTS INJURIES

• Do not make sudden changes in your exercise routine; ease into new activities. Start off with things that are easy for you and slowly build as you feel comfortable with higher levels of activity.
• Warm-up your muscles and stretch them before working out. Hold each stretch for about 30 seconds, but don’t bounce. It’s also important to stretch after working out.
• Wear proper-fitting shoes that provide shock absorption and stability.
• Avoid running on hard surfaces like asphalt and concrete. Run on flat surfaces instead of uphill. Running uphill may aggravate the Achilles tendon.
• Do not lock your knees, especially when stretching or when landing a jump. [top]

BIKE SAFETY

What should I look for in a helmet?

Although New Jersey law only requires children under 14 to wear bike helmets, many other areas in the U.S. require cyclists of all ages to wear them. Countless studies have shown that properly worn helmets provide significant protection in bike accidents.

A good helmet…

• Fits well to ensure stability. It doesn’t matter whether the helmet is cheap or expensive – a snug, comfortable fit is most important.
• Adjusts easily.
• Maintains the adjustments once they are made.
• Provides comfort, including ventilation.
• Is fashionable and unobtrusive to the wearer.
• Is light colored (preferably) to ensure visibility at night.
• Is smooth and round on the outside to prevent snagging in a crash.
• Is durable and easily cleaned.

What precautions can I take to ride safely on the road?
 

• Ride on the right side of the road (with traffic).
• Follow the same laws that regulate motorists.
• Ride predictably (use hand signals, stop at stop signs, don’t swerve, etc.). Avoid weaving between parked cars.
• Be visible (wear light colored and reflective clothing).
• Ride at least 3 feet from parked cars to avoid getting “doored.”
• Use headlights at night.
• Go slowly where there are pedestrians, yield to them, and give them audible warning when you pass.
• Get a horn or bell to warn cars and pedestrians who might not know you’re coming. If you don’t have either of these warning devices, just yell.

How can I ensure my bike doesn’t get stolen?

First of all, you should register your bike with the Department of Public Safety to lower the risk of theft and increase the chance of recovering a stolen bike. The Department of Public Safety also sells U-locks, heavy-duty locks that are virtually impossible to break open. Although this kind of lock is slightly more expensive than others, it will last you a long time, and will ensure the safety of your bike. If you have components and accessories for your bike that cannot be secured by the U-lock (e.g. quick-release wheels), use a cable lock in addition. Don’t lock your bike to itself (front wheel locked to frame) because someone who wants to move your bike can easily lift it and carry it away. It’s best to lock the frame directly to a bike rack or other immovable object. It also helps to leave your bike among others because thieves will most likely target the least secure bike. If your bike and components are secured with a sturdy lock, a vandal will pass over your bike and pick an easier target.

Any tips for riding in the rain?

You should be more cautious when it’s wet outside because water on the rims of your wheels will lubricate the brake system, making it harder to stop. Remember that roads will be slick during the first minutes of rainfall because oil that has accumulated on the pavement will rise to the surface of the water. To keep your bike in good riding condition, you should oil the chain before rain to prevent rust, and after wet weather to replace lube that washed off. [top]