chapter 23 general medical conditions and additional health concerns
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Chapter 23: General Medical Conditions and Additional Health Concerns. Like everyone athletes can become ill It is important to recognize these conditions early and refer them for the appropriate medical attention

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Like everyone athletes can become ill
  • It is important to recognize these conditions early and refer them for the appropriate medical attention
  • The majority of these illnesses and conditions will require referral to a physician for care
viral infections
Viral Infections
  • Virus
    • Small organism that can live only in a cell
    • Upon entering cell it may immediately trigger a disease (influenza) or remain dormant (herpes)
    • Can damage host cell by blocking normal function and using metabolism for own reproduction
    • Virus ultimately destroys cell
  • Cause of Condition
    • Herpes simplex – viral infection that tends to occur in the same location (mucous membranes)
      • Type I (cold sore) Type II (genitals)
    • Herpes zoster
      • Appears in specific pattern on body (innervated by specific nerve root
      • Re-appearance of chicken pox virus
Signs of Condition
    • Early indication = tingling or hypersensitivity in an infected area 24 hours prior to appearance of lesions
    • Local swelling followed by outbreak of vesicles
    • Heal in generally 10-14 days
  • Care
    • If an athlete has an outbreak they should be disqualified from competition due to contagious nature of condition
    • Utilize universal precautions when dealing with herpes virus
    • Use of antiviral drugs can reduce recurrence and shorten course of outbreak
verruca virus and warts
Verruca Virus and Warts
  • Varied of forms exist
    • verruca plana (flat wart), verruca plantaris (plantar wart), and condyloma acuminatum (venereal wart)
  • Different types of human papilloma virus have been identified
    • Uses epidermal layer of skin to reproduce and grow
  • Wart enters through lesion in skin
Signs of Condition
    • Small, round, elevated lesion with rough dry surfaces
    • Painful if pressure is applied
    • May be subject to secondary bacterial infection
  • Care
    • If vulnerable, they should be protected until treated by a physician
    • Use of electrocautery, topical salicylic acid or liquid nitrogen are common means of managing this condition
bacterial infections
Bacterial Infections
  • Bacteria are single celled micro-organisms
  • Disease development
    • Bacterial pathogen enters host, growth of bacteria and production of toxic substances occurs and host attempts to fight infection
  • Two types
    • Staphylococcus
    • Streptococcus
Impetigo Contagiosa
      • Caused by streptococci
      • Spread through close contact
  • Furuncle (Boils)
      • Infection of hair follicle that results in pustule formation
      • Generally the result of a staph infection
      • Become large and painful
  • Folliculitis
      • Inflammation of hair follicle around face/neck or in the groin
Symptoms of Condition
    • Mild itching and soreness followed by eruption of small vesicles and pustules that rupture and crust
    • Exhibits signs of inflammation
      • Tenderness, warmth, redness and swelling
  • Care
    • Cleansing and topical antibacterial agents
    • Systemic antibiotics
    • Pus filled lesions should be drained
    • Minimize the chances of the infection to spread to others
Methicillin-Resistant Staphylococcus Aureus (MRSA)
    • Cause
      • Strain of bacteria that is resistant to methicillin and other antibiotics
      • Often times occurs in patients in hospital that are already ill, have open wounds/bed sores/burns
      • Can also infect individuals outside of the hospital
    • Symptoms
      • Broad range of symptoms
      • Typically redness, tenderness and swelling
      • May carry MRSA without having symptoms
    • Care
      • May require much heavier dose of antibiotics
      • Some infections can only be treated with intravenous antibiotics (requires several weeks of treatment)
fungal infections
Fungal Infections
  • Cause of Condition
    • Ringworm fungi (tinea)
    • Cause of most skin, nail and hair fungal infections
  • Tinea of the Groin (tinea cruris)
