Overuse injuries from college athletics and future traumatic injury? Limitations in activity, obesity, and chronic diseases have already been linked.

Cervical Degenerative Disc Disease- this is the overuse injury (a form of arthritis) that possibly formed the bone spurs leading to a major injury, after a relatively minor accident that I should have  recovered from easily...

As I sit stuck in my bed after an auto accident, in a neck brace, almost 3 weeks later (and still progressing), I am watching the Alabama Crimson Tide play and this is the research publication I remembered completing at the Capstone (at UA) in 2006. I have followed a larger database of athletes to try to continue to answer a big question- is the stress of college athletics too much? Does it interfere with the long-term health and wellness of the athlete? Does the athlete have long-term limitations in activity due to injuries sustained in college athletics, or due to overtraining in college? Is the "price of competition" worth the cost?
In my current state, I can say no- after a high-speed rear end auto accident has left me bedridden due to a spinal cord injury. The bone spurs from overuse are what injured my cord. Ive lived the past 3 years with chronic pain, but this is scary and watching myself go downhill is even more disturbing. I have a hard time taking it easy, but I know it is essential to life/movement at this point. 
I want to revisit the impact of chronic injuries due to the excessive amount of training "necessary" in NCAA athletics and their long term risks...ironically, my research has led me to become a case study...

Prior Research:

Long Term Injuries in Athletes- My Open Access Publication in JEP:
http://www.asep.org/asep/asep/JEPonlineFebruary2007.html

Long-term Impact of Athletic Participation on Physical Capabilities. JEPonline 2007;10(1):34-47. Collegiate athletes undergo training regimens that place them under chronic stress, consequently increasing susceptibility to injuries and overtraining. The purpose of this study was to investigate the effects of prior participation in collegiate athletics on limitations in daily life and limitations during exercise in the years following. Former Division I college athletes, and a demographically similar group of non-athlete alumni (controls), were surveyed via e-mail (n=15,000) concerning injuries incurred during participation in all varsity sports. Also included were questions about current health and activity status, and physical limitations. Of former athletes, 50% had major injuries while in college compared to 10% of controls (p<0.01), while 52% of athletes reported chronic injuries while only 11% of controls reported the same (p<0.01). Of the alumni controls, 4% reported limitations in daily life, and 6% reported limitations during exercise, while the athletes reported 21% and 36%, respectively (p<0.01 for each). These data suggest that prior collegiate athletics participation may result in a substantial physical cost, and are a first step in determining the potential long-term risks associated with participation in athletics. 

INCIDENCE OF INJURY AND DISEASE AMONG FORMER

ATHLETES: A REVIEW

KELLY FRIERY

Friery, KB. Incidence of Injury and Disease Among Former Athletes:

A Review. JEPonline 2008;11(2):26-45. Athletes undergo vigorous

training in order to excel in their sport. They must participate in more

than the recommended amount of daily physical activity to be able to

reach a high level of competition. High levels of training may lead to high

amounts of injury in specific sports. The purpose of this review was to

examine the incidence of injury in athletes in specific sports. There have

been several studies that have tried to establish a link between future

disease risk and prior athletic participation. Prior injury may play a role in

the development of future disease. This review also examined the

relationship between specific sports and future chronic disease risk. A

comprehensive review of literature led to 2 review articles and 68

original research articles. These articles document onset of chronic

disease and injury risk in elite level athletes. Results confirm that more

research is needed in order to link injuries in early athletics with future

chronic disease risk. The risk of osteoarthritis after joint injury in athletic

competition is high, according to each study analyzed. Chronic disease

risk is not decreased for athletes versus nonathletes, unless activity is

maintained throughout the lifespan. This review may shed light into the

risk carried in specific sports for injury. This review may serve as a

starting place for future research into the risk of chronic disease in

athletes with prior injuries.

Key Words: Osteoarthritis, Chronic Disease, Athletic Injuries.

http://www.asep.org/asep/asep/FrieryJEPonlineApril2008.pdf

Sport Injury and College Athlete Health

Across the Lifespan

http://www.humankinetics.com/acucustom/sitename/Documents/DocumentItem/17176.pdf

Restricted Activity Levels of Former Collegiate Athletes

Overtraining, Exercise, and Adrenal Insufficiency 

Injuries and Physical Limitations in Division I Female Collegiate Athletes,

Overtraining and Adrenal Insufficiency

Running, or any aerobic training in moderation, has a positive effect on health. There is a point of diminishing returns, where chronic stress from overtraining, which is common in runners, may be linked to problems in the adrenal gland. Overtraining syndrome (OS) has been linked with adrenal insufficiency. There is a direct link between stress and the adrenal glands, and the physical stress of overtraining may cause the hormones produced in these glands to become depleted. 

Adrenal Insufficiency: Symptoms and Causes 

Adrenal insufficiency refers to the inability of the adrenal glands to produce a normal quantity of hormones, which leads to a reduced ability in the individual to cope with stress. Adrenal depletion is a milder form of insufficiency, while Addison's disease is a total adrenal gland shutdown, which involves more extreme symptoms which require longer to correct. Addison’s disease is an autoimmune disorder, which has life-threatening complications.

Symptoms of adrenal insufficiency can be directly traced to a reduced secretion of certain hormones when under stress. Within the medulla, or inner core, of the kidney, both epinephrine and norepinephrine are release during the fight-flight response to stress. Stress in the body can be physical, mental, emotional, or even imagined stress, and all have the same impact on the release of hormones and the effect of stress on our body. 

