My 16-year-old daughter is very involved in a gymnastics club. She practices up to 20 hours a week. I’ve noticed she’s lost a lot of weight, but I thought this was normal for her level of activity. Then she broke a bone in her foot. When they X-rayed her foot, there were signs of early osteoporosis. The doctor has diagnosed her with “female athlete triad.” What is this?

Female athlete triad is a new term used to describe a combination of three things: (1) disordered eating, (2) menstrual problems, and (3) osteoporosis or loss of bone density. When girls are involved in sports such as ballet, figure skating, and gymnastics, there is a lot of pressure to be abnormally thin. Girls may stop eating or change their eating patterns to lose weight.  


This kind of diet and weight loss causes estrogen hormone levels to drop and menstrual cycles to stop. These two problems cause a third problem: bone loss. This puts girls at risk for fractures now and later in life, when more bone loss occurs during menopause.


It is very important for young athletes to receive adequate nutrition and emotional support to avoid these problems. Ask your doctor if there are any programs in your area that may help. Individual counseling may also be a good next step.

Are soccer players more likely to be injured during practice or competition?

Researchers recently looked at the first season of Major League Soccer in the United States to answer this question. There were 237 pro soccer players in the league. Each player spent about 241 hours in practice over the course of the season. That’s eight times the number of hours they spent in competition. Even so, most injuries happened during games.


During practice, players had three injuries per 1,000 hours of playing time. Meanwhile, they had 35 injuries per 1,000 hours of game time. That means players were 12 times more likely to get hurt during games as compared to practice!


One-third of the injuries were so minor they didn’t require any time off from the sport. Most of the remaining injuries kept players off the field no longer than a week. Still, these results show that competition may be more rigorous–and more risky–than practice.

I am 35 and have been playing soccer for years. Am I more likely to get injured now that I’m older?

Not necessarily. Researchers recently reviewed injury reports from the first season of Major League Soccer in the United States. There were 237 players on 10 teams. Players’ ages ranged from 18 to 38. Their average age was 27.


Three hundred ninety-nine injuries were recorded over the course of the season. Most of them resulted in brief or no lapses in playing time. In general, players were more likely to be injured in competition than in practice. But there were no differences between older and younger players in rate or severity of injury. Players’ positions also didn’t make them more prone to injury.


Time and intensity of playing seemed to take a toll over the course of the season, regardless of players’ ages. There were more injuries at the end of the season than at the beginning or middle, though this increase was fairly slight.


If you’re still concerned about injury, talk with a doctor or trainer. He or she may be able to suggest some preventive measures.

How dangerous is soccer when it comes to injuries?

Like most sports, soccer poses some risks. But according to a recent article, the level of risk may be relatively small.


Two hundred thirty-seven athletes participated in the first season of US Major League Soccer. They had roughly six injuries for every 1,000 hours of playing time. Most injuries involved the knee or ankle. Injuries were 12 times more common during games as they were during practice.


Notably, however, one-third of the injuries didn’t result in any loss of playing time. Of the remaining 256 injuries, most (59 percent) put players out for less than a week. Only 13 percent were major injuries that kept players off the field for more than one month.


Obviously, soccer does cause injuries. But according to these figures, pro soccer players aren’t likely to be kept out of the game for long.

I’ve given birth three times. My mother says I’d better do Kegel exercises to avoid incontinence later. Is she right?

Kegel exercises, or squeezing the pelvic floor muscles to stop urinary flow, can help strengthen the pubococcygeal muscle which promotes continence. But a recent study suggests that this isn’t the only way to keep the pelvic muscles in good shape.


Researchers asked women to squeeze their deep abdominal muscles, to see whether this would activate the muscles of the pelvic floor. It did. In fact, women got as much of a contraction in the pelvic floor when they used their abs as when they tried to tighten the pelvic muscles alone.


It doesn’t hurt to do Kegel exercises. But this research suggests that you may strengthen your pelvic floor muscles just by using your abdominals and keeping active. Talk with your doctor about what kind of prevention he or she recommends in your case.

I’ve heard that people with major pelvic trauma may need to have surgery right away. Why is that?

Surgery can stabilize the fractured pelvis. Failing to operate quickly may prevent the area from healing properly. It may also make patients more prone to blood clots in their blood vessels.