    • Signs and Symptoms
      • Mild to moderate itching and found bilaterally
      • Brownish or reddish lesion resembling outline of butterfly in groin
    • Treat until cured
    • Will respond to many of the non-prescription medications
    • Medications that mask symptoms should be avoided
    • Failure to respond to normal management may suggest a non-fungal problem (such as bacteria) and should be referred to a physician
    • May require additional topical medications and oral prescriptions
Athlete’s Foot (tinea pedis)
    • Cause of Condition
      • Most common form of superficial fungal infection
      • Webs of toes may become infected by a combination of yeast and dermatophytes
    • Signs of Condition
      • Extreme itching on soles of feet, between and on top of toes
      • Appears as dry scaling patch or inflammatory scaling red papules forming larger plaques
      • May develop secondary infection from itching and bacteria
    • Care
      • Topical antifungal agents and good foot hygiene
respiratory conditions
Respiratory Conditions
  • The Common Cold
    • Cause of Condition
      • Attributed to filterable virus that produces infection in upper respiratory tract in susceptible individual
      • Susceptible individual
        • Physical debilitation from overwork or lack of sleep
        • Chronic inflammation from local infection
        • Inflammation of nasal mucosa from allergy or from breathing in foreign substance
        • Sensitivity to stress
Sign of Condition
    • Begins w/ scratchy, sore throat, stopped-up nose, watery discharge and sneezing
    • Some may experience a fever
    • Various aches and pains
    • Nasal discharge becomes thick and discolored from inflammation
  • Care
    • Symptomatic treatment (may last 5-10 days)
    • Non-prescription cold medications
    • Eat a balanced diet, consume 64 oz. of water
    • Avoid emotional stress and extreme fatigue
    • Cause of Condition
      • Stems from upper respiratory infection caused by a variety of bacteria
      • Inflammation of nasal sinuses
    • Sign of Condition
      • Nasal mucous swell and block sinuses
      • Painful pressure occurring from accumulation of mucus
      • Skin over sinus may be swollen and painful to the touch
      • Headache and malaise; purulent nasal discharge
    • Care
      • If infection is purulent, antibiotics may be warranted
      • Nasal vasoconstrictor may be helpful with drainage
Pharyngitis (sore throat)
    • Cause of Condition
      • Result of postnasal drip
      • May be virus or streptococcus bacteria
    • Symptoms of Condition
      • Pain w/ swallowing, fever, inflamed and swollen glands, malaise, weakness and fever (occasionally)
      • Throat may appear dark red and swollen with mucous membranes coated
    • Care
      • Throat culture
      • Topical gargles and rest
      • Antibiotic therapy may be prescribed by a physician
    • Cause of Condition
      • Acute inflammation and bacterial infection of tonsil epithelium
    • Sign and Symptoms
      • Tonsil appear red, swollen, w/ yellow exudate in pits
      • Pain w/ swallowing, high fever and chills, headache and neck pain
      • Sinusitis, otitis media, tonsillar abscesses may also develop
    • Care
      • Culture to check for streptococcal bacteria and antibiotics for 10 days
      • Gargling w/ saline water, liquid diet, and antipyretic medication
      • Frequent bouts of tonsillitis may necessitate removal
Influenza (Flu)
    • Cause of condition
      • Occurs in various forms as an annual epidemic
      • Caused by a virus
    • Symptoms of Condition
      • Fever (102-103 degrees F), chills, cough, headache, malaise, and inflamed respiratory mucous membrane w/ non-productive cough, watery eyes
      • General aches and pains, headache becomes worse
      • Weakness, sweating, fatigue may persist for many days
    • Care
      • Bed rest and supportive care
      • Steam inhalation, cough medicines, and gargles
      • Flu prevention – avoid contact with someone that has it
Seasonal Allergies (Rhinitis)
    • Cause of Condition
      • Hay fever from airborne pollens and in some cases fungal spores
    • Symptoms of Condition
      • Eyes, throat, mouth and nose begin to itch, followed by watering eyes, sneezing and clear watery discharge
