Revista de Medicina Desportiva (English) November 2018 - Page 8

What we are reading In this heading we intend to give news of recent articles or that deserve to be reread and commented. It will be an open page to all colleagues who wish to collaborate by describing or commenting on topics of sports medicine. Female Athlete Issues for the Team Physician: A Consensus Statement – 2017 Update 1 Dra. Helena Fernandes CUF Institute - Porto Rehabilitation Medicine and Sports Medicine Specialist Comentário e Resumo This paper is a valuable help to the doctor responsible for sportswomen because it includes the most impor- tant issues for the global approach to the musculoskeletal injuries and medical problems more prevalent that afflicts or/and are a result of sport practice. Within the scope of this project, where six north-Amer- ican organizations related to sports medicine participated, it was written and published in 2003 a consensus and now some updates were made, and that is why this text of the year 2017, and published in 2018, reflects the state of art of the specific impli- cations of the women in relation to the anterior cruciate ligament (ACL), patelofemoral pain, shoulder injury, bone injuries due to stress, concus- sion, low mineral bone density and osteoporosis, energetic intake and eating disorders, menstrual disor- ders, female athlete triad and still pregnancy and contraception. The ACL injuries caused by direct trauma have a similar frequency in both genders, mas the injuries 6 november 2018 without direct trauma are 2 t0 6 times more frequent in women than in men, and this difference become bigger after puberty. The etiology of the injuries without direct trauma can be multifactorial: environmen- tal, anatomical and hormonal, and the risk increases with changes on biomechanics and neuromuscular factors. The prevention programs of ACL injuries that include these two last factors decrease the rate of injuries. The treatment / reha- bilitation must start right after the injury, independently of an eventual programed surgery. The patelofemoral pain is fre- quent in the female athlete and is more prevalent than in the male athlete. The pain and the patelofem- oral dysfunction have a multifactorial etiology, that includes anatomical, static and dynamic deviations, inju- ries to the joint cartilage, instability and factors related to the soft tissue. There can be patelofemoral pain in the knee that looks structurally nor- mal. Besides the accurate physical examination of the knee, it is neces- sary to evaluate the kinetic chain, the pelvifemoral area, the flexibility and the posture. The rehabilitation aims the treatment the neuromus- cular control deficits, the muscle imbalances and the shortenings. The positive drop box test in the direc- tion of knee valgus and the prema- ture sports specialization are pre- dicting risk factors for patelofemoral pain in the asymptomatic athletes. The shoulder injuries are frequent in the overhead sports and the incidence of these injuries has been increasing for the last 10 years, where the most common injuries are the rotator cuff / conflict injuries, the labrum ruptures and the gleno- humeral instability. The risk factors include the overload, musculoskel- etal factors and changes on sports technic, and it is not proven that hyperlaxity is an independent risk factor. The physical examination of the shoulder includes the evaluation of the range of motion, the strength, the stability, the biceps, the integrity of the acromioclavicular joint of the cuff rotators, and still the scapula function. It is also needed the evalu- ation of the kinetic chain, includ- ing the muscle strength, flexibility, hip posture and the core. When the global rehabilitation program doesn’t ameliorate the symptoms and the function, the surgical treat- ment might be considered. The bone injuries caused by stress frequently occur in the female athlete and more often than in the men, being more common on the foot, peroneus, femur, pelvis and sacrum. The injuries occur as spec- trum, this is, they start as a stress reaction of the bone, and then stress fracture and after a total fracture. The risk factors can ben extrinsic, intrinsic, medical or psychological, and their regular identification is of paramount importance, because the bone injury can be an isolated injury or can indicate underlying medical and psychological problems. It is important to identify the bone injuries with higher risk of complica- tions and squeals. In the therapeutic plan it is important to include activ- ity modification. In sports with the same rules, brain concussion is more frequent in the female athlete and usually they report more symptoms than the male athlete. These differences between both sexes have several causes, including cultural factors, hormonal differences, biomechanical mechanisms and muscle strength in the cervical spine. All the athletes must be tracked for low energetic intake, disorder eating, menstrual dysfunction and low bone mineral density / osteo- porosis. The incidence of low bone mineral density and osteoporosis in the female athlete is unknown and this problem can exist in the young