Heat Stress
Any child or adolescent should avoid or limit exercise, sport participation, or other physical activity in the heat if he/she is currently ill or recovering from an illness, especially those involving ___ and/or ____
GI distress (e.g. vomiting, diarrhea) and/or fever
The female athlete triad was first widely known as 3 interrelated conditions in 1997 by the American College of Sports Medicine which was revised to have a more inclusive definition
Menstrual function, BMD (bone mineral density), and Energy Availability
Most commonly injured structure as a direct lateral force to the knee i.e. clipping in football
Medial collateral ligament
3 most commonly used performance enhancing substance by adolescents
protein supplements, creatine, and caffeine
12 y/o F with right hip pain after PE
Slipped Capital Femoral Epiphysis
A spectrum of clinical conditions that range from muscle (heat) cramps, heat syncope, and heat exhaustion to life-threatening heat stroke incurred as a result of exercise or other physical activity in the heat
Exertional heat illness
Although triad disorders occur in any sports, name 3 sports that are at increased risk
Wrestling, light-weight rowing, gymnastics, dance, figuring skating, cheerleading, long and middle distance running, pole vaulting
This test the integrity of the ACL. Patient is in supine position and the injured knee is flexed to 30 degrees with one hand stabilizing the distal femur and the other hand grasping the proximal tibia and then attempting to sublux the tibia anteriorly
Lachman Test
Enhances net protein synthesis by increasing transcription and decreasing catabolism. It increases strength and lean muscle mass
SE: premature physeal closure, decrease adult height, acne, gynecomastia (irreversible), hair loss/male pattern baldness (irreversible). Dependence. Hypogonadism. Behavioral change (hypomania, irritability, and aggression). Cardiomyopathy, etc
Anabolic agents (steroids)
14 y/o M with recent trauma to the finger
Salter-Harris Type II
Severe multisystem heat illness characterized by CNS abnormalities i.e. delirium, convulsion, or coma, endotoxemia, circulatory failure, temperature control dysregulation, and potentially organ and tissue damage resulting in core body temp (>104F or >40 C) induced by strenuous exercise or other physical activity and typically (not always) high environmental heat stress
Exertional heat stroke
This is defined as daily dietary energy intake minus daily exercise energy expenditure corrected for fat-free mass
Energy Availability
-Optimal EA has been identified to be 45 kcal/kg FFM/day for female adults (higher in adolescents) --Many athletes affected by triad do not exhibit pathologic eating behaviors and low EA is unintentional.
-Low EA adversely affects bone remodeling, disrupts menstrual function, and bone mineralization
Teenage boy with waxing and waning anterior knee pain for months worsening with squatting, walking up and down stairs.
PE: tibial tuberosity with tenderness, knee pain with resisted active extension or passive hyperflexion of knee
Tibial apophysitis "Osgood Schlatter"
Delays onset of muscle fatigue during high intensity training by ATP production in high intensity activities that rely upon phosphocreatine shuttle
SE: potential impact on kidneys
Creatine
4 y/o M with hx of fall while playing
Greenstick fracture
S/sx that are sufficient reasons to immediately stop participation and seek appropriate medical attention
Deterioration in performance i.e notable signs of struggling, negative changes in personality or mental status, or other concerning clinical markers of well-being such as pallor, bright-red flushing, dizziness, headache, excessive fatigue, vomiting, complaints of being extremely cold or hot
Criteria for performing DXA to measure BMD in athletes
Menstrual dysfunction or low EA (<45 kcal/kg FFM/day) for 6 months or more and/or hx of stress or insufficiency fractures
Overweight male with poorly localized knee pain and no hx of knee trauma
PE: affected hip is slightly flexed and externally rotated. Knee exam is normal. Hip pain with passive internal rotation or extension of affected hip
Slipped capital femoral epiphysis
Acts through IGF-1 resulting in increases in lean mass, decreases in fat mass
SE: elevated plasma glucose resistance, sodium retention and edema, myalgia/arthralgia, benign intracranial hypertension, acromegaly, cardiovascular disease, gynecomastia
human growth hormone
15 y/o football player with low back pain
Spondylolysis
Immediate management of a child/adolescent who collapses or exhibits moderate or severe CNS dysfunction during or after practice, competition, or other physical activity in heat
Activate EMS
On-site whole body cooling involves moving victim to shade, removing protective equipment and clothing, and cooling by cold or ice-water immersion or applying ice packs to neck, axillae, and groin and rotating ice-water soaked towels to all areas of body
If able, fluid hydration
Adequate intake of Calcium and Vitamin D important role in bone mass accrual for all adolescents
Calcium 1300 mg/day and Vitamin D 600 IU/day
A history of locking episodes suggests
Meniscal tear
Use of recombinant EPO and synthetic analogs which increase oxygen delivery to exercising muscles
SE: hyperviscosity-> thrombogenic or embolic
Blood doping
12 y/o F gymnast with back pain
Spondylolisthesis