January - April 2006 Issue
Women's Sports Medicine Program Links Triad to Vascular ChangesThe Women’s Sports Medicine Program at Froedtert & Medical College of Wisconsin is the only one of its kind in the Midwest, and one of three in the country. It’s the only women’s program with a research component examining the issues unique to female athletes.
Anne Z. Hoch, DO, director of the Women’s Sports Medicine Program and a Medical College of Wisconsin physiatrist, is driven to better understand these issues and to raise awareness of them. “The big picture is that women athletes sometimes develop a condition called the Female Athlete Triad, which is an interrelated condition of disordered eating, amenorrhea (absence of a menstrual flow), and osteoporosis.”
Dr. Hoch and her team have been working with the Froedtert & Medical College of Wisconsin Cardiovascular Center to see what the cardiovascular ramifications of the Triad might be. David Harder, PhD, and David Gutterman, MD, of the Cardiovascular Center have created a research program that pairs scientists with clinicians to solve these clinical problems. “They have helped me significantly with the research component of the women’s program,” Dr. Hoch says. “One day we hope to change the name of the Female Athlete Triad to the Female Athlete Tetrad.”
“Women and girls with the Triad,” she says, “have the same steroid and hormonal profile as postmenopausal women, and we know that postmenopausal women start to develop cardiovascular disease. So, our big question is whether the 20-year-old woman that comes into our clinic with the Triad also has early cardiovascular disease.”
“We worked with the Cardiovascular Center, and they did the testing on our girls and evaluated their endothelial function, which is the seminal event in cardiovascular disease. We discovered, with their help, that Marquette and UWM women who had the Triad also had this early vascular change that is a precursor to cardiovascular disease. And women who have normal periods did not. “It’s a huge discovery.”
Beyond groundbreaking research, the Women’s Sports Medicine Program takes a multidisciplinary approach to treating female athletes and educating women and girls about preventing injuries and their overall health.
Created in 2002 as part of the Sports Medicine Center, the Women’s Sports Medicine Program has sports medicine physicians, a nurse educator, a sports dietitian, athletic trainers, physical therapists, a sports psychologist and a research assistant all in the same building. “All these professionals are familiar with the unique issues for female athletes, including disordered eating, menstrual dysfunction and low bone mineral density,” Dr. Hoch explains.
Female athletes are also more likely to experience an ACL (anterior cruciate ligament) injury than males, she adds. To address ACL injuries, which are six to eight times more common in women than in men, Dr. Hoch says, they offer a prevention program. “It’s proven that prevention programs work. There’s an 88 percent decrease in ACL tears in girls who go through the prevention program. And, if they do come to us with an ACL injury, we have two surgeons, Carole Vetter, MD and William Raasch, MD, who can reconstruct their ACL,” she says.
“There are other problems that we address for the girls that aren’t issues for males,” says Dr. Hoch. “We have a program for pregnant athletes to monitor their exercise throughout their pregnancy. We also have a program for musculoskeletal and orthopedic conditions associated with pregnancy, such as low back pain and carpal tunnel syndrome.”
The program also strives to educate every patient that comes through the doors. “What’s unique about our program is that if a girl comes in for an ankle sprain, we’ll give her all the best care for her sprain, but then our nurse educator will sit down with her and her mother and discuss our resource manual. They’ll go through all the unique issues that affect girls and women, all the injuries that women get, and what you can do to prevent these situations. Then we give them that resource manual. Everyone who comes in, regardless of what brought them here, is getting educated on a whole spectrum of issues.”
Education and awareness are important issues for Dr. Hoch. “In the past — perhaps five years ago — girls and moms were under the impression that it was normal not to have a period associated with sports,” she notes. “It may be common but it’s not normal. What’s great is that now girls are coming in with their moms and saying ‘I’m not having my period, I know this is abnormal, and I know you can help me with it.’ So the word is out to an extent.”
But Dr. Hoch would like to see more awareness among physicians, coaches and other health professionals about the problems female athletes face and that those problems are preventable. “Women’s issues are different from the males, and their issues aren’t being addressed. People aren’t aware of their issues.”
Dr. Hoch did a study in 2003 on awareness of the Female Athlete Triad and found that only 48 percent of physicians, 43 percent of physical therapists, 38 percent of athletic trainers, 32 percent of medical students and 8 percent of coaches had knowledge of the Triad.
“It’s not just us at the Medical College that thinks this is a major problem,” Dr. Hoch says. “The International Olympic Committee came out in November with a position paper that said we need to take better care of the female athlete and we need to make a better effort at preventing the Triad.”
She’s pleased about another consensus statement issued by six different medical academies. “It’s called ‘Female Athlete Issues for the Team Physician,’ and it’s a consensus statement that says if you’re a team physician and you’re taking care of a female athlete, you should be aware of these issues.” That statement was issued by the American Academy of Family Physicians; American Academy of Orthopaedic Surgeons; American College of Sports Medicine; American Medical Society for Sports Medicine; American Orthopaedic Society for Sports Medicine; and the American Osteopathic Academy of Sports Medicine.
Source: Every Day
Date: January - April 2006 Issue