The Whole Patient

The patient as a whole:

The female athlete triad:

 

As a physical therapy student, we have been taught to look at all patients as a whole and not solely on their diagnosis. For example, take a patient who may have torn her ACL. The goal for our treatment may be to rehab her knee, but in order to do so we need to know the whole story of her life, what she does for fun, for work, and what her support system is like at home. This bigger picture will allow us to develop an individualized treatment plan for this patient to get her back to where she was prior to this injury. Additionally, more than just the knee will be addressed. Say she is an aspiring college volleyball player. Joints above and below the level of the injury should always be observed for impairments. You also need a strong core and motor control to be able to play the sport. With this said, all of these impairments should be addressed in her treatment.

Since we treat the patient as a whole, we need to be able get a thorough background of what is going on in the patient’s life. When you think female athlete, you should almost always consider the female athlete triad.

FAT

-          Amenorrhea – menstrual dysfunction

-          Osteoporosis – low bone density

-          Eating disorder – low energy availability (may not actually have eating disorder)

The complete female athlete triad occurs in 2.7% of college athletes and 1.2% of high school athletes¹. It is important to note that even though these numbers are rather small, the female athlete triad can present with just one of the above and doesn’t always have to be complete.

The reason I mention this is because low energy availability and eating disorders can be a risk factor for urinary incontinence^2,3,4. In fact, one research study showed the prevalence of stress urinary incontinence in female athletes with eating disorders was found to be 49.5% which was significantly higher than the nonathlete with an eating disorder⁴.  With this said, addressing nutrition of the patient could help with their problem.

Another study has shown that decreased foot flexibility increased the risk of urinary continence in female athletes⁵. They suggested that this could affect how impact forces were absorbed up the chain, affecting pelvic floor muscles.  This further supports the idea of treating the patient as a whole when in the healthcare system.

 

Take away:

*Look at the whole patient*

 

 

 

1.      Nichols JF, Rauh MJ, Lawson MJ, Ji M, Barkai HS. Prevalence of the female athlete triad syndrome among high school athletes. Arch Pediatr Adolesc Med. 2006 Feb;160(2):137-42.

2.      Carvalhais A., Natal R., Bø K. Performing high-level sport is strongly associated with urinary incontinence in elite athletes: A comparative study of 372 elite female athletes and 372 controls. Br. J. Sports Med. 2018;52:1586–1590. doi: 10.1136/bjsports-2017-097587.

3.      Kruger J.A., Dietz H.P., Murphy B.A. Pelvic floor function in elite nulliparous athletes. Ultrasound Obstet. Gynecol. 2007;30:81–85. doi: 10.1002/uog.4027. 

4.      Bø K., Borgen J.S. Prevalence of stress and urge urinary incontinence in elite athletes and controls. Med. Sci. Sports Exerc. 2001;33:1797–1802.

5.      Nygaard I.E., Glowacki C., Saltzman C.L. Relationship between foot flexibility and urinary incontinence in nulliparous varsity athletes. Obstet. Gynecol. 1996;87:1049–1051. doi: 10.1016/0029-7844(96)00079-8.