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Return to Sport: Running Injuries in Student-Athletes: Summary
the last 2 years. For males, screening for signs of low testosterone is important, including loss of facial hair, sexual dysfunction, or loss of morning erections. Similarly, discussing proper sleep hygiene is important in youth athletes. Poor sleep affects every system of your body, including the ability to perceive pain. In youth athletes, specifically, sleeping <8 hours per night was associated with 1.7 times higher chance of injury. Risk Assessment Tools Table 2. Triad Cumulative Risk Assessment (Triad CRA) Six risk factors stratified into low (0), moderate (1), or high risk (2): • Low energy availability • Low BMI • Delayed menarche • Amenorrhea/ oligomenorrhea • Low bone mineral density • Bone stress injury Total score : 0–1: Low risk; 2–5: Moderate risk; 6+ High risk
LEARNING TIP! Nutrition screening for youth athletes may include a food diary and questions regarding energy levels and menstruations (for females).
There are two common tools (Tables 2 and 3) to help with categorizing athletes into low, moderate, and high risk. Those in the low risk category can continue training. Athletes in the moderate risk category require some modifications to their training, diet, or lifestyle and should require some medical clearance to train or compete. Finally, athletes in the high risk category should be restricted from training and competing until other issues are addressed. For females, asking about menstrual cycles can be very beneficial in determining overall energy availability to maintain the endocrine system. Questions should include date of first period, last period, and how often they have occurred over
Table 3. Relative Energy Deficiency in Sport Clinical Assessment Tool (RED-S CAT) High Risk Moderate Risk Low Risk • Eating disorder • Other serious medical disorder • Extreme weight loss techniques • Abnormal electrocardiogram (ECG) • Substantial or prolonged weight loss • Menstrual dysfunction • Prolonged relative energy deficiency • Abnormal lab values (white blood count [WBC], ferritin, testosterone, T3)
• Healthy eating habits • Functioning endocrine system • Healthy bone mineral density • Healthy musculoskeletal system
EXAMINATION
athletes to help determine need for nutritional interventions. Other basic examinations should include range of motion of the lower quarter, including flexibility of hamstrings, quadriceps, hip flexors, and gastrocnemius. Furthermore, screening for systemic hypermobility via the Beighton Scale (score >/= 4).
Basic Examination Basic examination should start with looking at vital signs to determine if further medical help is necessary (e.g., tachycardia, postural hypotension). BMI measurements can be helpful to take to examine due to growth spurts in young
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