A recent study found that patients who developed blood clots after pelvic trauma had about a ten-day delay between their injury and surgery. Meanwhile, patients who had surgery within five days of injury were less likely to develop blood clots.


Blood clots are a very serious condition. They can even be fatal. Operating sooner seems to be one means of prevention. Other treatment, such as using mechanical devices to keep good blood flow, may lower the chances a clot will form.

I am a nurse in a trauma unit. We have a few different kinds of mechanical compression devices for patients to use after pelvic trauma to prevent blood clots. Is there one device that’s better than the rest?

Research isn’t yet clear on this issue. A recent study compared two such compression devices. One gave a low-pressure pulse, first to the calf and then to the thigh. The other gave a high-pressure pulse to the calf and foot. Patients with major trauma to the pelvis wore one of these devices after surgery until they were discharged from the hospital.


The authors thought the high-pressure calf-foot device would be more effective in preventing blood clots than the low-pressure thigh-calf device. Yet there were no major differences between the two, possibly because there weren’t enough patients in the study to show such differences. Patients who had the low-pressure device were a little more likely to have larger clots, but this trend was slight.


What is clear is that either type of device is far better than nothing at all. Without preventive care, the rate of blood clots may be as high as 61 percent with pelvic trauma. In contrast, the rate of blood clots in this study was 14 percent overall.

My son is involved in water polo and track. He recently broke his arm in an accident which made me wonder. Is one sport better for bones than the other?

One recent study found that overall bone density was better in impact sport athletes (those who play basketball, tennis, and so on) when compared to water sport athletes. No other differences were found between these two groups. However, both groups of athletes showed better bone health when compared to other kids the same age who weren’t physically active.

What is the difference between an autograft and an allograft?

An autograft is tissue taken from one part of a patient’s body in order to repair or replace injured tissue in another part of the same patient’s body. An allograft is tissue taken from one patient (the donor) to be used in another, such as for a heart or kidney transplant.

I recently read that hormone and growth levels in swimmers are less than in basketball players or runners. Our swim-team workouts are much more strenuous than the workouts for these other sports. What gives?

Some researchers have found higher levels of testosterone in athletes who do impact sports (running, basketball) compared to athletes in water sports. But other studies have not confirmed this difference. Research has also failed to show a difference between these two groups of athletes in regard to growth and development.

I am a sophomore in high school. My friends and I don’t play sports. We seem to be much smaller than the “jocks” our age. Is this just a coincidence?

There is a correlation between physical activity and physical development in young men your age. A recent study found that boys involved in sports of any kind (swimming, tennis, football) were taller, heavier, and leaner than their less physically active peers. They also had better bone mineral content.


Perhaps you and your friends could get your own sports group going. The study made no distinction between those who excel at sports versus those who were just out there trying! Your efforts to become more physically active can improve the health of your bones today, establishing a better reserve of bone for your future years.

I’ve been a baseball fan for years. Is it my imagination, or are more players out of the game due to injuries now than ever before?

According to a recent study, you’re not imagining things. Researchers looked at injuries in Major League Baseball between 1989 and 1999. Results showed that the number of injuries has actually increased over time. And these injuries tend to keep players out of the game longer.


Why the increase? There are several possibilities. One is that sports medicine isn’t working as well as expected. Or maybe some kinds of injuries have decreased while others are still on the rise.


A few other changes also merit consideration. For instance, players who would have already retired in the old days are still playing the game. These athletes may be more prone to injury. Also, players with severe injuries may be returning to the sport more quickly, with a higher risk of re-injury.


More research is needed to learn about the increase in baseball injuries and what to do about it.

Should I use heat or ice for the muscle I strained last night?

Ice is generally prescribed in the acute stages of healing, the period occurring right after the onset of pain or injury and lasting up to three days. The cold temperature makes the blood vessels in the sore area vasoconstrict (become narrower), assisting with the initial stages of healing. Putting cold on the sore muscle is known to ease pain, but it doesn’t always take away swelling. If the temperature is too cold, the body may be triggered to actually pump extra blood to the sore spot, making the swelling worse. To prevent this, layer a towel over your skin before applying the cold treatment. In general, cold treatments can include cold packs or ice bags, which are generally put on the sore muscle for 10 to 15 minutes.

My older sister who is in college (and therefore thinks she knows everything) told me my bones are constantly rebuilding themselves and that now is the time to get lots of calcium. (I’m 16.) Should my parents get their money back, or did her college anatomy class teach her something?

