Nutrition in Combat Sports

138 C.B. Pasque
surgery may also be necessary in some athletes, especially with associated chronic
neck and upper back problems. Although not reported in the literature, blunt trauma
is the most likely breast problem to be encountered in combat sports. Previous
reports in the literature of blunt breast trauma have been mainly from motor vehicle
trauma. [22– 24] Direct breast trauma can cause edema, structural damage or distortion,
dystrophic calcification, and fat necrosis.[ 24] Breast asymmetry can also
occur, especially with trauma to the developing breast.[ 25] Acute management of
blunt breast trauma consists of ice, elevation, support, and rest. Localized hematomas
can be aspirated if needed. Close follow-up with serial examinations, with or
without mammography, should be performed based on the clinical presentation.
Women with long-standing palpable masses or other abnormalities on physical
exam or screening mammography can sometimes present a more difficult situation,
since many of them cannot remember a history of trauma. Similar serial follow-up
examinations are warranted, with or without biopsy as dictated by the clinical situation.
Prevention of blunt trauma includes a well-fitted, well-padded sports bra.
Some sports also allow padded breast protectors, with or without hard plastic shells.
Strict enforcement of governing rules and regulations prohibiting blows to the
breast area must also be a high priority of competition officials.
9.5 Pregnancy in Combat Sports
Pregnancy causes a wide variety of changes to the women’s body that can alter or
affect her ability to participate in exercise and sports. Changes include weight gain
and an upward and forward shift in the center of gravity that can result in loss of
balance. [26, 27 ] Increased forces across joints and increased ligamentous laxity can
result in joint dysfunction or injury.[ 26, 28] Other physiologic changes include
decreases in systemic vascular resistance and increases in heart rate, cardiac output,
blood volume, respiratory rate, and VO2. [5, 26, 29– 31] Increases in overall caloric
needs and fluid intake occur in pregnancy as well, and include specific increased
needs for iron, calcium, and folic acid. [5, 31, 32] Finally, pregnancy results in
increases in the basal metabolic rate, and thus increases in heat production. Core
temperature can rise if heat production exceeds heat dissipation as can be seen in
extreme heat conditions or high-intensity exercise. The potential harm to the fetus
from high core temperatures has been documented in animal studies, and suggested
in human studies. [31, 33– 36] The ability to dissipate heat is much more efficient in
humans than animals, [37, 38] but pregnant athletes still need to make sure they stay
well hydrated and avoid extreme temperature environments.[ 26, 39– 41 ]
Pregnancy in actively competing athletes has become a very controversial subject
given the many potential issues regarding not only the health of the mother and
fetus, but also the medical–legal ramifications for coaches, trainers, physicians, and
sponsoring institutions. Many organizations are just now developing policies
regarding pregnant athletes given the ever-increasing participation of female
athletes later into their pregnancies,[ 26] and situations such as scholarship collegiate