Pain Is Not Gain: Injuries from training
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Transcript of Pain Is Not Gain: Injuries from training
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Overuse, Overtraining, and the Female Athlete Triad
John Cissik, MS, CSCS, NSCA-CPT, NASM-CPT, CES
Human Performance Services, LLC
Pain is Not Gain
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Overview
• Exercise has many benefits, including:– Weight control, cardio-vascular health,
increased strength/endurance/flexibility, protection from many diseases, improved performance in sports, etc.
• Exercise can be harmful, however:– Overtraining– Overuse Injuries– Female Athlete Triad
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Overtraining Syndrome
• Is it real?• What is it?
– Inability to adapt to exercise demands leading to accumulated fatigue and a performance decrease. To be overtraining it must affect performance (Uusitalo, A.L.T., 2001; Smith, L.L., 2000).
– Not all aspects of performance are affected simultaneously nor are they impacted to the same degree, making diagnosis difficult (Smith, L.L., 2000).
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Effects of Overtraining
• Psychological problems such as:– Anger
– Fatigue
– Tension
– Sleep problems
– Depression
• Physical problems:– Long-term soreness
– Injury
– Decreased testosterone levels
– Increased cortisol levels
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More Symptoms of Overtraining (Smith, L.L., 2000).
• Physiological performance:– Mineral depletion
– Increased urea concentrations
– Loss of coordination
– Abnormal T wave pattern in ECG
• Psychological– Depression
– Apathy
– Emotional instability
– Fear of competition
• Immunological– Flu-like illness
– Slow healing of minor scratches
– One-day colds
– Bacterial infection
• Biochemical– Negative nitrogen balance
– Hypothalamic dysfunction
– Decreased muscle glycogen
– Decreased bone mineral content
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Causes of Overtraining: Simple
• Insufficient recovery
• Lack of sleep
• Inadequate nutrition
• A combination of all the above
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Causes of Overtraining: Complex
• Adaptive Microtrauma
• Local Acute Inflammation
• Local Chronic Inflammation
• Systemic Inflammation/Inflammatory Response
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Adaptive Microtrauma
• Result of “normal” exercise-induced injury• Microtrauma to muscle, connective tissue,
bones, and joints as a result of exercise• Caused by eccentric exercise, pockets of
ischemia due to energy demands, and joint loading
• Normally results in an “overshoot” phenomena
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AMT, cont.
• Exercise-induced musculoskeletal trauma results in the release of cytokines to help with inflammation
• Cytokines: soluble hormone-like proteins
• May be pro- or anti-inflammatory
• Include interlukins, interferons, tumor necrosis factor, growth factor, and chemokines
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Local Acute Inflammation
• With continued stimulus, AMT becomes a local acute inflammation as body attempts to heal
• Fluid, plasma protein, and leukocytes circulate into injured tissue
• Neutrophils begin cleaning up the damaged tissue
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Local Chronic Inflammation
• With continued exercise stimulus, acute becomes chronic inflammation.
• Circulating monocytes and macrophages become involved to help repair damage
• Cytokines are helping to mediate all the immune system activity
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Systemic Immune/Inflammatory Response
• At this phase pro-inflammatory cytokines have begun to act on the liver and hypothalamus to help produce proteins, regulate temperature, and affect mood (defense mechanisms)
• Anti-inflammatory cytokines have begun to act on hypothalamic-pituitary-adrenal axis to release cortisol and suppress testosterone
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How to Prevent Overtraining
• Get enough recovery:– Sleep– Massage– Sauna/Jacuzzi
• Nutrition!
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Rest and Restoration
• Rest: sleep, frequency of training
• Restoration: – Nutrition
– Psycho-Regulatory Training
• Meditation
• Mental Imagery
• Relaxation
• Restoration, cont.– Modalities
• Sauna
• Water Therapies
• Contrasting immersion baths (5 minutes each)
• Massage
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Overuse Injuries
• Essentially two types:– Inflammation– Tissue degeneration
• To be overuse: gradual onset; acute onset usually represents more serious injury (fracture)
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Overuse Injuries: Signs and Symptoms
• Pain that is aggravated by activity and relieved by rest.
• Stiffness
• Decreased range of motion
• Weakness
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Overuse Injuries: Examples
• Stress Fracture– Typically from
changing training
– Equipment (running shoes)
– Surfaces (concrete)
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Overuse Injuries: More Examples
• Shin splints– From changing training
(increased volume)
– Equipment
– Technique
– Surfaces
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Overuse Injuries: Treatment
• REST!!! (most important)
• Ice
• NSAIDs
• Address technique problems
• Address equipment/surface problems
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Overuse Injuries: Causes
• Sudden increase in training volume
• Equipment (especially shoes)
• Exercise surface (e.g. running on concrete, basketball court)
• Technique
• Insufficient rest
• Inadequate nutrition
• Combination of the above
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Overuse Injuries: Prevention
• Don’t increase training volume by more than 10%
• Insure you are using the proper equipment
• Don’t exercise on surfaces that cause or aggravate pain
• Get enough sleep
• Get proper nutrition
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Female Athlete Triad
• Disordered eating
• +
• Amenorrhea
• +
• Osteoporosis
• =
• Female Athlete Triad
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Disordered Eating
• Primarily anorexia nervosa and bulimia nervosa• 15-62 percent of college athletes demonstrate
disordered eating (Hobart, J.A. & D.R. Smucker, 2000; Smith, A.G., 1996)
• Problems associated with include: menstral dysfunction, disturbances of CV, endocrine, and GI systems, problems regulating temperature, psychological problems, irreversible bone loss, death (American Academy of Pediatrics, 2000)
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Amenorrhea
• Amenorrhea is prevalent in 3.4% to 66% of athletes (depending upon sport) compared with 2-5% in general population (American Academy of Pediatrics, 2000; Smith, A.D., 1996)
• Associated with decreased serum estrogen levels, leading to decreased bone mass and increased cardiac risk
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Osteoporosis
• Loss of bone mineral density and the inadequate formation of bone
• Increased bone fragility and risk of fracture
• Loss may be irreplaceable
• Relationship between amenorrhea and osteoporosis in adolescents and young women
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Female Athlete Triad: Treatment
• Cutting back on training volume
• Getting professional help
• Rest and recovery
• Hormone replacement therapy ?
• Proper nutrition
• Calcium supplementation