EDUCATIONAL OBJECTIVES

The learner should, at the completion of the chapter, be able to perform the following:

• Recognize the signs and symptoms of nutritional/eating disorders among athletes.
• Understand common cold and respiratory tract infections.
• Identify the various skin conditions that are common in athletic training situations.
• Identify the common medical illnesses that are seen in athletic training.

What and when an athlete eats can affect performance. Common advice is that an individual should wait an hour or more after eating to exercise. Although athletes with full stomachs will not necessarily have performance problems, there is some truth in this advice. It is a fact that when there is food in the stomach, more blood is required for digestion and that during physical activity, the active muscles need more blood. Therefore, unless an adequate amount of blood can be pumped out in order to fulfill both needs, either the digestion process or the working muscles will be in short supply of blood. This can cause stomach cramping, other digestive upsets, and overall muscle weakness.

Athletes vary in their ability to exercise after eating (or without eating). Some complain of becoming dizzy or weak during practice unless they have a snack beforehand. Eating a substantial, well-balanced meal can prevent this. Normal gastric emptying (from the stomach into the small intestine) can take from one to four hours, depending on the composition of the meal. High carbohydrate and liquid meals will pass through the digestive system more quickly than meals high in fats and solids.

Another factor in digestion rate is how well food is chewed. The stomach has to work harder on food that hasn't been adequately chewed, and it holds it for a longer period of time. This often causes a feeling of fullness or bloating.

If an athlete eats a good meal and still experiences hunger pangs or weakness during and after practice, they may need an extra snack, as long as the feeling of having food in the stomach does not interfere with their athletic performance. However, they should select small portions of foods that are not spicy or bulky and that are easily digested. Pre-activity foods should exclude the following items:

• Fatty foods. These are digested slowly and can interfere with efficiency in exercise.
• Gas forming foods that can cause discomfort and detract from physical abilities.
• Salt tablets; the average diet already contains enough salt.
• Special "magic" foods.
• Nutritional supplements can be costly and potentially dangerous.

Remember that the total diet consumed during the days before the event is far more important than the meal eaten immediately prior to strenuous exercise. For futher diet and nutrition information you can visit http://www.nal.usda.gov/fnic/.

Anorexia Nervosa

This is one of the two eating disorders most commonly associated with athletics. A person refusing to eat or not eating enough to maintain normal body functions characterizes this disorder. This is commonly seen in the sports that have a high body image profile. Although the disorder can occur with any athlete, the sports most affected include, but are not limited to, cheerleading, gymnastics, cross country, wrestling, figure skating, and other sports that have weight classifications or weight limitations.

Bulimia

This is the second of the two eating disorders commonly associated with participation in sports. Overeating (binge) and then vomiting (purge) characterize this particular disorder. The athlete will consume large quantities of food and immediately purge the food. This routine by the athlete is an attempt to gain essential energy requirements, but not the weight associated with the food. A person qualified in psychological disorders can best handle this psychological problem. The best plan of action by the athletic trainer is to refer the athlete to the most qualified health care provider.

Female Triad

This gender specific condition involves components of disorder eating, the absence of menstruation (amenorrhea), and loss of bone density (osteoporosis). The three separate conditions combine to give rise to this very serious and long term disorder referred to as the female triad. When a female exhibits the signs associated with disorder eating, prompt referral is recommended.

Food and Vitamin Supplements

While food is important for both general health and athletic performance, the nutritional needs of athletes are no different from those of their non-athletic peers. Misinformation concerning the role of nutrition and athletics can be confusing to the coach and athlete, sometimes leading to the improper and unnecessary use of food and vitamin supplements. There are no "super foods" or wonder diets, and following dietary plans based on these concepts can result in an unbalanced diet and may actually interfere with peak athletic performance.

Besides being an unnecessary expense, megadoses of vitamin supplements taken inappropriately can also lead to nutritional imbalances and can endanger the athlete's health. A balanced diet is the best way to give the body pep and energy. Thus, athletes should follow a nutritious diet that emphasizes a variety of high-carbohydrate, lowfat foods.

SKIN CONDITIONS

There are a number of skin conditions that the athletic trainer will be exposed to during a typical sport season. These conditions will range from very minor to the medical emergency. The establishment of appropriate protocol for the handling of all skin conditions will make your job easier and the care given to your athletes more complete. As with all conditions in which bodily fluids are present, you need to utilize latex gloves and follow the set of universal precautions in order to safeguard yourself in these matters. Additionally, the disposal of biohazardous waste must be done according to accepted guidelines of the local, state, and federal agencies.

Herpes Simplex: A common problem in sports, particularly among wrestlers, is the skin infection called herpes simplex. The virus, which can enter the body through breaks in the skin, can produce painful lesions anywhere on the body. Most often, a lesion will appear as a cold sore on the lip. Even after the disease subsides, the athlete will continue to be a carrier of the virus and will be susceptible to future attacks. The danger of skin diseases such as herpes simplex is that they are highly contagious and can spread easily and rapidly to other members of the team. Another skin infection, impetigo, is similar in appearance to herpes simplex, but is much more contagious. Treatment and isolation can help prevent the infection of other athletes. The student athletic trainer should look for skin lesions on athletes. If they exist, medical referral to a physician is requested and you should advise the coaching staff to keep equipment (especially wrestling mats) clean and disinfected.

Fungus Infections: Athlete's Foot (Tinea Pedis) The spread of athlete's foot depends mainly on the individual athlete's susceptibility. But, as a team, your athletes can help prevent athlete's foot from spreading by following this program:

• Powder the feet daily, using a standard fungicide.
• Dry the feet thoroughly after every shower, especially between and under the toes.
• Keep athletic shoes and street shoes dry by dusting them with powder daily.
• Wear clean sports socks and street socks daily.
• The shower and dressing rooms should be cleaned and disinfected daily.
• Athletes should use shower shoes.