      • Sinus type headache, emotional irritability, difficulty sleeping, red & swollen eyes and nasal mucus membranes, and wheezing cough
      • May also experience adverse allergic reactions
    • Care
      • Oral antihistamines and decongestants
Acute Bronchitis
    • Cause of Condition
      • Infectious winter disease that follows common cold or viral infection
      • Fatigue, malnutrition or becoming chilled could be predisposing factors
    • Sign of Condition
      • Upper respiratory infection, nasal inflammation and profuse discharge, slight fever, sore throat and back muscle pains
      • Fever lasts 3-5 days while cough can last 2-3 weeks
      • Yellow mucus indicates infection
      • Pneumonia can complicate condition
    • Care
      • Avoid sleeping in cold environment, avoid exercise in extreme cold w/out protection
      • Rest until fever subsides, drink 3-4 quarts of water daily, ingest antipyretic analgesic, cough suppressant, and antibiotic
Bronchial Asthma
    • Cause of Condition
      • Caused by viral respiratory tract infection, emotional upset, changes in barometric pressure or temperature, exercise, inhalation of noxious odor or exposure to specific allergen
    • Sign of Condition
      • Spasm of smooth bronchial musculature, edema, inflammation of mucus membrane
      • Difficulty breathing, may cause hyperventilation resulting in dizziness, coughing, wheezing, shortness of breath and fatigue
    • Care
      • Prevention – determine causative factors
      • Use of prescribed inhalers are effective in acute cases
Exercise-Induced Bronchial Obstruction (Asthma)
    • Cause of Condition
      • Brought on by exercise w/ exact cause unknown
        • Loss of heat and water (airway reaction), eating certain foods, sinusitis may also trigger
    • Sign of Condition
      • Airway narrowing due to spasm and excess mucus production
      • Tight chest, breathlessness, coughing, wheezing, nausea, hypertension, fatigue, headache, and redness of skin
EIA (continued)
    • Care
      • Regular exercise, appropriate warm-up and cool down, w/ intensity graduated
      • Inhaled bronchodilators may be useful
      • Exercise in warm, humid environment
      • Coaches should be sure to remind athletes to have inhaler with them at all times
    • Cause of Condition
      • Some athletes develop food idiosyncrasies which cause them distress after eating
      • Reactions before competition
      • Emotional stress, esophageal and stomach spasms, or inflammation of mucous linings in stomach and esophagus
    • Signs of Condition
      • Increased HCl secretion, nausea, and flatulence
    • Care
      • Elimination of irritating foods, development of regular eating habits, avoidance of anxieties that cause gastric distress
    • Cause of Condition
      • Result of some irritation, most often in the stomach
      • Stimulates vomiting center of the brain, causing a series of forceful diaphragm and abdominal contractions to compress stomach
    • Care
      • Antinausea medications should be administered
      • Fluids to prevent dehydration (by mouth or intravenously depending on the situation)
Food Poisoning (Gastroenteritis)
    • Cause of Condition
      • Ranges from mild to severe
      • Caused by infectious microorganisms that contaminate food particularly during warm weather and periods of improper refrigeration
    • Signs of Condition
      • Nausea, vomiting, cramps, diarrhea and anorexia
      • Usually subsides within 3-6 hours (staph. infection)
    • Care
      • Rapid replacement of fluids lost
      • Bed rest in all but mild cases
      • Nothing should be given by mouth if vomiting and nausea persist
      • Re-introduce easy food first
      • Physician referral is necessary
    • Cause of Condition
      • Acute or chronic
      • Caused by a problem in diet, inflammation of the intestinal lining, GI infection, ingestion of certain drugs and psychogenic factors
    • Signs of Condition
      • Abnormal, loose stool or passage of fluid, unformed stool
      • Abdominal cramps, nausea, vomiting and frequent elimination of stools
      • Extreme weakness caused by dehydration
Diarrhea (continued)
    • Care
      • Determine cause (irritant, infection, or emotional upset)
      • ATC can treat less severe cases by omitting certain foods from athlete’s diet
