Presentation looks at overuse injuries as well as the female athlete triad.

1. Pain is Not Gain
Overuse, Overtraining, and the
Female Athlete Triad
John Cissik, MS, CSCS, NSCA-CPT, NASM-CPT,
CES
Human Performance Services, LLC

2. Overview
• Exercise has many benefits, including:
– Weight control, cardio-vascular health,
increased strength/endurance/flexibility,
protection from many diseases, improved
performance in sports, etc.
• Exercise can be harmful, however:
– Overtraining
– Overuse Injuries
– Female Athlete Triad

3. Overtraining Syndrome
• Is it real?
• What is it?
– Inability to adapt to exercise demands leading to
accumulated fatigue and a performance decrease. To
be overtraining it must affect performance (Uusitalo,
A.L.T., 2001; Smith, L.L., 2000).
– Not all aspects of performance are affected
simultaneously nor are they impacted to the same
degree, making diagnosis difficult (Smith, L.L., 2000).

4. Effects of Overtraining
• Psychological
problems such as:
– Anger
– Fatigue
– Tension
– Sleep problems
– Depression
• Physical problems:
– Long-term soreness
– Injury
– Decreased testosterone
levels
– Increased cortisol
levels

5. More Symptoms of Overtraining
(Smith, L.L., 2000).
• Physiological
performance:
– Mineral depletion
– Increased urea
concentrations
– Loss of coordination
– Abnormal T wave pattern
in ECG
• Psychological
– Depression
– Apathy
– Emotional instability
– Fear of competition
• Immunological
– Flu-like illness
– Slow healing of minor
scratches
– One-day colds
– Bacterial infection
• Biochemical
– Negative nitrogen balance
– Hypothalamic dysfunction
– Decreased muscle glycogen
– Decreased bone mineral
content

6. Causes of Overtraining: Simple
• Insufficient recovery
• Lack of sleep
• Inadequate nutrition
• A combination of all the above

7. Causes of Overtraining: Complex
• Adaptive Microtrauma
• Local Acute Inflammation
• Local Chronic Inflammation
• Systemic Inflammation/Inflammatory Response

8. Adaptive Microtrauma
• Result of “normal” exercise-induced injury
• Microtrauma to muscle, connective tissue,
bones, and joints as a result of exercise
• Caused by eccentric exercise, pockets of
ischemia due to energy demands, and joint
loading
• Normally results in an “overshoot”
phenomena

9. AMT, cont.
• Exercise-induced musculoskeletal trauma
results in the release of cytokines to help
with inflammation
• Cytokines: soluble hormone-like proteins
• May be pro- or anti-inflammatory
• Include interlukins, interferons, tumor
necrosis factor, growth factor, and
chemokines

10. Local Acute Inflammation
• With continued stimulus, AMT becomes a
local acute inflammation as body attempts
to heal
• Fluid, plasma protein, and leukocytes
circulate into injured tissue
• Neutrophils begin cleaning up the damaged
tissue

11. Local Chronic Inflammation
• With continued exercise stimulus, acute
becomes chronic inflammation.
• Circulating monocytes and macrophages
become involved to help repair damage
• Cytokines are helping to mediate all the
immune system activity

12. Systemic Immune/Inflammatory
Response
• At this phase pro-inflammatory cytokines
have begun to act on the liver and
hypothalamus to help produce proteins,
regulate temperature, and affect mood
(defense mechanisms)
• Anti-inflammatory cytokines have begun to
act on hypothalamic-pituitary-adrenal axis
to release cortisol and suppress testosterone

13. How to Prevent Overtraining
• Get enough recovery:
– Sleep
– Massage
– Sauna/Jacuzzi
• Nutrition!

14. Rest and Restoration
• Rest: sleep, frequency
of training
• Restoration:
– Nutrition
– Psycho-Regulatory
Training
• Meditation
• Mental Imagery
• Relaxation
• Restoration, cont.
– Modalities
• Sauna
• Water Therapies
• Contrasting immersion
baths (5 minutes each)
• Massage

15. Overuse Injuries
• Essentially two types:
– Inflammation
– Tissue degeneration
• To be overuse: gradual onset; acute onset
usually represents more serious injury
(fracture)

16. Overuse Injuries: Signs and
Symptoms
• Pain that is aggravated by activity and
relieved by rest.
• Stiffness
• Decreased range of motion
• Weakness

17. Overuse Injuries: Examples
• Stress Fracture
– Typically from
changing training
– Equipment (running
shoes)
– Surfaces (concrete)

18. Overuse Injuries: More Examples
• Shin splints
– From changing training
(increased volume)
– Equipment
– Technique
– Surfaces

19. Overuse Injuries: Treatment
• REST!!! (most important)
• Ice
• NSAIDs
• Address technique problems
• Address equipment/surface problems

20. Overuse Injuries: Causes
• Sudden increase in training volume
• Equipment (especially shoes)
• Exercise surface (e.g. running on concrete,
basketball court)
• Technique
• Insufficient rest
• Inadequate nutrition
• Combination of the above

21. Overuse Injuries: Prevention
• Don’t increase training volume by more
than 10%
• Insure you are using the proper equipment
• Don’t exercise on surfaces that cause or
aggravate pain
• Get enough sleep
• Get proper nutrition

22. Female Athlete Triad
• Disordered eating
• +
• Amenorrhea
• +
• Osteoporosis
• =
• Female Athlete Triad

23. Disordered Eating
• Primarily anorexia nervosa and bulimia nervosa
• 15-62 percent of college athletes demonstrate
disordered eating (Hobart, J.A. & D.R. Smucker,
2000; Smith, A.G., 1996)
• Problems associated with include: menstral
dysfunction, disturbances of CV, endocrine, and
GI systems, problems regulating temperature,
psychological problems, irreversible bone loss,
death (American Academy of Pediatrics, 2000)

24. Amenorrhea
• Amenorrhea is prevalent in 3.4% to 66% of
athletes (depending upon sport) compared
with 2-5% in general population (American
Academy of Pediatrics, 2000; Smith, A.D.,
1996)
• Associated with decreased serum estrogen
levels, leading to decreased bone mass and
increased cardiac risk

25. Osteoporosis
• Loss of bone mineral density and the
inadequate formation of bone
• Increased bone fragility and risk of fracture
• Loss may be irreplaceable
• Relationship between amenorrhea and
osteoporosis in adolescents and young
women

26. Female Athlete Triad: Treatment
• Cutting back on training volume
• Getting professional help
• Rest and recovery
• Hormone replacement therapy ?
• Proper nutrition
• Calcium supplementation