Emily Sweeney, Madison L. Brna, David Howell, Aubrey M. Armento, Gabrielle Gilmer, Corinna Franklin
BACKGROUND: Relative Energy Deficiency in Sport, or RED-S, is a multi-scale physiological response to a mismatch between energy intake and exercise energy expenditure that affects up to 50% of adolescent athletes. RED-S symptomology was first described as the Female Athlete Triad (the Triad) and includes specifically low energy availability with or without disordered eating, menstrual dysfunction, and low bone mineral density. Despite the wide impact of RED-S/the Triad, there is a lack of standardization of screening in adolescent athletes. Therefore, the purpose of this study was to assess if there are differences in practitioner demographics when screening for RED-S/the Triad in adolescent athletes. In addition, we sought to assess if providers’ screening habits differ based on specific patient characteristics. METHODS: We conducted a cross-sectional online questionnaire of members of the Pediatric Research in Sports Medicine (PRiSM) Society. PRiSM is an interdisciplinary group of professionals who are dedicated to advancing the research and medical care of young athletes. The questionnaire assessed screening tools that members used to assess for RED-S/the Triad, practices implemented when providers were concerned for RED-S/the Triad, demographic data, and type of training. RESULTS: Of 389 PRiSM members, 60 completed the survey and were included in subsequent analyses (15% response rate). Most participants were primary care sports medicine physicians (37%), orthopaedic surgeons (27%), or physical therapists (23%), and about half of respondents identified as a cis gender woman (55%). There was a trend toward more women screening for RED-S routinely than men (55% vs. 33%: p=0.10), and orthopaedic surgeons were less likely to screen than other specialties (25% vs. 52%, p = 0.06). Eating disorders (88%), menstrual dysfunction (76%), and bone stress injury (74%) were reported as specific red flags that make providers screen for RED-S/the Triad. Participants reported that lack of time (57%) and lack of resources (37%) were barriers to screen for RED-S/the Triad. The most commonly utilized tools to screen for RED-S/the Triad were the Female Athlete Screening Tool (FAST), Female Athlete Triad Risk Scale, Female Athlete Triad Consensus Panel Screening questions, and RED-S Specific Screening Tool (RST). CONCLUSION: Orthopaedic surgeons were less likely than other health care professionals to screen for RED-S/the Triad. Barriers that prevent healthcare providers from screening for RED-S/the Triad included limited time and resources. By describing current practices, we have identified gaps and areas of need to enhance screening for RED-S/the Triad across multiple sports medicine disciplines.
{"title":"Screening for Relative Energy Deficiency in Sport and Female Athlete Triad: A Survey of Pediatric Sports Medicine Professionals","authors":"Emily Sweeney, Madison L. Brna, David Howell, Aubrey M. Armento, Gabrielle Gilmer, Corinna Franklin","doi":"10.53646/vxe7wx77","DOIUrl":"https://doi.org/10.53646/vxe7wx77","url":null,"abstract":"BACKGROUND: Relative Energy Deficiency in Sport, or RED-S, is a multi-scale physiological response to a mismatch between energy intake and exercise energy expenditure that affects up to 50% of adolescent athletes. RED-S symptomology was first described as the Female Athlete Triad (the Triad) and includes specifically low energy availability with or without disordered eating, menstrual dysfunction, and low bone mineral density. Despite the wide impact of RED-S/the Triad, there is a lack of standardization of screening in adolescent athletes. Therefore, the purpose of this study was to assess if there are differences in practitioner demographics when screening for RED-S/the Triad in adolescent athletes. In addition, we sought to assess if providers’ screening habits differ based on specific patient characteristics. \u0000METHODS: We conducted a cross-sectional online questionnaire of members of the Pediatric Research in Sports Medicine (PRiSM) Society. PRiSM is an interdisciplinary group of professionals who are dedicated to advancing the research and medical care of young athletes. The questionnaire assessed screening tools that members used to assess for RED-S/the Triad, practices implemented when providers were concerned for RED-S/the Triad, demographic data, and type of training.\u0000RESULTS: Of 389 PRiSM members, 60 completed the survey and were included in subsequent analyses (15% response rate). Most participants were primary care sports medicine physicians (37%), orthopaedic surgeons (27%), or physical therapists (23%), and about half of respondents identified as a cis gender woman (55%). There was a trend toward more women screening for RED-S routinely than men (55% vs. 33%: p=0.10), and orthopaedic surgeons were less likely to screen than other specialties (25% vs. 52%, p = 0.06). Eating disorders (88%), menstrual dysfunction (76%), and bone stress injury (74%) were reported as specific red flags that make providers screen for RED-S/the Triad. Participants reported that lack of time (57%) and lack of resources (37%) were barriers to screen for RED-S/the Triad. The most commonly utilized tools to screen for RED-S/the Triad were the Female Athlete Screening Tool (FAST), Female Athlete Triad Risk Scale, Female Athlete Triad Consensus Panel Screening questions, and RED-S Specific Screening Tool (RST).