      • Utilizing over the counter medications
      • Have athlete consume bland food that does not irritate system
      • The BRAT diet (bananas, rice, apples and toast) has also been recommended
      • Continue to hydrate
    • Cause of Condition
      • Failure of the bowels to evacuate feces
      • Causes include, lack of abdominal tone, insufficient moisture in the feces, lack of roughage and bulk in diet to stimulate peristalsis, poor bowel habits, nervousness, anxiety, and overuse of laxatives and enemas
    • Signs of Condition
      • Feeling of fullness, with occasional cramping and pain in lower abdomen
    • Care
      • Regulate eating patterns (cereal, fruits, vegetables)
      • Avoid medications unless prescribed by a physician
Gastrointestinal Bleeding
    • Cause of Condition
      • Distance running, gastritis, iron-deficiency anemia, ingestion of aspirin or NSAID’s, stress, bowel irritation, colitis
    • Care
      • Refer to physician is bleeding is occurring
Infectious Mononucleosis
    • Cause of Condition
      • Virus that has incubation period of 4-6 weeks
      • Transmitted through saliva
    • Sign and Symptoms
      • First 3-5 days -severe fatigue, headache, loss of appetite and myalgia
      • Days 5-15 - fever, swollen lymph nodes and sore throat (50% will experience enlarged spleen)
      • Possible jaundice, skin rash, puffy eyelids
    • Care
      • Supportive symptomatic treatment
      • Acetaminophen for headache, fever and malaise
      • Resume training after 3 weeks after onset if spleen not markedly enlarged/painful, athlete is afebrile, liver function is normal, and pharyngitis is resolved
Iron Deficiency Anemia
    • Cause of Condition
      • Prevalent in menstruating women and males age 7-14
      • Three things occur during anemia
        • Small erythrocytes
        • Decreased hemoglobin
        • Low ferritin concentration (compound that contains 23% iron)
      • GI loss of iron in runners is common
      • Aspirin and NSAID’s may cause GI bleeding and iron loss
      • Menstruation accounts for most iron lost in women
      • Vegetarian athletes may also be deficient in intake relative to iron loss
Sign of Condition
    • First stage of deficiency, performance declines
    • Athlete may feel burning thighs and nausea from becoming anaerobic
    • May display some mild impairments in maximum performance
  • Care
    • Eat a proper diet including more red meat or dark poultry; avoid coffee and tea (hamper iron absorption)
    • Consume vitamin C (enhance absorption)
    • Take supplements (dependent on degree of anemia)
Sickle-Cell Anemia
    • Cause of Condition
      • Hereditary hemolytic anemia - RBC’s are sickle or crescent shaped (irregular hemoglobin)
      • Less ability to carry oxygen, limited ability to pass through vessels, causing clustering and clogging of vessels (thrombi)
    • Signs of Condition
      • Fever, pallor, muscle weakness, pain in limbs
      • Pain in upper right quadrant indicating possible splenic infarction
      • Headaches and convulsions are also possible
    • Care
      • Provide anticoagulants and analgesics for pain
diabetes mellitus
Diabetes Mellitus
  • Most common forms are Type I (insulin-dependent diabetes mellitus) and Type II (non-insulin-dependent diabetes mellitus)
  • Cause of Condition
    • Result of interaction between physical and environmental factors
    • Involves a complete or partial decrease in insulin secretion
Insulin Shock
    • Cause of Condition
      • Occurs when the body has too much insulin and too little blood sugar
    • Sign and Symptoms
      • Tingling in mouth, hands, or other parts of the body, physical weakness, headaches, abdominal pain
      • Normal or shallow respiration, rapid heart rate, tremors along with irritability and drowsiness
    • Care
      • Adhere to a carefully planned diet including snacks before exercise
      • Must determine food and insulin intake during questioning
Diabetic Coma
    • Cause of Condition
      • Loss of sodium, potassium and ketone bodies through excessive urination (ketoacidosis)
    • Sign and Symptoms
      • Labored breathing, fruity smelling breath (due to acetone), nausea, vomiting, thirst, dry mucous membranes, flushed skin, mental confusion or unconsciousness followed by coma.
