Warren B. Howe

Does gymnastics training inhibit growth of females

ObjectiveThe increasingly dominant performance of smaller-sized female gymnasts and increased magnitude of training beginning at an early age have prompted public and medical concerns, especially from an auxological perspective. The objective of this review is to determine if gymnastics training inhibits growth of females. Data SourcesAn extensive research of MedLine (PubMed interface) along with cross-referencing was conducted using the Text and MeSH words “gymnastics” in combination with “growth,” “maturation,” “body height,” “body weight,” and “growth plate.” Our analysis is limited to English articles only. Study SelectionAll published studies that included data related to the research questions were included. Main ResultsAlthough data from three historical cohort studies indicate that female gymnasts are short even before they begin training, clinical reports and cohort studies do suggest that some female gymnasts experience attenuated growth during training followed by catch-up growth during periods of reduced training or retirement. There is conflicting evidence whether the “catch-up” is complete. There were no studies reporting prevalence or incidence of inadequate growth. Three cohort studies provide evidence of reduced growth but training was not partitioned from other confounding factors in the gymnastics environment. Although there is a paucity of studies examining the link of dietary practices with diminished growth in female gymnasts, a review of related dietary literature indicates the potential for insufficient energy and nutrient intake among female gymnasts. ConclusionsElite level or heavily involved female gymnasts may experience attenuated growth during their years of training and competition followed by catch-up growth during reduced training schedules or the months following retirement. However, a cause–effect relation between gymnastics training and inadequate growth of females has not been demonstrated.

A three-year epidemiological study of injuries affecting young female gymnasts

Abstract Objectives . The purpose of this study was to determine the rate and distribution of injuries affecting beginning- and advanced-level competitive female gymnasts over a three-year period. Of particular interest, was the comparison of risk and severity of injury among these groups during training and competition. Design . Prospective cohort. Setting . Regional university and community-based gymnastics club in the Pacific Northwest. Participants . Seventy nine female artistic gymnasts, ages 7–18 years, representing USA Gymnastics competitive levels 4–10. Main outcome measures . Injury incidence. A log-linear model was used to estimate the relative risk (RR) of injury in competition versus training and among beginning versus advanced level gymnasts. Chi square analysis using Fishers exact test was used to compare the distribution of injuries by event, anatomical location, type and time loss. Results . During the study, 60 of 79 gymnasts sustained 192 injuries while 19 gymnasts remained injury-free. The overall injury rate was 2.5 injuries/1000h. The RR of injury during competition relative to practice was 2.69 (95% CI: 1.53, 4.75; p ≤0.001). This was mostly driven by the advanced group; when stratified by competition level and compared to all practice injuries, the RR of injury during competition was 0.47 (95% CI: 0.07, 3.42) for the beginning group, and 4.34 (95% CI: 2.39, 7.88; p =0.035) for the advanced group. Chi square analyses showed a variant injury distribution for injury location, event, and time loss depending on competitive group and whether injury occurred during practice or competition. Notably, a greater proportion of severe injuries, as measured by time loss, affected advanced- than beginning-level gymnasts (Fishers exact p -value=0.003) and occurred in competition relative to practice (Fishers exact p -value=0.007). Conclusions . The findings of this study suggest that advanced-level competitive female gymnasts experience a higher risk and severity of injury compared to their beginning-level counterparts, especially during competition.

Preventing infectious disease in sports.

Preventing infectious disease in sports is fundamental to maintaining team effectiveness and helping individual athletes avoid the adverse effects of illness. Good general hygiene practices, immunization, efforts to minimize exposure to specific diseases, and certain prophylactic measures are essential. Teammates, coaches, athletic trainers, officials, and healthcare providers should actively participate in these preventive efforts, and community public health resources may be involved when appropriate. In addition to treating individual athletes, the team physicians role is to increase awareness, vigilance, and compliance with procedures to prevent the spread of disease.

Pinning down skin infections: diagnosis, treatment, and prevention in wrestlers.

Wrestling fosters skin infections such as herpes simplex, tinea corporis, and impetigo. Visual examination often suggests the diagnosis, but some lesions, like late-stage herpes, can mimic other conditions, like impetigo; laboratory studies therefore may be required. Drug therapy can mitigate an infection and help prevent recurrence. In addition, physicians must know when to disqualify a wrestler and how to prevent an outbreak through measures like good hygiene and immediate diagnosis.

Does training affect growth? Answers to common questions

IN BRIEF: Adolescent athletes may be at risk of restricted growth and delayed maturation when intense training is combined with insufficient energy intake. Because catch-up growth commonly occurs when training is reduced or ceases, final adult stature is unlikely to be compromised. However, in athletes who have long-term, clinically delayed maturation, catch-up growth may be incomplete. By charting individual growth patterns, physicians, coaches, and athletic trainers can detect vulnerable periods when the training intensity should be reduced and energy intake may need to be increased.

Ankle Sprains: Expedient Assessment and Management

Most ankle injuries occur from excessive inversion, but it is important to be able to differentiate a simple inversion sprain from a potentially disabling injury. Expedient diagnosis includes first screening for deformities and then performing specific tests like the anterior drawer and side-to-side test. To optimize assessment, the examiner needs to take advantage of the preswelling period on the sidelines. Physicians can treat most ankle injuries nonoperatively, taking steps to ensure a quick return to play. Fracture signs and treatment are covered in a comprehensive table.

Emergency Removal of Football Helmets

In brief when a football player has a brief suspected head or neck injury, when and how to remove the football helmet become critical issues. Protocols differ; however, the National Collegiate Athletic Association guidelines, which state that the helmet should only be removed on the field under very special circumstances, are appropriate. An understanding of the technologically advanced design and tight fit of modern football helmets will help guide medical personnel through each step of the helmet removal process.

Acute knee injuries: when to refer.

Primary care physicians are being called on more frequently to treat patients who have musculoskeletal injuries. This article discusses mechanisms of injury, diagnosis, and treatment, with emphasis on determining when to refer patients to an orthopedist. Discussed here are several types of knee injuries that require referral, including extensor mechanism injuries, most subluxations and dislocations, ligament injuries, and meniscus injuries.

Posterior sternoclavicular joint dislocation.

Posterior sternoclavicular (SC) joint dislocations are rare but can have serious complications, such as hemorrhage or tracheal rupture or compression. Described here is the case of a 21-year-old college football player who fell on his right shoulder and, on the basis of a physical exam and plain radiographs, was first diagnosed as having an apophyseal injury of the SC joint. Increased shoulder and throat pain led to further evaluation; a CT scan revealed a posterior SC joint dislocation. Knowing the signs and symptoms that characterize these dislocations, the role of CT in diagnosis, and the techniques of emergency reduction can prevent or minimize serious complications.

When anxiety attacks: Treating hyperventilation and panic

The athlete who panics or hyperventilates requires immediate stabilization and assessment to rule out more serious diagnoses. Repeated attacks may indicate panic disorder, which can be treated effectively with a combination of psychological and pharmacologic therapy. Drug options include selective serotonin reuptake inhibitors, benzodiazepines, tricyclic antidepressants, and monoamine oxidase inhibitors.