\u0000CONCLUSION: Orthopaedic surgeons were less likely than other health care professionals to screen for RED-S/the Triad. Barriers that prevent healthcare providers from screening for RED-S/the Triad included limited time and resources. By describing current practices, we have identified gaps and areas of need to enhance screening for RED-S/the Triad across multiple sports medicine disciplines.","PeriodicalId":508022,"journal":{"name":"Journal of Women's Sports Medicine","volume":"20 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140735581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Female artistic gymnasts, defined as gymnasts who compete in the vault, uneven parallel bars, balance beam, and floor events, may be affected by a wide variety of acute and overuse injuries throughout their athletic careers. Returning these athletes to their sport safely after an injury requires detailed knowledge of the various events in which they compete as well as a familiarity with what is expected of these gymnasts at the various levels of training and competition. Despite the complexity described above, there are few published resources to help providers guide the female artistic gymnast back to sport after injury. Therefore, we developed two purposes for this paper: (1) to review important concepts regarding return to play (RTP) in women’s artistic gymnastics and (2) to add to the existing literature on RTP in women’s gymnastics by providing RTP protocols that consider a gymnast’s training level as well as injured body area.
{"title":"Returning to Sport: A Level-Based Guide for Women’s Artistic Developmental Program Gymnasts","authors":"MD Tatiana Patsimas, Dpt David Tilley, Atc Darby Glackin, MD Emily Sweeney","doi":"10.53646/n2fpwv97","DOIUrl":"https://doi.org/10.53646/n2fpwv97","url":null,"abstract":" \u0000Female artistic gymnasts, defined as gymnasts who compete in the vault, uneven parallel bars, balance beam, and floor events, may be affected by a wide variety of acute and overuse injuries throughout their athletic careers. Returning these athletes to their sport safely after an injury requires detailed knowledge of the various events in which they compete as well as a familiarity with what is expected of these gymnasts at the various levels of training and competition. Despite the complexity described above, there are few published resources to help providers guide the female artistic gymnast back to sport after injury. Therefore, we developed two purposes for this paper: (1) to review important concepts regarding return to play (RTP) in women’s artistic gymnastics and (2) to add to the existing literature on RTP in women’s gymnastics by providing RTP protocols that consider a gymnast’s training level as well as injured body area.","PeriodicalId":508022,"journal":{"name":"Journal of Women's Sports Medicine","volume":"43 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140733828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Erdman, Sophia Ulman, Jessica Dabis, Shane Miller, Jacob Jones, Henry Ellis, Jane Chung
BACKGROUND: Across all genres of dance, studies have reported musculoskeletal injury in 20-84% of dancers with 95% reporting a history of musculoskeletal pain. Compared to other dance styles, ballet dancers specifically are most affected by musculoskeletal injuries. The purpose of this study is to compare movement patterns and muscle activity in pediatric female pre-professional dancers with and without self- reported pain, using the Patient-Reported Outcomes Measurement Information System pediatric numeric rating scale. We hypothesize dancers reporting pain will exhibit compensatory strategies, such as asymmetrical movement patterns and muscle activity, across a series of ballet movements. METHODS: A total of 55 female ballet dancers who train en pointe were seen for testing (age 14.4±1.9 years), with 34 dancers (62%) self-reported pain in the 7 days preceding testing. Biomechanical testing, performed in pointe shoes, included performance of static (5 classical ballet positions) and dynamic ballet movements (développé, arabesqué and grand jeté) while instrumented with surface electromyography (EMG) to capture muscle activity and inertial measurement (IMU) dual sensors on the trunk and lower extremities to capture movement patterns. The experimental setup allowed for measurement of trunk and lower extremity muscle activity, as well as trunk, hip, knee, and ankle joint angles in the sagittal, coronal, and transverse planes. Student’s t-test was used to compare the pain and no pain groups across all variables with statistical significance set to α=0.05. RESULTS: Movement patterns and EMG differences were seen between groups. During first and third positions, the right (non-barre sided) leg demonstrated less external knee rotation in the pain group (p≤0.05). In fifth position, the left (barre-sided) leg exhibited increased ankle flexion (p=0.048), reduced hip abduction (p=0.027), and reduced knee adduction (p=0.026) in the pain group. The pain group exhibited decreased trunk flexion/extension range-of-motion during the grand jeté (p=0.004), and increased trunk rotation range-of-motion when performing the arabesqué en pointe (p=0.034). Rectus femoris activation was reduced for the pain group on the left leg in fifth position (p<0.03). The up leg in the pain group during the développé (flat) showed increased hamstring activation (p=0.04). CONCLUSION: Ballet dancers with pain exhibited differences in movement patterns while performing certain ballet movements, notably during fifth position, grand jeté, and arabesqué (en pointe). Additionally, dancers with pain exhibited reduced rectus femoris activation in fifth position and increased hamstring activation on the working leg during the développé (flat). Future work should investigate how movement patterns and muscle activation in ballet dancers vary by location and severity of reported pain.
