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Eating Disorders in Athletes

Overview The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DMS-V), updated in 2013, and the World Health Organization’s (WHO’s) International Statistical Classification of Diseases and Related Health Problems, updated in 2019, identifies and defines the following eating disorders (EDs): anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified feeding or eating disorder (OSFED), unspecified feeding or eating disorder (UFED), and…

Drugs and Doping in Athletes

Definition According to the World Anti-Doping Agency (WADA) Code, doping is defined as the occurrence of one or more of the following antidoping rule violations: The presence of a prohibited substance or its metabolites or markers in an athlete’s bodily specimen. Use or attempted use of a prohibited substance or prohibited method. Refusing, or failing without compelling justification, to submit to sample collection after notification as…

The Role of Sport Psychology and Sports Psychiatry

Introduction Athlete mental health (MH) symptoms and disorders have emerged as a major focus within athletic/sports organizations, international and national sport governing bodies, and the sports medicine environment. This focus has resulted in the development of multiple consensus statements and guidelines regarding MH issues in athletes and articles aimed at increasing awareness and reducing stigma. The sport psychology and sports psychiatry fields have been leaders in…

Travel Considerations for the Athlete and Sports Medical Team

General Principles Modern transportation systems facilitate easy access to most regions of the world. Although this has allowed for the rapid growth of international competition, it also creates unique physiologic and psychological challenges for athletes as well as the sports medicine team. Jet Lag and Chronobiology The American Academy of Sleep Medicine defines jet lag as a syndrome involving insomnia or excessive daytime sleepiness after travel…

Altitude Training and Competition

Acknowledgment The authors would like to acknowledge James Stray-Gundersen, MD, for his major contributions to the previous editions of this chapter. Altitude Environment Barometric pressure is reduced at high altitudes, with a parallel decrease in inspired partial pressure of oxygen (P I O 2 ); thus, hypobaric hypoxia is the most prominent physiologic manifestation at high altitudes. Fig. 23.1 shows the accepted terminology for the range…

Exercise in the Cold and Cold Injuries

General Principles Physiology of Cold Exposure Mechanisms of Heat Loss Radiation Radiation involves the direct emission or absorption of heat energy from the body (mostly infrared radiation). Radiation is the largest source of heat loss from the body. Clothed, sedentary individuals in a calm, temperate climate lose more body heat (approximately 60%) by radiation than active individuals (approximately 45%) in a thermoneutral environment where heat production…

Exercise in the Heat and Heat Illness

Heat Production Exercise: The Body’s Furnace Caused by the Inefficiency of Work The body utilizes energy in the form of energy-rich chemical compounds to maintain normal function ( Fig. 21.1 ) and is inefficient; most reactions produce heat. Resting Heat Production Sources of nonexercising heat production include involuntary smooth muscle contraction, myocardial contraction, muscle group contraction to maintain posture, shivering, digestion, and cellular metabolism. Heat Production…

Flexibility

General Principles The term flexibility is often used as a synonym for range of motion (ROM) around a joint. Both muscles and ligaments can limit ROM. Mobility refers to a limited ROM because of ligaments; flexibility is usually reserved to refer to limited ROM caused by the muscle–tendon unit. Flexibility depends on both muscle stiffness (force required to stretch a muscle) and the stretch tolerance of…

Resistance Training

General Principles Resistance training is the most potent form of exercise to strengthen tissues and help prevent injury and improve sports performance. Appropriately prescribed and implemented resistance training programs are necessary to achieve these goals. The size principle of motor unit recruitment demonstrates that the recruitment of motor units and their associated muscle fibers occurs in an orderly manner from low- to higher-threshold motor units, and…

Aerobic Training

Introduction In the early days of sporting events, coaches and athletes learned through trial and error that they could not simultaneously develop maximal endurance and maximal power. They found that by first establishing an aerobic endurance base and later adding faster training, they could peak at appropriate times. It was not until the 1960s that the study of exercise as a science became widespread, and gradual…