• Keep the feet as dry as possible through the frequent use of foot powder.
• Wear clean, sports socks to avoid re-infection, changing them daily.
• Use specific medicated fungicide.

Powders, sprays and creams are used for treating jock itch but avoid medications that are irritating or tend to mask the symptoms of a groin infection. Infections that do not respond to normal treatment should be referred to the team physician.

COMMON COLD AND RESPIRATORY TRACT INFECTIONS

Colds and other respiratory tract infections are common among athletes and can sideline an entire team if proper precautions are not taken. Contrary to what many believe, colds are primarily transmitted by touch, not by coughing and sneezing. These viruses are able to live for several days on hard surfaces, such as doorknobs, countertops, and equipment. All an athlete has to do to become infected is touch an infected surface and then transfer the virus to the respiratory system by rubbing the eyes or nose or touching the mouth. As a student athletic trainer, you should remind athletes to be especially conscious about keeping their hands clean and keeping them away from the eyes and nose. Also, avoid the use of a community towel or drinking cup, as viruses can live on them as well. Once an athlete has contracted a cold, there is no magic cure. Rest and light eating will generally be all that is necessary or helpful in treating the virus. Aspirin or non-aspirin pain relievers can minimize aching and discomfort by lowering fever. However, as a student athletic trainer, you are not the one who should dispense these medications. The athlete must be fully recovered from a cold before returning to activity. Returning too soon can cause the virus to linger and possibly turn into a more serious illness.

COMMON MEDICAL CONDITIONS/ILLNESSES

In addition to skin conditions, the athletic trainer will be expected to evaluate for medical referral a number of medical illnesses. Once again, the range on these illnesses will be from mild to severe. The athletic trainer should realize his/her individual limitations and refer to the most appropriate health care provider when there is doubt as to the condition or treatment.

Hypertension (High Blood Pressure): Sustained elevated blood pressure, systolic 140, diastolic 90 in adults.

Blister (Bullae): A bleb or vesicle containing fluid (serum, blood, pus) sometimes caused by pressure. A collection of fluid below the epidermis.

Burn: Tissue injury resulting from excessive exposure to thermal, chemical, electrical, or radioactive agents. Classified as:

First Degree--Superficial, damage limited to outer layer of the epidermis. Characterized by erythema, hyperemia, tenderness, pain.

Second Degree--Damage extends through the epidermis and into the dermis, but not of sufficient extent to interfere with regeneration of epidermis. Vesicles present.

Third Degree--Both the epidermis and dermis are destroyed with damage extending into the underlying tissues. Tissue may be charred or coagulated.

Shock: A state of collapse resulting from acute peripheral circulatory failure. Characterized by blood pressure less than 90/60. May be caused by decreased volume, vasodilation. Shock is a medical emergency!

Asthma: An inflammatory respiratory condition characterized by bronchospasm (wheezing) and shortness of breath (dyspnea). This condition may be exercise induced.

Hyperventilation: Increased inspiration and expiration of air as a result of increase in rate or depth of respiration or both. Leads to decreased CO2, increased O2,, respiratory alkalosis. Characterized by shortness of breath, lightheadedness, perioral numbness.

Epilepsy: Recurrent disturbances of brain function that may be manifested as seizures, loss of consciousness, or psychic disturbances.

Amenorrhea: Cessation of the menstrual cycle and can be primary (never starting) or secondary (start and then stop for no reason). Often seen in athletes (cross country, gymnasts, or swimmers) due to training, diet, stress, pregnancy.

Dysmenorrhea: Painful or difficult menstruation.

Primary--Beginning with first period. No known etiology.
Secondary--Originally normal, changed due to pathologic state.

Athletes are not immune to the various eating disorders commonly associated with our culture. Health care providers must be able to recognize that an athlete has a problem and provide that athlete with the proper referral. Eating disorders must be treated as any other physical disease and should not be dismissed as a minor issue. Understand that the government regulates medications, but vitamins and food supplements are not held to the same high standards. Food supplements must be scrutinized prior to consumption and not relied on to replace good nutrition. Recognition and management of common medical conditions/illnesses is critical.

REFERENCES

Hegarty, V. (1988) Decisions in Nutrition. St. Louis: Mosby.

Lohman, T. (1992) Advances in Body Composition Assessment. Champaign: Human Kinetics.

McArdle, W., Katch, F. & Katch, V. (1991) Exercise Physiology: Energy, Nutrition, and Human Performance. Philadelphia: Lea & Febiger.

Mellion, M., Walsh, W. & Shelton, G. (1992) The Team Physician's Handbook. Philadelphia: Hanley & Belfus.

Porth, C. (1994) Pathophysiology. Philadelphia: Lippincott.

Price, S. & Wilson, L. (1992) Pathophysiology: Clinical Concepts of Disease Processes St. Louis: Mosby

Sizer, F. & Whitney, E. (1997) Nutrition: Concepts and Controversies (7^th ed.) Belmont, CA: Wadsworth.

Completion:

1. Most fungus infections grow in an environment that is ____, _____, and ____.
2. The common cold virus is transmitted primarily by ________.
3. Pre-activity foods should exclude the following items:
4. The gender specific condition called "Female Triad" involves what three components.

Short Answer:

1. List food that should be excluded from a pre-activity diet.

2. How are colds primarily transmitted?

3. List three ways to help prevent a cold virus from spreading among team members.

4. What can happen if an athlete returns to activity before fully recovering from a cold?

5. Why is Herpes Simplex a serious skin disease within an athletic team?

6. How would you care for athlete’s foot?