Pain Is Not Gain: Injuries from training

Overuse, Overtraining, and the Female Athlete Triad

John Cissik, MS, CSCS, NSCA-CPT, NASM-CPT, CES

Human Performance Services, LLC

Pain is Not Gain

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

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).

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

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

Causes of Overtraining: Simple

• Insufficient recovery

• Lack of sleep

• Inadequate nutrition

• A combination of all the above

Causes of Overtraining: Complex

• Adaptive Microtrauma

• Local Acute Inflammation

• Local Chronic Inflammation

• Systemic Inflammation/Inflammatory Response

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

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

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

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

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

How to Prevent Overtraining

• Get enough recovery:– Sleep– Massage– Sauna/Jacuzzi

• Nutrition!

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

Overuse Injuries

• Essentially two types:– Inflammation– Tissue degeneration

• To be overuse: gradual onset; acute onset usually represents more serious injury (fracture)

Overuse Injuries: Signs and Symptoms

• Pain that is aggravated by activity and relieved by rest.

• Stiffness

• Decreased range of motion

• Weakness

Overuse Injuries: Examples

• Stress Fracture– Typically from

changing training

– Equipment (running shoes)

– Surfaces (concrete)

Overuse Injuries: More Examples

• Shin splints– From changing training

(increased volume)

– Equipment

– Technique

– Surfaces

Overuse Injuries: Treatment

• REST!!! (most important)

• Ice

• NSAIDs

• Address technique problems

• Address equipment/surface problems

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

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

Female Athlete Triad

• Disordered eating

• +

• Amenorrhea

• +

• Osteoporosis

• =

• Female Athlete Triad

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)

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

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

Female Athlete Triad: Treatment

• Cutting back on training volume

• Getting professional help

• Rest and recovery

• Hormone replacement therapy ?

• Proper nutrition

• Calcium supplementation