Matzkin also highlighted the concerns over the Female Athlete Triad (FAT)/Relative Energy Deficit in Sport (RED-S). The Female Athlete Triad is a syndrome resulting from the combination of eating disorders (or low energy availability), amenorrhoea/oligomenorrhea and decreased bone mineral density (osteoporosis and osteopenia).
She explained that about 20 years after Title IX, which really opened the doors for female athletes, a group of physicians started to notice this triad of symptoms in female athletes that come in to be treated for stress fractures.
According to statistics she shared, about 36% of high school female athletes have low energy availability and 54% have menstrual dysfunction. Low energy availability is highest in ballet dancers and endurance athletes.
Matzkin added that 90% of our bone mineral density (BMD) is accrued by the age of 20 so these years are crucial when it comes to bone growth. A normal female gains 2% bone mass per year while an amenorrheic female loses 2% bone mass per year. And if they don’t have adequate BMD accrued, they will struggle with osteoporosis and stress fractures later in life.
The concern, Matzkin said, is that these stress fractures can be prevented so we need to ask our female athletes about nutrition and their menstruation, if they are of age, and we need to educate our parents, our athletes and our athletic trainers, coaches and everyone involved in our female athlete’s care.
Recently there has been a call to rename it to Relative Energy Deficit in Sport to include the effects of low energy availability and decreased bone mineral density on male athletes as well.
The Money Problem
More money, more problems? The second set of new data that was revealed during the webcast suggests a crucial role socioeconomic factors may play in overuse injuries.
The study, “Socioeconomic Factors for Sports Specialization and Injury in Young Athletes” was published in the July issue of Sports Health: A Multidisciplinary Approach.
Lead author, Neeru Jayanthi, M,D,, associate professor, Orthopedics and Family Medicine, Emory University School of Medicine, director, Emory Sports Medicine Research and Education, director, Emory’s Tennis Medicine Program and colleagues enrolled injured athletes aged 7 to 18 from two hospital-based sports medicine clinics in the Chicago area and compared them with uninjured athletes undergoing sports physicals between 2010 and 2013.
Overall, nearly 1,200 athletes were evaluated using training and injury surveys and electronic medical records to determine injury type.
According to the data they collected, 96% of the athletes had satisfactory socioeconomic (SES) data. Compared with low-SES athletes, high-SES athletes reported more hours per week spent playing organized sports (11.2 ± 6.0 vs 10.0 ± 6.5; p = 0.02), trained more months per year in their main sport (9.7 ± 3.1 vs. 7.6 ± 3.7; p < 0.01), were more often highly specialized (38.9% vs. 16.6%; p < 0.01), and had increased participation in individual sports (64.8% vs 40.0%; p < 0.01).
In addition, they found that the proportion of athletes with a greater than 2:1 ratio of weekly hours in organized sports to free play increased with SES and the odds of reporting a serious overuse injury increased with SES (OR, 1.5; p < 0.01).
Jayanthi said, “High socioeconomic status (SES) athletes reported more serious overuse injuries than low SES athletes, potentially due to higher rates of sports specialization, more weekly hours in organized sports, less frequent opportunities for free play, and greater participation in individual sports.”
“We think it is possible that injury risk happens not just from how much you play, but rather how you spend that time. Unorganized free play may potentially be protective of overuse injury. We believe that this allows an environment where the child can be self-directed.”
According to Jayanthi, prior research defined specialization to be intense year-round and more than eight months training in a single, main sport at the exclusion of others; and the risk that comes from that level of specialization participation.
Prior studies, he said, also suggest that adolescent females may be at highest risk for overuse injuries, especially in individual sports like tennis and dance.