{"title":"Biomechanical Comparison of Pediatric Female Ballet Dancers With and Without Pain","authors":"A. Erdman, Sophia Ulman, Jessica Dabis, Shane Miller, Jacob Jones, Henry Ellis, Jane Chung","doi":"10.53646/n4ejsa24","DOIUrl":"https://doi.org/10.53646/n4ejsa24","url":null,"abstract":"BACKGROUND: Across all genres of dance, studies have reported musculoskeletal injury in 20-84% of dancers with 95% reporting a history of musculoskeletal pain. Compared to other dance styles, ballet dancers specifically are most affected by musculoskeletal injuries. The purpose of this study is to compare movement patterns and muscle activity in pediatric female pre-professional dancers with and without self- reported pain, using the Patient-Reported Outcomes Measurement Information System pediatric numeric rating scale. We hypothesize dancers reporting pain will exhibit compensatory strategies, such as asymmetrical movement patterns and muscle activity, across a series of ballet movements.\u0000METHODS: A total of 55 female ballet dancers who train en pointe were seen for testing (age 14.4±1.9 years), with 34 dancers (62%) self-reported pain in the 7 days preceding testing. Biomechanical testing, performed in pointe shoes, included performance of static (5 classical ballet positions) and dynamic ballet movements (développé, arabesqué and grand jeté) while instrumented with surface electromyography (EMG) to capture muscle activity and inertial measurement (IMU) dual sensors on the trunk and lower extremities to capture movement patterns. The experimental setup allowed for measurement of trunk and lower extremity muscle activity, as well as trunk, hip, knee, and ankle joint angles in the sagittal, coronal, and transverse planes. Student’s t-test was used to compare the pain and no pain groups across all variables with statistical significance set to α=0.05.\u0000RESULTS: Movement patterns and EMG differences were seen between groups. During first and third positions, the right (non-barre sided) leg demonstrated less external knee rotation in the pain group (p≤0.05). In fifth position, the left (barre-sided) leg exhibited increased ankle flexion (p=0.048), reduced hip abduction (p=0.027), and reduced knee adduction (p=0.026) in the pain group. The pain group exhibited decreased trunk flexion/extension range-of-motion during the grand jeté (p=0.004), and increased trunk rotation range-of-motion when performing the arabesqué en pointe (p=0.034). Rectus femoris activation was reduced for the pain group on the left leg in fifth position (p<0.03). The up leg in the pain group during the développé (flat) showed increased hamstring activation (p=0.04).\u0000CONCLUSION: Ballet dancers with pain exhibited differences in movement patterns while performing certain ballet movements, notably during fifth position, grand jeté, and arabesqué (en pointe). Additionally, dancers with pain exhibited reduced rectus femoris activation in fifth position and increased hamstring activation on the working leg during the développé (flat). Future work should investigate how movement patterns and muscle activation in ballet dancers vary by location and severity of reported pain.","PeriodicalId":508022,"journal":{"name":"Journal of Women's Sports Medicine","volume":"9 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140734848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND: Breast motion may cause breast pain in active women, which can negatively impact physical activity. Sports bras are essential pieces of sporting equipment and were designed to help women comfortably participate in sports and engage in physical activity. Thus, the purpose of this systematic review was to summarize how breasts and bras influence physical activity in women and girls. METHODS: A systematic review was conducted by performing electronic searches of PubMed, Physiotherapy Evidence Database, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials. Title, abstract, and full text screening were performed by two independent reviewers to identify articles investigating how breasts or bras impact physical activity related outcomes in women or girls. We performed meta-analyses to evaluate the effect of (i) breast size, (ii) bra type, and (iii) breast reduction on (i) breast pain, (ii) physical activity level, and (iii) breast biomechanics. Standardized mean differences and pooled standard deviations of outcome measures were calculated using the DerSimonian-Laird method. All meta-analyses were performed using SPSS Statistics Software. RESULTS: Of the 323 articles identified, 77 were included in the final analysis. The majority of articles studied participants who were 20-29 years old, identified as white, lived in Western countries, were non-athletes, and