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Sarah J. Hanson, Penny McCullagh and Phyllis Tonymon

In 1988, Andersen and Williams proposed a model to explain the stress-injury relationship. The present study tested portions of this framework by investigating frequency and severity of injury occurrence in track and field athletes from four NCAA Division I and II universities. Personality characteristics (locus of control and sport competition trait anxiety), history of stressors (life stress, daily hassles, and past injury), and moderating variables (coping resources and social support) were assessed before the season began. Discriminant analyses indicated that four variables (coping resources, negative life stress, social support, and competitive anxiety) differentiated the severity groups. For injury frequency, coping resources and positive life stress differentiated the groups.

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Susan K. Grimston, Jack R. Engsberg, Reinhard Kloiber and David A. Hanley

Increased incidence of stress fracture has been reported for amenorrheic runners, while some studies have reported decreased spinal bone mass in amenorrheic runners. Based on results from these studies, one tends to associate decreased spinal bone mass with an increased risk of stress fracture. The present study compared regional bone mass and external loads during running between six female runners reporting a history of stress fracture (seven tibial and three femoral neck) and eight female runners with no history of stress fracture. Dual photon absorptiometry measures indicated significantly greater spinal (L2-L4) and femoral neck bone mineral density in stress fracture subjects (p<0.05) but no differences between groups for tibial bone density. Normalized forces recorded from Kistler force plates indicated significantly greater vertical propulsive, maximal medial, lateral, and posterior forces for stress fracture subjects during running (p<0.05).

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Katie N. Brown, Heidi J. Wengreen, Katherine A. Beals and Edward M. Heath

This quasi-experimental study aimed to assess risk for the female athlete triad (Triad) and pilot a peer-led Triad educational intervention. Twenty-nine female high school track and field athletes (N = 29) at one high school in the western United States consented to participate. Participants were weighed and measured, and completed pre- and postsurveys that included Triad risk factor questions and 10 questions assessing Triad knowledge. 54% of athletes reported current menstrual irregularity; 7% reported a history of stress fractures. Significant increases in Triad knowledge were observed pre- to postintervention (4.7 ± 2.6 to 7.7 ± 1.78 out of 10; p < .0001). Triad education was generally accepted and enjoyed by participants; however, 86% preferred that a coach or other adult provide education instead of a peer.

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Stephanie M. Miller, Sonja Kukuljan, Anne I. Turner, Paige van der Pligt and Gaele Ducher

Purpose:

Prevention of the female athlete triad is essential to protect female athletes’ health. The aim of this study was to investigate the knowledge, attitudes, and behaviors of regularly exercising adult women in Australia toward eating patterns, menstrual cycles, and bone health.

Methods:

A total of 191 female exercisers, age 18–40 yr, engaging in ≥2 hr/wk of strenuous activity, completed a survey. After 11 surveys were excluded (due to incomplete answers), the 180 participants were categorized into lean-build sports (n = 82; running/athletics, triathlon, swimming, cycling, dancing, rowing), non-lean-build sports (n = 94; basketball, netball, soccer, hockey, volleyball, tennis, trampoline, squash, Australian football), or gym/fitness activities (n = 4).

Results:

Mean (± SD) training volume was 9.0 ± 5.5 hr/wk, with participants competing from local up to international level. Only 10% of respondents could name the 3 components of the female athlete triad. Regardless of reported history of stress fracture, 45% of the respondents did not think that amenorrhea (absence of menses for ≥3 months) could affect bone health, and 22% of those involved in lean-build sports would do nothing if experiencing amenorrhea (vs. 3.2% in non-lean-build sports, p = .005). Lean-build sports, history of amenorrhea, and history of stress fracture were all significantly associated with not taking action in the presence of amenorrhea (all p < .005).

Conclusions:

Few active Australian women are aware of the detrimental effects of menstrual dysfunction on bone health. Education programs are needed to prevent the female athlete triad and ensure that appropriate actions are taken by athletes when experiencing amenorrhea.

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Laurel Wentz, Pei-Yang Liu, Jasminka Z. Ilich and Emily M. Haymes

Purpose:

To compare female runners with and without a history of stress fractures to determine possible predictors of such fractures.

