health issues in athletics health issues in athletics health issues of athletics concern the health and well-being of athletes who participate in an organized sport. if athletes are physically and mentally underdeveloped, they are susceptible to mental or physical problems. athletes trying to improve their performance in sports can harm themselves by overtraining, adopting eating habits that damage them physically or psychologically, and using steroids or supplements. female athlete triad main article: female athlete triad syndrome the female athlete triad is a condition among women that consists of three related health irregularities: disordered eating habits, irregular menstruation, and premature bone loss or osteoporosis. the term was coined in the early 1990s when researchers from the national institutes of health noticed unusual health patterns among female athletes. these researchers observed increases in eating habit disorders in young female athletes. exercising intensely while getting inadequate nutrition can lead to amenorrhea - or irregular menstrual cycles - which in turn can lead to osteoporosis. the factors that can lead to developing triad syndrome, come from things like frequent weigh-ins and consequences for any weight gain. sports that emphasize a low body weight and lean physique, like gymnastics and running, can increase the risk of developing female athlete triad syndrome. competitive thinness female athletes tend to compare themselves to their competitors, which is another factor for athletes to develop female athlete triad. competitive thinness is a term used when athletes compare themselves to their rivals who are performing better than them. when athletes begin to compare themselves to their competitors and notice the athletes who are performing better than them are thinner, it can lead to a weight loss mentality. another risk factor to competitive thinness is related to revealing uniforms. for aesthetic sports, these uniforms are normally very tight, which shows off the athletes' body. these uniforms can cause athletes to develop unhealthy body comparisons. over-training a female athlete who feels pressured to maintain a certain physique or body weight may exercise excessively and develop eating disorders to restrict calorie intake. over-exercising increases the need for rest; her overall energy declines, causing her total body fat and estrogen levels to drop - a condition known as amenorrhea. both male and female athletes may feel the pressure to over-train excessively in order to achieve a certain body image. the human body has a tremendous capacity to adapt to physical stress. "stress" does not mean only physical damage. it can also refer to activity beneficial to bones, muscles, tendons, and ligaments, making them stronger and more functional. this is also known as "remodeling," and involves both the breakdown and buildup of tissue. however, if breakdown occurs more rapidly than buildup, an overuse injury can result. nearly half of all injuries encountered in pediatric sports medicine are due to overuse. an overuse injury is traumatic damage to a bone, muscle, or tendon that is subjected to repetitive stress without time to heal naturally, as a result of long and/or high-intensity workouts. many young athletes participate in sports year-round or on multiple teams at once. within the past seven years. majority of children from ages 6–12 have participated in a team and/or individual sport. another factor could be parental pressure to compete and succeed. other risk factors include sleep deprivation, general physical and cognitive immaturity, dietary imbalance and inadequate physical fitness. among young athletes, a common form of overuse injury is stress fractures, which include injuries of the: femoral neck/pubis femoral shaft tibia fibula metatarsals calcaneus cuboid 'over-training syndrome' is a term that has been used to describe athletes who, while training for competition, train beyond the body's ability to recover naturally. common warning signs include tiredness, soreness, drop in performance, headaches, and loss of enthusiasm. without adequate rest and recovery, training regimens can backfire, eventually harming an athlete's performance. over-training can also be associated with eating disorders; athletes can turn to excessive exercise in order to lose weight. over-training syndrome is also associated with exercise-induced central fatigue which is fatigue in our central nervous system caused by hyperactivity in our neurotransmitters responding to stress. central fatigue often leads to mood disorders, sleep disturbances, and/or depression. in cases where athletes are over-training, the most effective treatment is rest and proper nutrition. mental health athletes tend to be at higher risk for serious mental health complications than non-athletes due to increased stresses from sports and potential injury. one reason for higher vulnerability may be because athletes are less likely to seek help or pursue treatment. this may be attributed to the stigma that it makes them look "weak". this stigma creates a sense of fear that makes these athletes push through the mental pain. along with physical injury, mental health can be affected by an array of various other factors such as serious concussions, body standards, pressure from a highly competitive atmosphere, etc. studies have shown that collegiate athletes are at a higher risk for problems such as depression, suicidal ideation, alcohol and substance use, and disordered eating, with an estimated 33% of division 1 collegiate athletes self-identifying as being depressed. it was also found that 26% of college athletes were moderately to severely inclined to seek mental health services. even more concerning, suicide is the fourth leading cause of death among college sports participants, with 9% of athletes across all divisions of the ncaa feeling the need to pursue suicide prevention. alcohol and substance use remains an issue as well, with upwards of 52% of collegiate athletes reporting to have consumed five or more drinks on numerous occasions in the last year. of these consumers, 11% indicated the need to get help for alcohol related problems. in 2017, the ncaa also found that roughly 22% of its participants used marijuana, which is a banned substance for all athletes. in the united states each year, 3.5 million sports participants are injured, causing a short or long term disruption from sport. injured athletes may exhibit high rates of depression and anxiety, followed by low rates of self-esteem directly following an injury and throughout the duration of recovery and return to