Injuries and The Female Triathlete

May 1, 2006

Sally Edwards

Injuries are common in both sexes and have been found to be more sport-specific than sex-specific. There are some indications that women may have a higher overall incidence of injury, but the injury patterns are the same.

It appears that there is a higher rate of injury among female athletes, but that it is predominantly caused by their lower initial levels of fitness. As women become more active and competitive, their rates of injury approach those of men.

So are women more at risk of overuse injuries than men? Women do appear to have a higher incidence of shin splints and stress fractures, but they also seem to have a lower incidence of certain types of tendinitis.

Most people believe that women suffer from more knee problems than do men because of the wider female pelvis and greater joint flexibility. In fact, knee pain among runners is the most common injury for both sexes, occurring in 24 percent of the men and 27 percent of the women runners, which is not a significant difference.

It appears that women suffer from more stress fractures overall than do men, but some specific stress fractures may occur less often in women. Studies indicate that stress fractures of the iliac crest (the bone you feel when you put your hands on your hips) and the tarsal navicular (one of the bones in the middle and inside of the foot ) are more predominant among men. Again, the increased rate of stress fractures, similar to other overuse injuries, is likely to be related to the initial lack of proper conditioning.

Another orthopedic stress trauma is swimmer's shoulder (pain from repeated trauma to the head of the upper arm bone). The incidence is higher among women (reported by 68 percent, versus 50 percent of men).

The most common problem for swimmers is ear infection, which is not gender-dependent. Ear infections are caused by exposure of the tissues in the ear canal to prolonged irritation. The best treatment is prevention-wearing earplugs and thoroughly drying the ears (there are chemicals that can do this). Once symptoms are present, you must decrease the inflammation and simultaneously treat the infection.

Treatment

For overuse injuries, rest is the best treatment. However, if your condition is serious, then casting, crutches, anti-inflammatory drugs, or physical therapy may be required. For nonserious injuries, it's permissible to treat it yourself first by using ice, compression, and elevation of the injured part.

Diagnose the pain, because you can't keep the problem from recurring if you don't know its cause. Every overuse injury is caused by a force on a tissue that is greater than the tissue's basic strength, and every injury-causing force can be traced to one of the following causes:

1. Training errors that do not allow for adequate recovery 2. Tissues that are weak and susceptible to injury 3. Biomechanical weaknesses that put excessive stress on certain parts of your body

When you know what caused it, you can begin to fix it. Rehabilitation, using flexibility, strengthening, and aerobic/anaerobic conditioning, is the key to returning to your training program. If you are injured, cross-train in a different skill that doesn't hurt, until the pain disappears. If you continue to train with pain, you only exacerbate the problem and delay healing. Upper Respiratory or Short-Term Illness It's a tough call whether to exercise when you are sick. But it's better to be safe than sorry, so it's generally not a bad idea to take a few days off when your immune system is impaired by illness. If you must continue to train when you are ill, do so at a reduced amount and intensity.

For a cold, if you can take a few days off, do so. There is no proof that complete bed rest cures virus colds any faster, nor is there any proof that training extends the duration of a cold, but do take it easy.

If you have a fever, don't work out. Your heart is already working double time by maintaining metabolic function as well as pumping blood to the skin's surface in order to reduce the heat from the fever. Don't add a third load on your system.

Gynecological Concerns

The past two decades have brought hundreds of thousands of women into the world of exercise and athletic training. The medical experts have given them the green light-regular exercise can only improve the quality of women's lives.

Here are some of the conditions that can affect any woman, athletic or not, and the facts that relate to these conditions as they pertain to training.

Vaginitis

Training itself does not cause vaginitis, nor does it cure it. However, wearing nonbreathable training apparel can cause a moister than normal vaginal environment, which can encourage the overgrowth of yeast, the major cause of vaginitis (one of the common forms is known as a "yeast infection"). If you have a recurring problem with vaginitis (or even if you don't), it would be a good idea to wear training apparel made of breathable fabrics, such as cotton or rayon blends. In any case, if you notice the onset of vaginitis (the common symptoms are discharge, itching, odor, and discomfort), consult your gynecologist, who will treat it with appropriate medication. Stress Urinary Incontinence

This is a condition of involuntary urine leakage, which occurs when there is an increase in abdominal pressure such as from jumping, running, or straining. It is not directly caused by sports activities and is usually found in women who have given birth several times. Training can cause an increase in abdominal pressure and, as a result, involuntary leakage symptoms, but exercise does not worsen a condition that is already present. Consult a urologist to determine the cause. To aid with the problem, empty your bladder before you train, follow specific exercises that can strengthen the muscles involved, and wear a minipad. Don't let this problem stop you from training.