Methods:

27 female runners (age 18–40 yr) who had had at least 1 stress fracture were matched to a control sample of 32 female runners without a history of stress fractures. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (iDXA). Subjects answered questionnaires on stress-fracture history, training, menstrual status, and diet.

Results:

No significant differences were found in menstrual characteristics, diet and dairy intake, or bone measurements. Weekly servings of milk during middle school significantly predicted BMD at the femur (p = .010), femoral neck (p = .002), Ward’s triangle (p = .014), and femoral shaft (p = .005). Number of menstrual cycles in the previous year predicted femoral-neck BMD (p = .004). Caffeine intake was negatively associated with BMD of the femur (p = .010), femoral neck (p = .003), trochanter (p = .038), and femoral shaft (p = .035). Weekly hours of training were negatively associated with total-body BMD (p = .021), total-body bone mineral content (p = .028), and lumbar-spine BMD (p = .011). Predictors for stress fractures included the number of years running, predominantly running on hard ground, irregular menstrual history, low total-body BMD, and low current dietary calcium intake when controlling for body-mass index (Nagelkerke R 2 = .364).

Conclusions:

Servings of milk during middle-school years were positively correlated with hip BMD, although current calcium intake, low BMD, irregular menstrual history, hard training surface, and long history of training duration were the most important predictors of stress fractures.

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Laurel M. Wentz, Pei-Yang Liu, Jasminka Z. Ilich and Emily M. Haymes

Background:

High rates of vitamin D deficiency have been reported in athletes. The purpose of this study was to evaluate the associations between vitamin D with bone health and parathyroid hormone (PTH) concentrations in female runners who trained at 30.4° degrees north.

Methods:

Serum 25-hydroxyvitamin D (25(OH) D), PTH, body composition, and bone mineral density (BMD) were measured in 59 female runners, aged 18–40 years. Stress fracture history, training duration and frequency were evaluated by questionnaire. As per National Endocrine Society cut-offs, serum vitamin D ranges were: 25(OH)D < 50 nmol/L for deficient; 50–75 nmol/L for insufficient; and ≥ 75 nmol/L for sufficient status.

Results:

Mean serum 25(OH)D concentrations were 122.6 ± 63.9 nmol/L, with 18.6% of subjects in the deficient (5.1%) or insufficient (13.5%) range. No significant differences were observed between sufficient and deficient/insufficient subjects for BMD, PTH, history of stress fractures, or demographic data.

Conclusions:

The majority of distance runners maintained sufficient vitamin D status, suggesting that training outdoors in latitude where vitamin D synthesis occurs year-round reduces the risk for vitamin D deficiency. Data do not support the indiscriminate supplementation of outdoor athletes in southern latitudes without prior screening.

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Mattias Eckerman, Kjell Svensson, Gunnar Edman and Marie Alricsson

found the need to further study psychological factors to determine that psychological variables might represent a risk factor. Another review by Ivarsson et al 17 concluded that stress-related factors, such as stress response and history of stressors, are related to injury rates among athletes. The

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Johanna M. Hoch, Megan N. Houston, Shelby E. Baez and Matthew C. Hoch

during a stressful athletic situation can also be affected by history of stressors, such as injury-related fear. Thus, elevated levels of FAB may increase the risk of sustaining a reinjury to the reconstructed limb in individuals with a history of ACLR. 22 Although treatment algorithms designed to

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of injuries, and presented statistical data necessary for the calculation of effect sizes. A total of 48 articles were included in the meta-analyses. Results from the meta-analysis of injury prediction variables showed that the history of stressors and the stress response was most strongly related to

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Jennifer Sygo, Alexandra M. Coates, Erik Sesbreno, Margo L. Mountjoy and Jamie F. Burr

-releasing intrauterine device); first day of last menstrual period, if not on exogenous hormones or hormone-releasing intrauterine device; and previous history of stress fracture or bone stress reaction. Participants completed the Low Energy Availability in Females Questionnaire (LEAF-Q), a screening tool using self