weighed between 45-65 kg (BMI: 18.5-29.9), while they were performing a running movement. Very few articles reported household income and ethnicity/race. Key themes investigated by this body of literature were breast biomechanics, breast pain, and physical activity levels. Meta-analyses revealed that women and girls with larger breasts reported more exercise-induced breast pain and experienced greater breast mediolateral velocity and anterior/poster acceleration during physical activity than women and girls with smaller breasts. Meta-analyses revealed that sports bras were associated with less breast pain during physical activity than standard bras. CONCLUSION: This body of literature largely studied a homogenous population, and there is a need for greater inclusion of women and girls who identify with under-represented minorities, with disability, who are post-menopausal, and who are overweight. Factors such as ethnicity/race and household income, were underreported in the literature, and studies of movement patterns beyond running are needed. Mediolateral breast velocity and anterior/posterior breast acceleration may be contributors to breast pain in women and girls with larger breasts, thus these biomechanical outcomes are of particular interest for future research and for consideration in sports bra optimization.
{"title":"The Impact of Breasts and Bras on Physical Activity Amongst Women and Girls: A Systematic Review and Meta-Analysis","authors":"Gabrielle Gilmer, Elaine Xu, Corinna Franklin, Nailah Adams, Katherine Rizzone","doi":"10.53646/cdp9k364","DOIUrl":"https://doi.org/10.53646/cdp9k364","url":null,"abstract":"BACKGROUND: Breast motion may cause breast pain in active women, which can negatively impact physical activity. Sports bras are essential pieces of sporting equipment and were designed to help women comfortably participate in sports and engage in physical activity. Thus, the purpose of this systematic review was to summarize how breasts and bras influence physical activity in women and girls.\u0000METHODS: A systematic review was conducted by performing electronic searches of PubMed, Physiotherapy Evidence Database, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials. Title, abstract, and full text screening were performed by two independent reviewers to identify articles investigating how breasts or bras impact physical activity related outcomes in women or girls. We performed meta-analyses to evaluate the effect of (i) breast size, (ii) bra type, and (iii) breast reduction on (i) breast pain, (ii) physical activity level, and (iii) breast biomechanics. Standardized mean differences and pooled standard deviations of outcome measures were calculated using the DerSimonian-Laird method. All meta-analyses were performed using SPSS Statistics Software.\u0000RESULTS: Of the 323 articles identified, 77 were included in the final analysis. The majority of articles studied participants who were 20-29 years old, identified as white, lived in Western countries, were non-athletes, and weighed between 45-65 kg (BMI: 18.5-29.9), while they were performing a running movement. Very few articles reported household income and ethnicity/race. Key themes investigated by this body of literature were breast biomechanics, breast pain, and physical activity levels. Meta-analyses revealed that women and girls with larger breasts reported more exercise-induced breast pain and experienced greater breast mediolateral velocity and anterior/poster acceleration during physical activity than women and girls with smaller breasts. Meta-analyses revealed that sports bras were associated with less breast pain during physical activity than standard bras.\u0000CONCLUSION: This body of literature largely studied a homogenous population, and there is a need for greater inclusion of women and girls who identify with under-represented minorities, with disability, who are post-menopausal, and who are overweight. Factors such as ethnicity/race and household income, were underreported in the literature, and studies of movement patterns beyond running are needed. Mediolateral breast velocity and anterior/posterior breast acceleration may be contributors to breast pain in women and girls with larger breasts, thus these biomechanical outcomes are of particular interest for future research and for consideration in sports bra optimization.