Within the adrenal cortex, or outer shell, aldosterone, cortisol, and cortisone are regulated. These hormones are more critical in body function. Aldosterone helps kidneys retain sodium and excrete potassium. If production falls too low, the kidneys are not able to regulate salt and water balance, causing blood volume and blood pressure to drop, which can result in a life-threatening situation. Cortisol has many functions such as maintaining blood pressure and cardiovascular function, slowing the immune system's inflammatory response, and balancing the effects of insulin in breaking down glucose for energy. Cortisol is also involved in regulation of the metabolism of proteins, carbohydrates, and fats, as it stimulates the liver to raise the blood sugar as needed, in response to metabolic demands, physical activity, and stress. Cortisol has a long half-life in the blood and if often thought to be the body's long-term response to stress, in contrast to adrenaline which is a very immediate and short-term response. Cortisol production is regulated by adrenocorticotrophic hormone (ACTH), made in the pituitary gland.

The hypothalamic-pituitary-adrenal (HPA) axis is highly involved in our body’s short-term and long-term response to stress. Other hormones related to the stress response include corticotropin-releasing hormone and  adrenocorticotrophic hormone. In cases of adrenal depletion, these other hormones are often found to be in short supply (in early stages of adrenal stress) or they can be found to be abnormally high, while another hormone is in short supply. The HPA axis functions to maintain hormone levels by balancing hormones ateach level of the axis. The hypothalalmus releases corticotropin-releasing hormone (CRH), which causes the pituitary to release adrenocorticotrophic hormone (ACTH). ACTH causes the outer cortex of the adrenal gland to increase in size and to release cortisol. At times, serum cortisol may be found to be at a normal level, while ACTH is low. Adrenal depletion involves the entire HPA-axis, and the earlier the problem is discovered, the less the axis will be affected.

Low serum cortisol is a marker of adrenal depletion. There are several symptoms of low cortisol levels, although they are vague and often related to other disorders. Some symptoms include:

• fatigue
• unrefreshing sleep 
• ill-defined malaise
• loss of ambition
• increased fear and apprehension,
• scattered thinking
• decreased concentration and memory
• short fuse
• hypoglycemia symptoms
• sugar cravings
• slow recovery from illness
• allergies or autoimmune disease
• increased achiness or arthritis
• nausea/ no appetite in a.m.
• excessive consumption of caffeine or other stimulants
• tendency to feel best towards evening
• decreased sex drive

Low cortisol levels have been linked to the following:

• personality/lifestyle/occupational factors lead to adrenal insufficiency:
• perfectionism
• a history of severe physical or emotional trauma or prolonged stress
• shiftwork
• teaching or healthcare profession/middle management position
• overtraining 
• any job where the individual feels trapped or powerless
• high consumption of refined flour and sugar
• hypothyroidism

Adrenal insufficiency can be divided into two types, a primary and a secondary form, depending on the length of disease and the primary hormones affected. Primary adrenal insufficiency results from a loss of both cortisol and aldosterone secretion due to the near or total destruction (Addison’s) of both adrenal glands. Most reported cases of primary adrenal insufficiency result from destruction of the adrenal cortex by the body's own immune system and the process takes months to years. Often times, individuals are not aware they have the disease and may me misdiagnosed with another similar disorder. Secondary adrenal insufficiency can be traced to a lack of ACTH, which causes a drop in the adrenal glands' production of cortisol but not aldosterone. This is most commonly found with overtraining in athletes. Symptoms are not usually apparent until over 90% of the adrenal cortex has been destroyed and very little adrenal capacity is left. This is due to the non-specific nature of symptoms and their slow progression. Symptoms are more times than not, often missed or ignored until physically stressful event or crisis, known as an Addisonian crisis, which is characterized by a sudden, penetrating pain in the lower back, abdomen, or legs, along with severe vomiting and diarrhea, followed by dehydration, low blood pressure and a loss of consciousness. 

Symptoms of adrenal insufficiency include:

• chronic, steadily worsening fatigue 
• severe fatigue/low stamina 
• irritability and depression
• weakness/muscle spasm
• loss of appetite/weight
• increased pigmentation of the skin
• inability to cope with stress
• allergies
• faintness and low blood pressure
• nausea/vomiting
• poor circulation
• salt loss/salt cravings 
• painful muscles and joints
• inability to digest food
• hypoglycemia
• intolerance to heat or cold
• lowered resistance to infection

In the recovery from mild cases of adrenal insufficiency, if caught early, correction can occur in a matter of months. In more severe cases, complete correction may require several years; replacement therapy is not suggested in these cases if normal cortisol levels exist, as the body will cease to produce essential hormones naturally. Addison’s disease require lifetime replacement therapy of corticosteroids. The prognosis for those with Addison’s disease is that with replacement medication every day, the individual can lead a normal crisis-free life. There are no specific physical or occupational restrictions, though an individual must learn their limitations and find coping methods for stress. 

Kelly Brooks, Ph.D.

Further Reading:

http://217.160.4.72/NutritionPractitioner/Issues/Issue_11_1/Articles/3%20Overtrainingformatted4_IC_ML3.pdf

http://europepmc.org/abstract/MED/9662686/reload=0;jsessionid=KiPHmJeAq4FTl1cMYqqy.22

http://europepmc.org/abstract/MED/15717662

http://link.springer.com/chapter/10.1007%2F978-0-585-34048-7_2?LI=true