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Sports and exercise medicine 

Sports and exercise medicine

Chapter:
Sports and exercise medicine
Author(s):

Roger L. Wolman

DOI:
10.1093/med/9780199204854.003.02801
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date: 30 March 2017

Physicians are increasingly confronted with medical problems related to sport.

Female athlete triad—consists of disordered eating, amenorrhoea, and osteoporosis, which are most commonly seen in those pursuing endurance sports or gymnastics. Clinical assessment includes a nutritional screen to assess calorie and calcium intake, measurement of serum tri-iodothyronine level (typically low) and of bone density, along with exclusion of other causes of amenorrhoea. The most effective treatment is to re-establish natural menstruation with a combination of reducing training intensity and increasing calorie intake, both of which the athlete may find hard to accept.

Overtraining syndrome—is characterized by performance deterioration refractory to normal regeneration strategies and often associated with loss of appetite, depression and anxiety, sleep disturbance, fatigue, upper respiratory tract infections, and a raised resting heart rate. Treatment requires rest to allow regeneration and recovery, but most athletes will only accept absolute rest for a few days, hence it is important to follow this up with a period of relative rest that allows very low intensity training after which exercise can be slowly increased, but it may take up to 12 weeks to achieve full recovery.

Medical complications in sport—these include (1) delayed-onset muscle soreness, rhabdomyolysis, and heat stroke; (2) exercise-induced gastrointestinal symptoms including reflux/heartburn, intestinal cramps, the urge to defecate, and diarrhoea (sometimes bloody); (3) exercise-related anaemia, which can be due to faecal blood loss, also intravascular haemolysis caused by high impact forces on the feet; (4) hyponatraemia—a well-recognized problem in the marathon and other endurance events; can be severe, leading to encephalopathy, pulmonary oedema, and death; primarily caused by excessive fluid intake during the event; it is vital to measure the serum sodium concentration of any collapsed or confused competitor at the end of a race.

Overuse injuries—these are the most common type of injury seen in sports medicine clinics. Diagnosis is usually relatively straightforward by history and examination, but it is important to determine the aetiological factors responsible for the injury (training methods, equipment, and biomechanical factors) to prevent recurrence.

Drugs and nutritional supplements—these are widely used in competitive sports. Anabolic agents include anabolic–androgenic steroids, human growth hormone, β‎2-agonists, and creatine. Stimulants include amphetamines, ephedrine, cocaine and caffeine. Other agents include β‎-blockers, diuretics, erythropoietin and blood doping, bicarbonate and β‎-hydoxy-β‎-methylbutyrate. Use of many of these agents is banned or restricted by sports governing bodies.

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