\u0000 ","PeriodicalId":508022,"journal":{"name":"Journal of Women's Sports Medicine","volume":"21 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140740234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND: Relative Energy Deficiency in Sport (RED-S) refers to compromised functioning of one’s metabolism, reproductive system, immune system, cardiovascular system and more due to a relative energy deficiency. Most prevailing RED-S research has focused on its physiological symptoms, yet little data exists regarding the psychological and social aspects that might contribute to its development. The purpose of this study is to determine the role of psychosocial factors in RED-S risk for female collegiate athletes. METHODS: 105 female collegiate athletes under National Collegiate Athletic Association (NCAA) jurisdiction were surveyed representing a variety of varsity sports. All participants were assessed for low energy availability using the Low Energy Availability in Females Questionnaire (LEAF-Q) through an online survey battery, which also included sources of nutrition information scale (SONI scale), the revised group environment questionnaire (GEQ), and the revised exercise group social provisions scale (EXSPS questionnaire). The participants were sorted into an At Risk (AR) and Not At Risk (NAR) group based on their LEAF-Q scores. One-tailed independent t-tests and chi square tests were used to determine the difference between AR and NAR for dependent measures, and multiple linear regression determined the relationship between risk of LEA and GEQ, EXSPS, and SONI. RESULTS: Overall, 66 participants (62.8%) were at risk for LEA based on LEAF-Q scores. Significant differences were identified between the AR (11.5%; 66.7%) and NAR (40.0%; 37.0%) groups regarding comfort with discussing nutrition with coaches or teammates, respectively (p = 0.034, p = 0.035). However, none of the social measures predicted LEA risk (group cohesion: R = 0.04, p = 0.92; social support: R = 1.85, p = 0.09; SONI: p = 0.136) Awareness of RED-S (using a Yes (1) or No (0) question) was also found to be not significantly different between the AR (0.28 ± 0.45, 29%) and NAR (0.39 ± 0.50, 41%) groups (p = 0.12). CONCLUSION: Overall, risk for RED-S is high in female collegiate athletes, however group cohesion, social support, and the athletes’ sources of nutrition information did not predict RED-S incidence.
{"title":"The Role of Social Factors in Relative Energy Deficiency Risk for Female Collegiate Athletes","authors":"Lauren R. Masden, Allison Tripure, Sara Mahoney","doi":"10.53646/jkm6yw15","DOIUrl":"https://doi.org/10.53646/jkm6yw15","url":null,"abstract":"BACKGROUND: Relative Energy Deficiency in Sport (RED-S) refers to compromised functioning of one’s metabolism, reproductive system, immune system, cardiovascular system and more due to a relative energy deficiency. Most prevailing RED-S research has focused on its physiological symptoms, yet little data exists regarding the psychological and social aspects that might contribute to its development. The purpose of this study is to determine the role of psychosocial factors in RED-S risk for female collegiate athletes. METHODS: 105 female collegiate athletes under National Collegiate Athletic Association (NCAA) jurisdiction were surveyed representing a variety of varsity sports. All participants were assessed for low energy availability using the Low Energy Availability in Females Questionnaire (LEAF-Q) through an online survey battery, which also included sources of nutrition information scale (SONI scale), the revised group environment questionnaire (GEQ), and the revised exercise group social provisions scale (EXSPS questionnaire). The participants were sorted into an At Risk (AR) and Not At Risk (NAR) group based on their LEAF-Q scores. One-tailed independent t-tests and chi square tests were used to determine the difference between AR and NAR for dependent measures, and multiple linear regression determined the relationship between risk of LEA and GEQ, EXSPS, and SONI. RESULTS: Overall, 66 participants (62.8%) were at risk for LEA based on LEAF-Q scores. Significant differences were identified between the AR (11.5%; 66.7%) and NAR (40.0%; 37.0%) groups regarding comfort with discussing nutrition with coaches or teammates, respectively (p = 0.034, p = 0.035). However, none of the social measures predicted LEA risk (group cohesion: R = 0.04, p = 0.92; social support: R = 1.85, p = 0.09; SONI: p = 0.136) Awareness of RED-S (using a Yes (1) or No (0) question) was also found to be not significantly different between the AR (0.28 ± 0.45, 29%) and NAR (0.39 ± 0.50, 41%) groups (p = 0.12). CONCLUSION: Overall, risk for RED-S is high in female collegiate athletes, however group cohesion, social support, and the athletes’ sources of nutrition information did not predict RED-S incidence.","PeriodicalId":508022,"journal":{"name":"Journal of Women's Sports Medicine","volume":"173 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139174541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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