play. research has shown that athletic injury has a significant psychological impact on the athlete. a number of studies conducted between athletes who have been injured vs. athletes who have not gone through an injury show that injured athletes undergo greater negative effects, lower self-esteem, and higher levels of depression and anxiety. likewise, studies done on athletes before and after injury show that there are greater levels of mood disturbance, lowered self-esteem and increased rates of depression following injury. in more recent times the covid-19 pandemic has caused athletes to suffer through a tremendous pause in their usual sports routine. athletes and their mental health had been impacted poorly because of the limits that the pandemic has placed in their lives. an abrupt change in the lives of elite athletes during the pandemic had negative effects on athletes and their performance. a cohort study that was created to examine the amount of training, sports performance, physical and mental health among swiss elite athletes for a 6-month follow up period. during the course of the study 203 swiss elite athletes participated in repeated amounts of online surveys which were created to examine health, training, and sports performance. over the course of the 6-month lockdown it had been analyzed that sports performance and mental health had been negatively affected due to the realities of the covid-19 pandemic. stricter covid-19 restrictions were related with decreased subjective sports execution, as well as lower preparing escalated, expanded money related fears, poorer adapting with limitations, and more depressive indications, as measured by the 9-item module of the understanding wellbeing questionnaire-9 (phq-9). depression in the united states each year, 3.5 million sports participants are injured, causing a short or long term disruption from sport. injured athletes may exhibit high rates of depression and anxiety, followed by low rates of self-esteem directly following an injury and throughout the duration of recovery and return to play. perfectionism it is common for athletes, especially those of elite status, to strive for perfectionism in their sport. coaches may pound it into their athletes that "practice makes perfect" - a common misconception that with more and more training, perfectionism will be reached. although having high standards may be part of elite athletics and can, in return, be beneficial for the athlete's performance, this idea that nothing but a perfect performance is good enough plays a key role in developing a negative self-concept and a fear-of-failure syndrome. individuals who struggle with a negative self-concept and strive towards perfectionism may excessively engage in cognitive rumination about the need to be perfect. they may also be more susceptible to be more concerned about every little mistake, struggle with forgetting about a past error, and doubt their physical abilities. these athletes may be at a significantly higher risk of a low self-esteem in results of the slightest negative feedback. athletes who over-strive for perfectionism also put themselves at risk to experience more levels of negative emotions and heightened levels of anxiety and depression. it is common for athletes, especially those of elite status, to strive for perfectionism in their sport. coaches may pound it into their athletes that "practice makes perfect" - a common misconception that with more and more training, perfectionism will be reached. although having high standards may be part of elite athletics and can, in return, be beneficial for the athlete's performance, this idea that nothing but a perfect performance is good enough plays a key role in developing a negative self-concept and a fear-of-failure syndrome. individuals who struggle with a negative self-concept and strive towards perfectionism may excessively engage in cognitive rumination about the need to be perfect. they may also be more susceptible to be more concerned about every little mistake, struggle with forgetting about a past error, and doubt their physical abilities. athletes, especially those who balance sport and academics, have the responsibility of managing their academics, maintaining a healthy lifestyle, recovering from possible injuries, and managing their performance expectations and anxiety. all of which may present themselves as added stressors in the athletes' life. regardless of all these other stressors, it seems as if failure in competition is one of the biggest causes that increases susceptibility to negative affects and depressive disorders. stress builds as they attempt to balance the workload they are given, working to satisfy the coaching staff, and continuing to try to play at their best. this pressure gets to a lot of the athletes and they start to break down mentally. constant demand to perform at their best is very hard to attain, and puts wear and tear on the human body and mind. this is why they see many athletes step away from their sport that they have been playing since they were young because the love, the passion, and their mental state is no longer there. suicide as mentioned previously, psychological distress as a result from a sports related injury has been shown to increase the risk of suicide among athletes. in a review of five collegiate athletes who committed suicide, several common factors were found. these included: considerable success before injury, serious injury requiring surgery, long rehabilitation with restriction to play, inability to return to the prior level of play, and being replaced in his or her position by a teammate. the greatest predictor of suicide was the severity of their injury. other risk factors for suicide included stressful life events, chronic mental illness, family history of suicidal tendency, and psychiatric disorders of any type. depression is a leading cause of suicide. one study that investigated depression in retired athletes found that one of the largest barriers to seeking help was that athletes did not recognize symptoms of depression and, therefore, would not see the need to seek treatment. undetected and untreated depression can lead to suicide or suicidal ideation in the worst cases. previous research has looked at the relationship between athletic status, gender, depression, and suicidality. athletes who base their identities solely around the sport they play may be at higher risk for depression and possible suicidal ideation if the athletic status may be disturbed. these studies showed that a high amount of athletic identity did not significantly predict depression scores, but it did show a positive