Sophia Lal, D.O., loves to swim, bike and run — so much so that she often participates in triathlons. “I like to train, and I like to race,” she says.

Sandra Milstead, left, a nurse with Critical Care Transport, reviews her medical chart with Sophia Lal, sports medicine physician with Physical Medicine and Rehabilitation and Orthopedics.

Athletes, professional and amateur, constantly work to keep their bodies at peak performance, and no time is more frustrating than that spent rehabilitating an injury. Lal understands that fact both as an athlete and as a sports medicine physician in the departments of Physical Medicine and Rehabilitation and Orthopedics. She recently joined UAB and sees patients at UAB Highlands and UAB Sports Medicine Clinic at Children’s Hospital.

“As an athlete, I understand the mindset of someone who has a sports injury,” Lal says. “Being pulled back from training is something none of us wants. I do my best to be creative at times like this so that the patient has something to do after their visit with me, even if it means they cannot participate in their usual sport.”

Although Lal treats men, women and children, her research is focused on women’s needs, and she is creating a women’s sports medicine clinic. She also will be one of the new UAB Women’s Athletics team physicians.

“Some issues that female athletes face are specific to them as women,” Lal says.

Sports medicine training
Lal completed medical school at the University of North Texas Health Science Center and conducted her residency in Physical Medicine and Rehabilitation at Emory University. She completed her sports medicine fellowship at the Medical College of Wisconsin, one of only three women’s sports medicine centers in the country.

Lal’s specific areas of interest include:
• Musculoskeletal injuries, including all major joints, muscles, tendons and ligaments
• Overuse and chronic injuries
• Sports injuries
• Stress fractures
• Osteoarthritis
• Issues related to the female athlete, especially disordered eating, menstrual problems and poor bone health, also known as the Female Athlete Triad
• Musculoskeletal pelvic floor pain
• Other orthopedic-type injuries that result in sprains and strains that occur in day-to-day life

The Female Athlete Triad
Lal’s fellowship research examines a syndrome of three inter-related health problems related to low energy availability, menstrual disorders and weak bones. These problems, known as the Female Athlete Triad, may be expressed as a lack of good nutrition, loss of menstrual periods and osteoporosis.

“A young woman can fall anywhere in this spectrum,” Lal says. “The spectrum typically starts with issues related to eating and may be as simple as not taking in enough calories for the amount of energy she’s expending. Not eating enough has a cascade effect that can lead to missing their periods and/or poor bone growth or strength. They may then be more likely to have stress fractures and can even develop osteoporosis, even at a young age.”

Any factor that increases energy expenditure or reduces energy intake would be considered a risk factor. These issues include prolonged exercise training to develop greater endurance or to promote weight loss; dieting to lose weight or fat for participation in sports that require a thin body or weight classes, to improve performance or to improve appearance; perfectionist personality traits; decreased eating with family and friends; and the attitude that excessive exercise and weight-loss does not affect performance.

“Eating issues in America can start at a very young age,” Lal says. “If I tell a high-school track star to eat a little more or cut back on her exercise intensity and frequency, she’s not going to like me. If she is not careful about getting enough calories or enough rest, she might be lighter on the scale, but it could affect her performance in a negative way.”

Restrictive dieting, binge eating, induced vomiting and excessive use of laxatives and prolonged exercise are prominent signs of low energy availability. Physical signs of the triad include noticeable weight loss, cold hands and feet, dry skin, hair loss, absent or irregular menstrual periods, increased rate of injury, delayed healing time for injuries and stress fractures. Emotional signs include mood changes, decreased ability to concentrate and depression.

“As a physician who takes care of a girl who has the Triad, I am a team leader,” she says. “I may need the help of several other people including the pediatrician, orthopedic surgeon, endocrinologist, sports psychologist and sports dietician. It takes a large group of people to affect the teenage girl and her eating habits, and having access to these specialties at UAB is a tremendous resource.”

Exercise is medicine
In addition to the women’s sports medicine clinic and Triad research, Lal also incorporates Exercise is Medicine™, a national initiative that calls for physical activity to be considered by all health-care providers as a vital sign in every patient visit. It also asks that patients be counseled about their physical activity. The ultimate goal is to kick start an overall improvement in the public’s health and long-term reduction in health-care costs.

“I think Exercise is Medicine could really mushroom in this area,” Lal says. “Some parts of the country are writing exercise prescriptions, and local gyms are setting up workout programs. It’s a great approach to improving the health and physical fitness of the community at large.”

If you are a physician or caregiver interested in working with Lal, e-mail her at slal@uab.edu or call 934-3490.