BAL HARBOUR, FLA. — In the 1970s, only about 20,000 girls in the United States were involved in high school sports. Now more than 3 million girls participate in sports at that level, and that means primary care physicians are seeing more sports-related injuries, Jordan Metzl, M.D., said at the annual Masters of Pediatrics conference sponsored by the University of Miami.
In fact, studies suggest sports are the most common source of musculoskeletal problems seen in youngsters, said Dr. Metzl, medical director at the Sports Medicine Institute for Young Athletes, New York.
Girls are particularly prone to certain injuries and problems, including anterior cruciate ligament tears (fourfold increased risk compared with boys), stress fractures, and problems associated with the female athlete triad, which includes amenorrhea, anorexia athletica, and osteoporosis, he said.
Primary care physicians can help prevent or provide early recognition of these sports-related injuries and health problems because they see girls at a young age, often before they become highly competitive, he added.
The following tips are helpful in identifying sports-related problems in teen girls:
▸ Provide education about injury prevention, and screen for things such as delayed menarche and bone health at every opportunity, Dr. Metzl advised.
It helps to keep in mind stages of development. For example, a girl's axis of rotation, which is important in many sports such as ice-skating and gymnastics, can change dramatically during Tanner stage IV-V, and this is the time when disordered eating is most likely to emerge.
▸ Weight loss of more than 5% of body weight in the absence of medical illness, along with excessive fear of obesity and severe calorie restrictions, could be an indicator of anorexia athletica. Primary amenorrhea, gastrointestinal complaints, and compulsive exercise also can suggest this.
▸ Remember the importance of early bone health. Bone mass peaks at age 31 years; osteopenic teens become osteopenic adults, Dr. Metzl said.
To promote good bone health, advise young patients—particularly those who are active in sports—to maintain an intake of 1,500 mg/day of calcium.
A landmark study in the early 1990s showed that young girls randomized to receive a 500-mg supplement of calcium citrate (for an average total of 1,350 mg/day) had a significant (1.3%) increase of 24 g in total body and spine bone mineral density after 18 months, compared with those who did not receive a calcium supplement (and who had an average daily calcium intake of 940 mg), he said (JAMA 1993;270:841–4).
The investigators concluded that this increase could protect against future osteoporotic fractures.
Dr. Metzl also recommends 400 units of vitamin D daily to promote bone health.
When evaluating a patient with an injury or sports-related complaint, consider not only the patient's level of activity, but also biomechanics and bone density, he advised.
It's not enough to say, “Just stay off of it until you feel better,” Dr. Metzl noted.