As health practitioners, it’s important to us to offer not only the best management and treatment for our patients, but to ensure that every person’s unique factors are considered when doing so. While factors like occupation, activity levels, injury history, footwear and lifestyle preferences are commonly discussed, the anatomical and physiological differences arising from gender is an important consideration that is often missed, despite being crucial when working with female athletes.
As we take a holistic, considerate and well-rounded approach to all of our assessments here at Sole Motion, today we’ve shared what the female athlete triad is, what it can mean for you, and how our team can support you in both optimising your performance or recovering from pain or injury as a female athlete.
The Three Components Of The Female Athlete Triad
The female athlete triad describes the relationship between three key components associated with athletic training, and their overall effects on a woman’s health. Having even one of these problems below means that you may meet the criteria for the female athlete triad, which can have a significant impact on your long-term health, well-being, injury risk and your ability to continue competing in sports.
1. Low energy availability: this is often related to eating disorders, but it can include a range of irregular eating behaviours that do not necessarily meet criteria for anorexia or bulimia. It is fairly common in the athletic community:
- Up to 70% of elite athletes competing in sports are dieting and have some type of disordered eating pattern, with the goal to reduce weight
- As many as 47% of female elite athletes meet the criteria for a clinical eating disorders, compared to 10% among nonathletic women in the general population
2. Menstrual irregularities: this can mean either irregular or missed periods, or periods that do not start at all during puberty. This can happen because of high levels of physical exertion without adequate rest and nutrition, to the point where the woman’s body does not feel capable of supporting a pregnancy, and so stops ovulating altogether:
- While 2-5% of the general population have amenorrhea (lack of periods), it can be as high as 69% in women who participate in sports that emphasise appearance or thinness, including ballet, running, gymnastics, figure skating, and even lightweight rowing ,
3. Poor bone health: A woman is considered to have poor bone health if she has decreased bone mineral density (BMD), meaning that her bones are weaker, more brittle, and more prone to fractures and breaks – in medical terms, this is described as osteoporosis or osteopenia.
- Female athletes have up to 5 times more issues with their bone health than the average population – up to 50% of female athletes have low BMD, and around 13% have osteoporosis.,
What Makes A Person Vulnerable To The Triad?
Women can develop the triad for a range of reasons, including pressure from fellow athletes and coaches to perform well, concerns about self-image and weight influenced by media and society, and lack of education around the importance of nutrition and exercise. A female athlete may put high expectations on herself and engage in intense training schedules, have limited rest or downtime, attempt to lose weight to fit into a weight category or attain the ‘right’ body type for her sport, be facing high expectations from others – and much more. Any one of these, including her mental health, can start her on the downward slope of the triad.
In the long-term, the female athlete triad this can take a devastating toll on a female athlete’s career, reducing her endurance and causing her to tire earlier, seeing a decrease in her muscle strength, coordination and concentration, increasing her vulnerability to injuries, illnesses and mental health problems, and generally seeing her sports performance, health and well-being take a large hit. Currently, the best approach to the triad is early detection and prevention.
What Are The Signs And Symptoms Of The Female Athlete Triad?
The symptoms may be difficult to notice at first, as they often develop gradually over time. As well as complaining of fatigue or being tired, coaches, families and health professionals should look out for signs such as:
- Absent or irregular periods
- Weight loss
- Stress fractures, osteopenia or osteoporosis
- More frequent illnesses
- Disordered or abnormal eating
- Altered sleeping patterns
- Reductions in bone mineral density
- Compulsive exercise
- Longer recovery times for injuries
- Feelings of anxiety or depression
- Obsession with performance or self-image
Specific questions that health professionals may ask could also include:
Questions about nutrition:
- Are you worried about your weight?
- Are you trying to gain or lose weight, or has anyone pressured you to?
- Are you on a special diet or do you avoid certain types of foods or food groups?
Questions about menstrual function:
- Have you ever had a period?
- How old were you when you had your first period?
- When was your most recent period?
- How many periods have you had in the last 12 months?
- Are you taking any female hormones such as birth control pills?
Questions about bone health:
- Have you ever had a stress fracture?
- Have you ever been told you have low bone density such as osteopenia or osteoporosis?
Does The Menstrual Cycle Affect Injury Rate And Recovery?
Researchers have found that the hormones involved in our menstrual cycles are not only responsible for encouraging ovulation, but they also affect the way that our muscles react to exercise on a cellular level. For many women who participate in high levels of exercise, they may find that their periods become irregular, or stop altogether, which can have significant impacts on how often women are injured, and how easily recover:
- Female athletes with irregular periods have increased rates of musculoskeletal injuries, especially muscle injuries and tibia stress fractures
- Female athletes without periods have 2-4 times more stress fractures than those with regular periods
- The muscles of females with regular periods recover much faster after exercise than the muscles of females with irregular periods
Treatment: How Sole Motion Can Help
Our experienced podiatrists and health professionals work extensively with female athletes and always consider the triad in their care. Key ways we can help include:
- Treating the musculoskeletal problems that have developed as a result of the female athlete triad, like stress fractures and tendinopathies
- Helping to prevent the recurrence of problems as well as preventing the new development of problems for which the athlete may be at a high risk for
- Using custom foot orthotics to help prevent or treat injuries such as stress fractures to redistribute pressure and reduce force in certain areas of the foot
- Gait retraining to address any underlying walking or running styles that may be contributing to damage or injury risk over time
- Footwear education around which shoes best support your foot, ankle, knee and hip health for your particular sport, and when you are resting
- Strengthening and stretching of the structures to treat any underlying conditions
- Screening and educating around proper training requirements, guidelines and self-care to stop or prevent the effects of the triad (scans, x rays and assessments to measure bone density and damage, including stress therapies)
- Working with you to design safe and progressive training and return-to-activity programs in regard to your sport and the demands on your body. This may include reducing the frequency, the intensity, or the type of activity.
- Working alongside other health professionals, coaches and family members to optimise your outcomes, including psychologists, dieticians, physios and exercise physiologists.
Feel Energised, Empowered And Strengthened To Continue Doing The Exercise You Love
We believe that female athletes should succeed and be able to meet their professional goals without compromising their health and well-being in the process. By understanding how much fuel and rest is required to maintain specific physical activity levels, having a healthy and effective training program, treating any pains or problems efficiently and before they worsen, and seeking help from the right people where other factors may be impacting well-being and performance like nutrition or mental health, female athletes can recover from the effects of the triad – and our team is here to help them do this.
Book your appointment by calling 1300 FXFEET or book your appointment online here.
