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Defining Female Athlete Triad

Sports and exercise have become a routine practice among both sexes. Exercise is necessary for a healthy and fulfilling lifestyle, which is a primary goal for most people. However, in every field, there is an excess, which leads to overtraining among athletes.

Overtraining is defined as an imbalance between exercise and rest, occurring when athletes are subjected to an intensive training load without adequate rest and recovery. In addition to the physical effects, the overtraining syndrome manifests in simultaneous negative changes in the athlete’s psychosocial environment. Hence, repeated physical exercises stimulate the metabolism and improve physical performance; yet long-lasting exercises may result in overtraining, with decreased performance and disturbances in organ functions. Athletes are suffering from overtraining typically display irritation, carelessness, sleep disturbance, and frequent infections.

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Overtraining is an imbalance between exercise and rest in athletes that have intense programs. Even more severe is the Female Athlete Triad, which is a mixture of overtraining and under eating.

Female Athlete Triad is a damaging combination of overtraining and under eating. It is common knowledge that exercise offers many benefits such as increased strength and endurance of skeletal muscles and the cardiovascular system. Exercise has also been shown to improve self-esteem, self-confidence, self-discipline, and to build character. However, too much exercise can easily turn into overtraining, which will diminish the benefits and cause serious life-long ailments such as osteoporosis, arthritis, and autoimmune diseases. For women, a group of disorders may materialize that are collectively known as the Female Athlete Triad.



The Female Athlete Triad is a combination of severe athlete overtraining characterized by a compulsive need to exercise and shocking under eating. The female athlete is using up a lot of energy in training but refuses to eat accordingly, mainly due to other psychological aspects. Some of the signs, symptoms, and causes are as follows;

  • Symptoms
  1. disordered eating.
  2. Osteoporosis (loss of bone strength)
  3. Amenorrhea (loss of menstrual cycle).

Men can also suffer from similar disorders with the exception of the latter.

  • The Cause

These problems are caused by a strong desire to conform to standards of either appearance or performance, often unrealistic. This may cause the person to become obsessive/compulsive about exercise (in any form) or eat in an unhealthy manner (eating far too few calories and/or purging).

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  • Signs

Signs of overtraining, and FAT, will be exhibited in varying degrees depending on the extremity at which the person trains. Some of the most obvious signs are stress fractures and other overuse injuries. Less obvious signs include: Simple fatigue, prolonged weakness, chronic soreness, loss of body weight, insomnia, anorexia, depression, disordered eating, flu-like symptoms, frequent minor infections, under performance, excessive fatigue, amenorrhea, osteoporosis, or obsessive/compulsive behavior with exercise.

The athlete suffering from FAT will notice reduced body weight, anorexia, depressions, and flue like symptoms. The over-eating means that the female athlete does not have enough nutrients to use in the production of hormones meaning that they will miss their periods often. The lack of estrogen in the body will cause problems such as osteoporosis as the hormone is responsible for calcium deposition in bones.

Some athletes see amenorrhea (the absence of menstrual periods) as a sign of successful training. Others see it as a great answer to a monthly inconvenience. Also, some young women accept it blindly, not stopping to think of the consequences. However, missing your menstrual periods is often a sign of decreased estrogen levels. In addition, lower levels can lead to osteoporosis, a disease in which your bones become brittle and more likely to break.

Usually, bones become brittle and break when women are much older, but some young women, especially those who exercise so much that their periods stop, develop brittle bones, and may start to have fractures at a very early age. Some 20-year-old female athletes have been said to have the bones of an 80-year-old woman. Even if bones do not break when you are young, low estrogen levels during the peak years of bone building, the preteen and teen years, can affect bone density for the rest of your life. And studies show that bone growth lost during these years may not ever be regained.

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Treatment of Hyponatremia

Fatal hyponatremia is becoming a serious problem especially for serious athletes who are involved in intensive training. It has common in marathon runners and military recruits, as well as, anyone else in intensive training.

Fatal hyponatremia in athletes is rare, but it has claimed the lives of marathon runners and military recruits, and should therefore be brought to the attention of sports/health professionals. However, it is clear from epidemiological (population) data that hyponatremia associated with prolonged exercise is quite rare. It is very important to keep the risk of ‘overhydration’ in perspective. For example, one study of ‘higher risk’ athletes who developed symptomatic hyponatremia were participating in distance running events of 42 km and triathlons lasting 9–12 h. In these events, symptomatic hyponatremia still only occurred in 0.1–4% of the participants.

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Luckily, severe hyponatremia is quite rare but that does little to eliminate the seriousness of the ailment. It manifests in two types; acute and severe intoxication.

Acute and Chronic Water Intoxication

In acute water intoxication, blood sodium levels drop under 130 mmol/L within 48 hours, and in chronic water intoxication in more than 48 hours.

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Chronic water intoxication involves extremely low levels of sodium; under 130mmol/ L in more than 48 hours. Studies have shown that intake of excess water is a primary factor in hyponatremia.