    • Care
      • Early detection is critical as this is a life-threatening condition
      • Insulin injections may help to prevent coma
  • Defined as recurrent paroxysmal disorder of cerebral function characterized by periods of altered consciousness, motor activity, sensory phenomena or inappropriate behavior caused by abnormal cerebral neuron discharge
  • Not a disease
    • Symptom manifested by a large number of underlying disorders
  • Cause of Condition
    • For some forms of epilepsy there is genetic predisposition
    • Brain injury or altered brain metabolism
Sign of Condition
    • Periods of altered consciousness, motor activity, sensory phenomena or inappropriate behavior caused
    • May last 5-15 seconds (petit mal seizure) or longer (grand mal seizure)
    • Include unconsciousness and uncontrolled tonic-clonic muscle contractions
  • Care
    • Individuals that experience daily or weekly seizures should be prohibited from participating in collision sports (blow resulting in unconsciousness could result in serious injury)
    • Must be careful with activities involving changes in pressure
    • Can be managed with medication
Care (continued)
    • Athlete may experience undesirable side effects – care giver must be aware
    • Be sure to have individual sit or lie down
    • Remain composed
    • Try to cushion athlete’s fall
    • Keep athlete away from surrounding objects that could cause injury
    • Loosen restricting clothing
    • Do not force anything between the athlete’s teeth
    • Cause of Condition
      • Inflammation of meninges surrounding spinal cord and brain
      • Caused by infection brought on by meningococcus bacteria
    • Sign and Symptoms
      • High fever, stiff neck, intense headache, sensitivity to light and sound
      • Progress to vomiting, convulsions and coma
Meningitis (continued)
    • Care
      • Cerebrospinal fluid must be analyzed for bacteria and WBC’s.
      • If bacteria is found isolation is necessary for 24 hours (very contagious), antibiotics must be administered immediately
      • Monitored closely in intensive care unit
      • Ultimately, athletes should not share water bottles because of chance of transmitting meningitis
  • Cause
    • Primary hypertension accounts for 90% of all cases with no other disease association
    • Secondary hypertension is associated with kidney disorder, overactive adrenal glands, hormone-producing tumor, narrowing of aorta, pregnancy and medications
    • Long term cases increase the chances of premature mortality and morbidity due to coronary artery disease, congestive heart failure and stroke
Sign and Symptoms
    • Primary hypertension is generally asymptomatic until complications arise
    • May cause dizziness, flushed appearance, headache, fatigue, epistaxis and nervousness
  • Care
    • The upper range of normal blood pressure is 120/80
      • Risk of heart disease or stroke begins to rise at pressures over 115 and 75
      • Risk continue to double for every 20 or 10mm/Hg increase
      • Normal = <120/<80
      • Pre-hypertension = 120-139/80-89
      • Stage 1 hypertension = 140-159/90-99
      • Stage 2 hypertension = at or greater than 160/ at or greater than 100mm/Hg
Medication is not recommended for those with pre-hypertension unless other conditions (diabetes, kidney dysfunction) are present
  • Lifestyle changes may be necessary
    • Exercise
    • Diet/ weight loss
    • Quit smoking
    • Decrease alcohol consumption
  • Those that have stage 1 or 2 hypertension should be on medication, in addition to taking the aforementioned precautionary steps
common contagious viral diseases
Common Contagious Viral Diseases
  • Athlete exhibiting infectious disease should be referred to physician for treatment
  • Coach should be aware of certain signs
  • See Table 23-2
testicular cancer
Testicular Cancer
  • Cause
    • Most common form of cancer in males 15-34 year
    • Cause is not known
    • Potential risk factors include
      • Past medical history of undescended testicle, abnormal testicular development, low levels of male hormones, sterility, development of previous testicular cancer, family history of testicular cancer
    • Typically only affects one testicle

Signs & Symptoms

    • Pain and discomfort in testicle or scrotum
    • Lump or enlarged testicle
    • Swollen or collection of fluid in scrotum; feeling of heaviness in scrotum
    • Dull ache in groin or abdomen
    • Unexplained fatigue
    • Unexplained enlargement of breast
  • Care
    • Highly treatable when diagnosed early
    • Several treatments
      • Surgery, chemotherapy, radiation
      • Regular self exams can help to identify growths early
breast cancer
