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 www.revdesportiva.pt
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