Exercise Prescription and Physiology

Exercise Physiology Science of processes and mechanisms of skeletal muscle contraction and the corresponding interaction of other body systems that facilitate and respond to skeletal muscle contraction. Skeletal muscle contraction that exceeds physiologic limits, is inappropriate in duration or intensity, or for which the musculoskeletal system has been inadequately prepared can lead to injury or poor performance and adaptation to training. Clinical relevance lies in identification…

The Wilderness Athlete and Adventurer

Introduction Wilderness sports differ from traditional sports in several ways. Participation levels of athletes may vary: professional, sponsored, and paid athletes; athletic individuals and adventurers; and intermittent recreational participants. The setting of wilderness sports is often austere, remote, and not regulated by organized bodies as traditional sports are. Participants range in age from children to older adults and seniors. Typically, there is no distinction in participation…

Care of Athletes at Different Levels: From Pee-Wee to Professional

General Considerations ( Box 15.1 ) Availability Being a team physician requires a tremendous time commitment. BOX 15.1 The Five A’S of Being an Excellent Team Physician Availability Ability Affability Advocacy Affiliation Must have a sincere desire to care for athletes and allow their expedient return to play. Ability Possess the necessary skills to accurately diagnose and appropriately treat the athlete. In addition to the team…

The Athlete With Physical Disability

General Considerations Definitions Physically challenged, physically disabled, and “disabled” athletes are terms often used to collectively refer to all groups of athletes competing in international competitions such as Paralympics and have an impairment that limits their ability to participate in athletic arenas within a manner considered “normal” for regulated sport. The impairment is not a “disability” in their selected sport, as these athletes have tremendous ability…

The Senior Athlete

General Considerations Demographics It is widely accepted that the average life expectancy continues to increase; as it does, the proportion of older adults in the population also increases. In Western industrialized countries, the average life expectancy increased from 47 years in 1900 to 78 years in 2007. The number of individuals older than 85 years has increased by 232% from 1960 to 1990, along with a…

The Female Athlete

History of Women In Sports Throughout history, women have participated in sports at much lower rates than men. Still, Egyptian temple wall illustrations depict women playing ball games in 2000 BCE. The first recorded women’s athletic competition was the Heraean Games in the sixth century BCE held in the original Olympic stadium. The women of indigenous tribes in the Americas participated in multiple sports until European…

The High School Athlete: Setting Up A High School Sports Medicine Program

Acknowledgment We would like to acknowledge Dr. Stephen G. Rice for his contributions to prior versions of this chapter. General Principles Athletic Healthcare in High-Level Collegiate and Professional Sports At the highest levels of sports, organizations are much like corporations; they function to increase success of shareholders by providing a product (i.e., winning team) linked to profitability. Although there are ethical concerns with this model, it…

The Pediatric Athlete

General Principles A pediatric athlete can be any child or adolescent usually under the age of 18 years who participates regularly in sports activities. Understanding physical and physiologic differences between pediatric and adult patients aids in the prompt recognition and management of most medical and orthopedic conditions affecting a pediatric athlete. Activity type, skill level, and motivation for sports participation greatly vary at different ages and…

Sports Pharmacology of Psychiatry and Behavioral Medicine

Introduction Optimal treatment is determined through a collaborative approach, including team physicians, psychologists, psychiatrists, athletic trainers, academic advisors, coaches, teammates, parents, and administrative staff. More institutions are promoting an integrative approach to mental health and well-being using a wide variety of interventions: Self-care: exercise, sleep, nutrition Social connections: informal groups, team activities, interest-based communities Online or self-directed tools: mental health apps, life hacks, relaxation, mindfulness Group…

Sports Pharmacology of Chronic Disease

Introduction Adults are encouraged to engage in 150 minutes of moderate-intensity exercise weekly to maintain overall health and fitness. As the US population ages, many people are actively taking or have previously taken medications that may affect exercise performance. Managing athletes and patients on medications for chronic illnesses is an important skill for sports medicine physicians to master. Lipid-Lowering Agents Statins Statins are some of the…