Breast Cancer
  • Cause
    • Most common form of cancer in women and can occur at any age
    • Family history of breast cancer is a major risk
    • Hormonal influences play a significant role in the development of breast cancer
    • Often metastasizes into the lymph nodes, liver, brain and bones

Signs & Symptoms

    • Early stages present with no S&S and is not painful
    • Often presents with a lump in breast or armpit or identified via mammography before symptoms are noticed
  • Care
    • Self exams should be preformed frequently and any irregularities should be assessed by a physician (ultrasound, mammography, biopsy)
    • Surgery is primary treatment with additional treatment involving radiation, hormonal, chemotherapy
menstrual irregularities and the female reproductive system
Menstrual Irregularities and the Female Reproductive System
  • During the prepubertal period girls are of equal and often superior to boys of the same age in activities requiring speed, strength and endurance
  • Differences arise following puberty
    • Males exhibit slow gradual increases in speed, strength and endurance
    • Onset of menses occurs normally between the ages of 10 and 17 in females
    • Engaging in strenuous activity may delay onset
      • Particularly in high caliber athletes
      • Late maturing-girl often has longer legs, narrower hips and less adiposity and body weight for height – all conducive to sports
With growing participation and interest in female sports many myths have been dispelled concerning menarche, menstruation, childbirth
  • Impact of strenuous training on menstruation and menstruation on performance cannot be fully explained
Menstrual Cycle Irregularities
    • Strenuous training may alter cycle (25-38 day long cycles)
    • Amenorrhea – absence of menses
    • Oligomenorrhea - diminished flow (refers to fewer than 3-6 cycles per year)
    • Dysmenorrhea
    • Menorrhagia (excessive menstruation)
    • Polymenorrhea (abnormally frequent menstruation)
    • Irregular periods
    • Any combination of these
    • Cause of Condition
      • Painful menstruation prevalent in active women
      • May be caused by hormonal imbalance, ischemia of the pelvic organs, endometriosis
      • Most common menstrual disorder
    • Sign and Symptoms
      • Cramps, nausea, lower abdominal pain, headache, occasionally emotional lability
    • Management
      • Mild to vigorous exercise that help to ameliorate dysmenorrhea are usually prescribed
      • Continued activity as long as performance levels do not drop
the female athlete triad
The Female Athlete Triad
  • Cause of Condition
    • Relationship between disordered eating, amenorrhea and osteoporosis
    • Driven to meet standards of sport or to meet a specific athletic image to attain goals
  • Sign and Symptoms
    • Disordered eating - bulimia and anorexia
    • Osteoporosis - premature bone loss in young women, inadequate bone development
  • Care
    • Prevention is key; identify and educate
  • Oral contraceptives
    • Should not be used to delay menstruation during competition
      • May result in nausea, vomiting, fluid retention, amenorrhea, hypertension, double vision and thrombophlebitis
    • Use under supervision of a physician
    • Low dose preparations (<50mg of estrogen) provide little risk to healthy women
exercise during pregnancy
Exercise During Pregnancy
  • Physical activity and competition can be engaged in up to the 3rd month unless complications present
  • May even be able to continue up through the seventh month
  • Impact on performance
  • No indication that exercise is harmful to the fetal growth patterns
  • Extreme exercise may result in low birth weight
  • Should avoid activities that involve severe body contact, jarring or falls
sexually transmitted infections sti s
Sexually Transmitted Infections (STI’s)
  • Major concern in sports
    • Many athletes are at an age of increased sexual activity
  • Any STI could potentially be transmitted through sexual contact with an infected partner
  • While STI’s do not occur with participation in sports activities some understanding of how these infections can impact an individual is warranted on the part of coaches, healthcare providers and fitness professionals
  • May be bacterial or viral
Bacterial Infections
    • Gonorrhea, syphilis, chlamydia
    • Treated with antibiotics
  • Viral Infections
    • Herpes, genital warts, HIV
    • Difficult to treat – often no cure exists
  • STI’s do not go away by themselves
    • Quick and painless treatments are available
  • No one is immune to STI’s
  • Prevention
    • Safe sex practices and STI treatment
  • Some could cause serious long-term health problems or death