Excessive drinking is a key risk factor for hyponatremia, and this risk can be reduced by making certain that fluid intake does not exceed sweat loss and by ingesting sodium containing beverages or foods to help replace the sodium lost in sweat. As a safeguard, athletes can include sodium containing sports drinks for exercise lasting more than 1-2 hours, especially during activity in the heat when sweat losses are greatest. Sports drinks are also beneficial by means of supplying carbohydrates when muscle fuel stores may run low during intense training or competition lasting more than 1-2 hours.

It is advised that athletes should intake sports drinks with sodium for exercises lasting more than two hours. Sodium is an important electrolyte in the human body especially because the mineral is an important component of neurotransmission.



The electrolyte sodium is very important in hydration and electrolyte status. The Latin word for sodium is natrium, thus the term hyponatremia for the condition where the sodium concentration in body fluids is dangerously low. The sodium concentration in extra-cellular fluid is the ratio of weight of sodium ions to weight of water. So, if I have too much water, I can just add more sodium, right? Well, it depends on where you are with respect to normal sodium content in the body. If you have too little sodium, then adding more will help you return to normal. An example many runners have experienced would be low sodium with adequate water, leading to puffiness in the hands and wrists. Taking in more sodium will correct the situation and the puffiness will go down. But if you have the right amount of sodium, adding a lot more is not good. Excess sodium can increase thirst and prompt more drinking, which is bad if you already have too much water on board (excess weight). Thus, the safest course is to drink to maintain body weight (or be a little down), and take sodium supplementation conservatively. A deficiency of water or sodium can be corrected within minutes, but correcting excesses of either one can take hours.

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Many athletes however, may prefer to drink only water, and should be aware of misleading advice to ‘always drink as much as you can’. The amount of water an athlete should drink depends on their volume of sweat and the sodium concentration of their sweat, both of which can vary depending on aerobic fitness, exercise intensity and ambient temperature.

The problem is that most athletes prefer to take a lot of water during and after their intensive exercise, a situation that may lead to overhydration. The following are the short and long-term effects of hyponatremia on the body;

Short-Term Effects on the Body Organs

  • Brain swelling (cerebral edema)
  • Lung swelling (pulmonary edema)
  • Muscle breakdown (rhabdomyolysis)

Long-Term Complications

An episode of a severe hyponatremia may leave a person with a permanent brain damage resulting in:

  • Mental retardation
  • Diabetes insipidus
  • Persistent vegetative state
  • Hearing loss
  • Cerebral palsy
  • Gait abnormality

Severe hyponatremia has been linked to problems such as cerebral palsy, hearing loss, and even diabetes insipidus. The following are some preventive and treatment steps that athletes can take to monitor their health;

  • Weight in and weight out – make it a habit to weight yourself before pursuing any exhaustive activity. The target is to match the amount of weight loss due to sweat with an equivalent volume of fluid right after the exercise. The rule of thumb for these events is to drink at least 20 ounces of fluids, preferably with electrolytes, within several hours after each training session and, most importantly, after the event.
  • Keep drinking tabs – it is important that we keep track of our fluid intake, regardless if it is during training or during the event. Keeping track will help us understand our drinking patterns, which, in turn, will help us, determine the correct amount of fluid we should take. One important fact to note, sports drinks count as water and should be taken into consideration when tracking fluid intake.
  • Eat salt – not literally of course, but a steady intake of salty food while training will keep your sodium levels in check and prevent water retention.
  • Rest – beginners should take advantage of any rest stop available. Especially in high temperatures, endurance athletes should take a rest and let cool their body down.
  • Sip It – Never gulp down any fluid during or after an exercise, always take fast, short sips to slowly cool down the body and prevent accidental water intoxication. Gulping in too much at a time will prevent the body from absorbing the fluid and will result in excessive water in our system.

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Some of the Most Common Sport’s Injuries

Sport is an interesting hobby, interest, and profession. It is filled with a lot of energy, sweat, and adrenaline, which make sporting activities intriguing. Such large amounts of adrenaline have made sports a frequent injury zone.

Anytime you step out onto the field of play, whatever the sport or exercise and regardless of location, you always run the risk of some sort of injury. However remote that possibility is at any given moment that repeated wear and tear on your body eventually adds up, leading to excessive stress on the muscles and joints that lead to injury. In general, listen to your body, and do your best to distinguish good pain (general fatigue) from the bad (jolting or dull pains, excessive fatigue). Struggling to do those, last couple reps might seem like a good idea in the short term, but it could ruin your progress in the long run with a damaging and lingering injury.

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Sports activities will at one point lead to injury mainly due to stress on the muscles and joints that will result in injury. For example, American football, gymnastics, and cheerleading are common sports activities that result into various injuries.

