Know The Signs and Realities of the “Female Athlete Triad” - By Leah Versteegen

Our thanks to Alpine’s Leah Versteegen, DPT, who presented her findings on this important topic at our inservice last week. This is vital information for healthcare providers and for everyone who knows or works with female athletes.

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The number of female athletes has grown tremendously since the advent of Title IX. Alongside this growth have come both trials and tribulations associated with the participation of young females participating in sports. One of the trials has been educating and preparing these young minds and bodies for the stresses accompanying athletic competition. The Female Athlete Triad was identified originally in the 1980’s. It is currently defined as a syndrome of three interrelated conditions that present on a continuum; however, a fourth condition has also recently been described along this continuum. Each is listed and described here:

1. Low energy availability. An athlete’s dietary energy intake not enough to fuel their exercise energy expenditure. This can be due to either unintentional or intentional poor eating habits
2. Prolonged menstrual dysfunction or hypothalamic dysfunction. An athlete misses several menstrual cycles or altogether lacks menstruation. This happens as they lack proper energy/Caloric intake, and the hypothalamus does not properly release certain hormones.
3. Low bone density. This is the most severe condition of the spectrum and occurs as a result of the hormone imbalance accompanying menstrual dysfunction.
4. Cardiovascular disease. Another result of the hormonal imbalance is plaque build up and onset of hypertension leading to cardiovascular disease at a young age.

There are many possible contributing factors to the onset of the female athlete triad, among which are poor nutritional knowledge, athletes simply not paying attention to what they eat during the day, diet trends, pressure from peers/coaches/parents to perform, the misconception that thinner means faster, pressure on appearance in aesthetic sports, or an overall obsession with exercise.  Whatever the cause, it is our role as health care providers, coaches, parents, and friends to identify the red flags that are associated with the Female Athlete Triad. Early detection and proper support including nutritional education for these young athletes is key.

Some of the red flags that we can look out for include:

• Obsessive exercising outside of practice time/ rehab time
• Low energy/fatigue
• Slow healing time
• No menstruation by age 15
• Unable to cope with injury: disproportionate anger or fear regarding injury or increased stress due to missed practice/exercise time
• Obsessive discussion of return to sport
• Orthostatic hypotension (a sign of disordered eating patterns
•  Cold/discolored hands and feet
•  Elevated LDL and plasma cholesterol
• Depression or insomnia
• Recurrent musculoskeletal injuries, particularly stress fractures
•  Excessive focus on food and/or puposeful low Caloric intake

While it is important to be aware of the red flags associated with the female athlete triad and how to properly identify those at risk, it can be too late if we wait to see those red flags. Early prevention is essential. We must improve our awareness of how we talk about food choices and body image to our youth. It is essential that we all understand that food is a source of energy and that positive food choices fuel our bodies for general health, brain function, and improved athletic performance. Regardless of risk factors or red flags, our children should have a sound nutritional knowledge base that can prepare them for sport AND for life beyond sport.  Part II of this blog will discuss basic nutrition for the young athlete.

For more information, contact Alpine Physical Therapy by calling 406-251-2323.
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Leah Versteegen, DPT
Alpine Physical Therapy, South
5000 Blue Mountain Rd.
Missoula, MT 59804
(406) 251-2323
www.AlpinePTmissoula.com