Of Joints and Juveniles: For Some Young Olympic Hopefuls, All That Training Can Be Too Much of a Good Thing

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Of Joints and Juveniles

She was 14 when her grace on the balance beam and her lightning spins and twists from the lower to the upper parallel bar left Olympic judges with nothing to fault. Nadia Comaneci was a perfect gymnast, the darling of the summer games, and what's more, she was so young.

That was 1976, the year a bumper crop of adolescents in sweat-soaked leotards began spending mornings and afternoons at the gym, yearning for gold medals. "I think some people even called it 'The Nadia Syndrome,'" says Lyle Micheli, director of sports medicine at Children's Hospital in Boston. In the 12 years since, teenage athletes have become commonplace not only in gymnastics (where Mary Lour Retton took the 1984 gold at 16), but also in training for other demanding sports such as swimming and ice skating.

This week, more than 1,000 sports medicine researchers--among them physicians, psychologists and nutritionists--gathered in Seoul, Korea, for the 1988 Seoul Olympic Scientific Congress in anticipation of the summer games. Micheli, whose keynote address for the conference dealt with injuries and overtraining in young athletes, says pediatricians have two main worries about teenage athletics: The cessation of menstruation in some young females, and potential damage to the bones and joints of young athletes, male and female alike.

"We're trying to find out how much is too much," Micheli says about the rigors of training. In addition to the well-documented psychological strains of competition, the physical effects have long been of concern to sports medicine researchers, who are now forming some conclusions and offering some advice to the coaches and parents of children with Olympic dreams.

Teenage girls who train until their bodies stop menstruating may be risking permanent bone damage. Four years ago, Barbara Drinkwater of the University of Washington in Seattle studied 22 runners in their mid-20s, and concluded that the loss of menstruation brought on by extensive exercise results in brittle bones that usually come only with old age. In the Aug. 2, 1984 NEW ENGLAND JUURNAL OF MEDICINE, she attributed this problem--which amounts to premature osteoporosis -- primarily to a lack of the estrogen needed for bones to absorb calcium.

She stressed that exercise itself normally strengthens bone, and that this condition was a result of a very intense training regimen. While all the runners in the study exercised almost the same amount of time each day, those who stopped menstruating ran about 42 miles a week; those who didn't averaged 25.

A handful of separate studies later confirmed Drinkwater's findings, and she has continued to follow those same athletes, seven of whom have since resumed menstrual cycles. Now at the Pacific Medical Center in Seattle, Drinkwater says some women who resume menstruation do replenish lost bone mass over several months, suggesting the condition is at least partially reversible. Still, some effects linger. "They are plateauing at a level [of bone strength] significantly lower than their age group," she says.

Excessive exercise may be too simple an explanation for why some female athletes lose bone mass. The problem probably involves a host of additional factors, including nutrition, rate of weight loss, psychological stress and the regularity of cycles before menstruation ceases. Drinkwater says these individuals often resume menstruating if they put on a few pounds or slack off on exercise. "But," she notes, "it's very hard to get topnotch athletes to consider either of those."

Even if young women do not exercise to the point of losing their menstrual cycles, they still may wear out cartilage or damage growth plates that sit just beyond the joints. Each sport has its own particular menace: Gymnasts risk back and wrist injuries, runners and cyclists can suffer knee problems, weight-lifters strain joints in the arms. …