No refund necessary–so far. By the time you’re 18, you should have about 92 percent of the bone mineral content for all the bones in your body. And though your bones are constantly remodeling themselves, they can’t add much to what has been added in these crucial teen years. After about 30 or so, the amount of bone you’ve stored will begin to steadily drop. So be sure you’re getting the right amount of calcium now. Your bones will thank you later in life.

I’ve been taking birth control pills for a year. My mom is going through “the change” and has started taking some kind of hormone, too. It has helped her get back to normal. (Mr. Hyde is definitely making fewer appearances.) Besides that, she said it will help keep her bones strong. Will my pills do that too? If it makes any difference, I am a long distance runner. (I heard this is supposed to build strong bones.)

Recent evidence suggests that the pill may have a negative effect on bone health. If you are in your late teens or early twenties, you are still building bone. One study has shown that women in this age group who exercised while taking the pill ended up with less improvement in bone density than women who exercised and didn’t use the pill. Normally, exercise is helpful for improving bone density, so this finding was surprising. However, taking 1,000 mg of calcium per day may counteract this negative effect of the pill on bone density. The verdict is still out.

I am about 50 pounds overweight, and it’s killing my knees. I’m trying to loose weight. I swim laps three or four days a week. I usually swim for 45 minutes but have to admit sometimes my laps lack “oomph.” Some workouts I swim twice as many laps in that 45 minutes as I do on the days when my energy is low. Does the added intensity make much difference?

There are two parts of calorie burning with exercise: those burned during exercise and those burned after exercise. You burn close to the same number of calories swimming one mile fast or slow. However, the calories burned after exercise respond more to how intensively you swam, rather than how long. The calories you burn after exercise are mostly fat, because your body is attempting to replace sugars used during exercise. To do this, it turns to fat calories to restock energy stores. Take this for what it’s worth. The most important thing is that you are consistent with your exercise program.

I work for a construction company that builds skyscrapers. This involves a lot of heavy lifting and hard work. I’m the only woman on the crew and have a hard time keeping up with the guys. (Most are twice my weight.) I keep in good shape by running and stretching regularly. Any other suggestions?

Have you tried resistance training? This is the key to closing the physical gender gap in a work setting like yours. Seek the help of a competent trainer at your gym, someone who can guide you in a strength training program. The gains you make will likely help you perform your job duties more easily, while reducing your chances of getting hurt.

For about a year now, I’ve been walking and occasionally lifting weights. If I burn about 300 calories during a workout, then a single candy bar would cancel the benefits of my workout. Still, I’ve managed to take off 12 pounds in the last year without changing my diet much. How is that possible?

Exercise offers tremendous advantages. It can improve your strength, lower your risk for heart disease and diabetes, and improve your mental outlook and agility. Exercise also burns calories. This calorie-burning effect continues even after you’ve stopped exercising. One study of female weight lifters showed that an hour after the women exercised, they were still burning many more calories than they were before exercising. And after 90 minutes, they were burning much more fat (79 percent more) than normal. So when you exercise, you continue reaping the benefits for some time afterward. Keep up the good work (but watch those candy bars)!

What is “endurance training?”

Endurance training is physical training that requires prolonged effort. Unlike repeated sprinting, which eventually causes you to have to stop and catch your breath, endurance activities allow the body to keep enough oxygen going to the muscles so the activity can be done for long periods.


Endurance training conditions muscles to become better able to obtain the nutrients and oxygen they need from the blood. Athletes who use endurance training show an improved ability to get more blood to the working muscles with each heart beat. And the muscles are able to make better use of the oxygen in the blood. The end result is improved efficiency, leading to better performance. Examples of endurance sports include long-distance running, cycling, and swimming.

The pain and swelling in my leg have gotten worse since I strained my calf muscle yesterday. Is it true that wrapping it and keeping the leg elevated can help the swelling go down?

For anything more than a simple strain, you should see your doctor or physical therapist before treating it yourself. Wrapping the sore muscle with an elastic wrap can often provide some relief from pain and swelling. Even though there are no formal studies to confirm the benefits, most health care providers would recommend using these measures because they seem to help with pain and swelling. Be sure not to put the wrap on too tightly. If you feel extra throbbing or pain and your toes start to feel cold, it could mean you’ve got the wrap on too tightly.