Contraception

It's your call. Your decision on which type of contraceptive agent to use is not affected by the fact that you train. The decision is based solely on your choice of a safe and effective way of preventing conception.

Menstrual Irregularity

Any woman who has irregular menstrual cycles should consult a gynecologist to determine the cause. Irregular periods (amenorrhea) are indeed more common among athletically active women than sedentary women, but it is not known why. Athletic amenorrhea is a condition of menstrual irregularity caused by exercise. Amenorrhea may be caused by the physical stress of training, the emotional stress of competition, hormonal changes, possible loss of body weight due to increased physical activity, or a change in eating patterns. However, recent studies indicate that athletic amenorrhea may be primarily caused by eating disorders, not exercise, so don't stop training, and don't stop eating.

If you experience frequent, prolonged, heavy, or unexpected menstrual periods and there are no associated gynecological problems, it is not recommended that you try to manipulate your periods using hormones. Menstruation is an inconvenience, but it's just one of the things you deal with as a woman.

In athletic ammenorheic women, normal periods usually resume once training is reduced. Likewise, fertility is restored to normal upon resumption of a normal menstrual cycle.

Menstrual Cramps

For women who suffer from menstrual discomfort or pain, exercise has been shown to help alleviate symptoms. These strong and intermittent lower abdominal pains do not preclude you from working out. It's perfectly safe to exercise at all times during the month. If menstrual cramps are frequently or regularly severe or debilitating, consult your gynecologist and try to keep training.

Pregnancy

One of your greatest athletic achievements may be getting fit before becoming pregnant and staying fit during pregnancy. If it isn't your greatest athletic achievement, it can still be one of your life's high times.

Even though physical conditioning is certainly good for pregnant women, there are certain precautions that must be followed. Training vigorously can result in excessive heat (hyperthermia), lowered oxygen supply that could reduce that of the fetus, inadequate blood flow, or abdominal traumas.

A program of general conditioning is desirable for moms-to-be; your pregnancy, labor, and delivery will all likely be easier for your efforts. However, always check with your obstetrician before starting or continuing a vigorous conditioning program. If you weren't training before you became pregnant, you shouldn't start on a program any more strenuous than walking. Weight training, stretching, and calisthenics are good conditioning activities for pregnant women. Other Concerns

Anemia

A common affliction of female athletes, anemia is a disease characterized by an abnormally low number of red blood cells (RBC). It is usually caused by the loss of iron that occurs in menstruation, or by not eating sufficient iron-rich foods. Sometimes heavy training can cause a loss of iron through the intestines and in your stools. Athletic anemia is a condition of low RBC count, which is due to an increase in the volume of blood without a corresponding increase in the number of cells. This is not true anemia, but when you are training, your blood volume may increase by as much as 10 percent faster than your RBC concentration.

For whichever cause, one out of every four women in America is iron-deficient, and one out of twenty is anemic. To be iron-deficient means that your iron reserves (iron that is stored in your liver, spleen, bone marrow, and other tissues) are low. Once your iron stores are depleted, you become anemic. If you think you are anemic, check with your doctor. Self-medicating with large doses of iron can lead to problems with other nutrients.

Cancer and Exercise

Facing a diagnosis of cancer can evoke many responses, including fear, anger, depression, confusion, and hopelessness. Many cancer patients search for ways to take an active role in their treatment and recovery. One way a cancer patient can regain some sense of control in the direction of her health is through daily exercise.

Individuals who have exercised regularly prior to cancer treatment have a higher tolerance to cancer treatment and recover more quickly. Breast surgeon Paula Oliver of the Capitol Surgeons Group in Austin, Texas, has found that "the stronger a patient is at the point of diagnosis, the better chance they have of tolerating the most effective treatment." Lisa Talbott, M.P.H. and co-founder of Team Survivor, believes that exercising throughout treatment keeps a patient's energy level up and, more important, hastens post-surgery and treatment recovery time.

Varicose Veins

The enlarged veins that appear near the skin's surface are not caused by exercise but by malfunctioning blood vessel valves. Exercise not only helps relieve the pain from varicose veins but also can help treat the condition. Do not confuse athletic veins with varicose veins. Some athletes have large veins because of their bodies' need to carry larger amounts of blood to the skin's surface for its thermoregulatory (cooling) effects.

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