1.Common Football Injuries

  • Overuse Injuries – Lower back or overall back pain is a common complaint in Football (American) players due to overuse. Often a leading cause is overtraining syndrome. This is when a player trains beyond the ability for the body to easily recover. Knee pain is another problem that football players complain of; this can usually be dealt with by a quadriceps strengthening program.
  • Concussions – One of the most common injuries in Football (American). A concussion occurs due to a traumatic impact. Some signs of concussion are; a headache, dizziness, nausea, drowsiness, loss of balance, numbness, blurry vision, and difficulty concentrating. Concussions can be a severe injury if you think you may have suffered from one seek medical care immediately.
  • Heat Injuries – With the start of training camp, this is a large concern. Most often occurs with the intense physical activities associated with long outdoor training sessions in the height of summer. Sweating depletes the body of salt and water. Some of the symptoms you may note are cramping, if not treated with simple body cooling and fluids you can suffer from heat stroke or heat exhaustion, which can if untreated lead to death.
  • Traumatic Injuries – Knee injuries in football are the most common, especially those to the anterior or posterior cruciate ligament (ACL/PCL) and the menisci (cartilage of the knee). These knee injuries can adversely affect a player’s long-term involvement in the sport. Football players also have a higher chance of ankle sprains due to the surfaces played on and cutting motions. Shoulder injuries are also quite common, and the labrum (cartilage bumper surrounding the socket part of the shoulder) is particularly susceptible to injury, especially in offensive and defensive linemen. In addition, injuries to the acromioclavicular joint (ACJ) or shoulder are seen in football players.


2.Common Gymnastics Injuries

  • Labral tears – (sometimes called SLAP tears) may occur during any gymnastic exercise, but the ring and bar specialists seem particularly vulnerable. It is characterized by pain that initially resolves but tends to recur with a return to sport. An MRI can be helpful in establishing a definitive diagnosis.
  • Wrist Injuries – The wrist is subjected to forces that can exceed twice the body weight. The first step in treating wrist pain is to reduce the training volume of the athlete, relieve symptoms, and to participate in only pain-free activities. After an injury, gymnasts should avoid considerable pressure on the wrist joint for six weeks. If the gymnast is experiencing pain with non-gymnastic activities of daily living, using a brace or cast to immobilize the wrist temporarily may be helpful.
  • ACL injuries – can result when a gymnast lands “short” or is over-rotated while tumbling, dismounting, or vaulting. A “pop” may be heard or felt followed by knee swelling for hours. MRI is often used to confirm ACL injury. As with other sports, ACL reconstruction is recommended for gymnasts who wish to return to full sports participation.
  • Achilles Tendons – Gymnasts, can suffer from a variety of injuries to the Achilles tendon located just above the back of the heel, as a result of the repetitive stress of jumping and landing. Achilles tendinitis occurs in calf soreness that is aggravated with jumping and landing. Treatment should initially consist of ultrasound, stretching, activity modification, and calf exercises. Foot immobilization for seven to ten days may be beneficial for severe symptoms.
  • Foot & Ankle – Injuries to the foot and ankle are common in gymnastics. Acute injuries are usually sprains, which can be minor or more serious. Swelling, bruising and tenderness directly over the bones are signs of a more serious injury. Minor injuries typically have tenderness limited to one side of the joint without significant swelling. Serious injuries require evaluation by a qualified professional while a return to participation after a minor injury is often possible within a week if there is no pain (or limping) with weight bearing activity. Protection with taping or a brace can aid recovery and reduce the risk for re-injury. Chronic ankle pain or repeated injuries are worrisome and require evaluation before continuing with participation.
  • Muscle Strain – The cause of low-back pain can include muscle strain, ligament sprain, fracture, and/or disc disorders. Frequently, the low-back pain will worsen with activity, especially with extension movements, such as arching the shoulders backward. Low-back pain in gymnasts related to muscular strain or ligament sprain usually responds to rest and physical therapy exercises. Persistent back pain is uncommon and should not be ignored. An MRI or a bone scan is often helpful to rule out injuries that are more significant.

3.Common Cheerleading Injuries

One study estimates that cheerleading led to 28,000 emergency room visits in 2009 (the latest year for data). While not as frequent as injuries in other sports, cheerleading injuries tend to be more severe, making up more than half of the catastrophic injuries in female athletes. Cheerleading injuries affect all areas of the body — most commonly the wrists, shoulders, ankles, head, and neck.

Cheerleading Injury Prevention Tips:

  • Stunt restrictions – In an attempt to curb the amount of catastrophic injuries in cheerleading, restrictions have been placed on stunts. They range from height restrictions in human pyramids to the thrower-flyer ratio, to the number of spotters that must be present for each person lifted above shoulder level.Basket toss stunts in which a cheerleader is thrown into the air (sometimes as high as 20 feet) are only allowed to have four throwers. The person being tossed (flyer) is not allowed to drop the head below a horizontal plane with the torso. One of the throwers must remain behind the flyer at all times during the toss.Mats should be used during practice sessions and as much as possible during competitions. Cheerleaders should not attempt a stunt if they are tired, injured, or ill, as this may disrupt their focus and cause the stunt to be performed in an unsafe manner.
  • Training – The importance of a qualified coach is also critical. Coaching certification is encouraged. Precautions should always be taken during inclement weather for all stunts. In addition, a stunt should not be attempted without proper training, and not until the cheerleader is confident and comfortable with performing the stunt. Supervision should be provided at all times during stunt routines.