HEALTH & MEDICINE :: AUGUST/SEPTEMBER 2007
The Female Athlete Triad
Female athletes have made great strides in the past twenty-five years. An increasing number of girls and women are involved in exercise and sports, many of them are starting at a much younger age. Female athletes have benefited from increased media exposure which allows them to showcase their talent and skill levels. This increase in attention can also create an increased amount of pressure for success and sometimes winning at any cost, even at the expense of their bodies.
The Female Athlete Triad describes three conditions which can lead to a physical and mental breakdown in some athletes. They are disordered eating, amenorrhea, and osteoporosis. The American College of Sports Medicine coined the term “Female Triad” in 1992. Each of these disorders has been recognized and studied independently, but has also been found to be highly inter-related to one another within this triad.
The first part of the triad is disordered eating. This can range from abnormal eating habits like avoiding foods that are considered “bad” for you or full of fat, to more severe conditions like anorexia or bulimia. Anorexia Nervosa is marked by weight loss, disturbance of body image and fear of gaining weight or becoming obese. Bulimia Nervosa is characterized by recurrent episodes of binge eating, self induced vomiting or diarrhea, excessive exercise, dieting, fasting, and an exaggerated concern about body image and weight.
Poor nutrition, low calorie intake, high energy demands, physical and emotional stress, and low percentage of body fat can lead to hormonal changes that stop your period. The second part of the Female Athlete Triad is amenorrhea which is the absence of menstruation (your period) for longer than three months or the delayed onset of menarche (lack of your period by age 16). Loss of regular menstrual cycles often reduces the body’s production of estrogen, which normally restrains the rate of bone reabsorption. The resulting imbalance, in which reabsorption exceeds formation, can cause a progressive irreversible reduction in bone density.
This reduction in bone density, also known as osteoporosis, is the third component of the triad. This is a weakening of the bones due to the decrease of bone density and improper bone formation, which can lead to stress fractures and other orthopedic issues.
The female triad can strike recreational or competitive athletes of any sport. Some sports have a reputation for weight requirements such as rowing or martial arts. Others such as gymnastics, figure skating, diving and ballet are just traditionally known for certain “looks” where being thinner is to your aesthetic advantage. In these sports, the risk of the female triad is higher. As a society, most females are concerned with weight and looks. Having a distorted view that overly thin is good may lead to severe consequences both in and out of sports.
Noticeable signs that someone may be struggling with the triad include: weight loss, irregular or loss of her period, fatigue, inability to concentrate, reoccurrence of stress fractures or repetitive muscle strains. Girls will exhibit preoccupation with food and weight, use of laxatives and frequent trips to the bathroom near meal time. Other observations could include, brittle hair and nails (due to lack of nutrients), dental cavities (enamel is worn away due to frequent vomiting and increase in acidity in the mouth), and sensitivity to cold (decrease in circulation). When an athlete is found to have triad symptoms, a multi-disciplinary approach is warranted. This would include a primary care physician, a dietitian and a psychologist or psychiatrist. Parent and coaches of minors need to be involved, as well as athletic trainers and physical therapists.
The pressures that female athletes experience to be thin most likely will remain unchanged. Therefore, it is important to be alert to signs and symptoms that suggest the presence of the potentially very serious disorder of the female triad. Early recognition and intervention may decrease morbidity and most importantly save lives and promote healthier lifestyles.
Fannya Manchak is a Physical Therapist with over ten years of orthopedic and sports experience. She is the Clinical Director for Pike Creek Physical Therapy at Lantana Square. Fannya received her Master of Science Degree in Physical Therapy from Boston University, where she was a Division I scholarship athlete for the Woman’s Basketball Program and Graduate Assistant Coach.
Cheryl Lissy, MSPT, ATC is a Physical Therapist/Athletic Trainer with over 20 years of orthopedic and sports experience. She is a Physical Therapist for Pike Creek Physical Therapy at Lantana Square. She is also an avid golfer who has worked with many professional/amateur golfers, improving their strength and flexibility as well as helping with recovery from injury.
Pike Creek Physical Therapy at Lantana Square is one of Southern Delaware Physical Therapy’s six locations. If you would like to schedule an appointment at any of their locations, please call: Pike Creek at 239-2800; Lewes at 644-2530; Long Neck at 947-4460; Milford at 424-1810; Rehoboth at 227-2008; or Smyrna at 659-0173. Their professional and caring staff would be delighted to accommodate you. You may also visit them at their website, www.southerndelawarept.com.
TESTIMONIALS for PIKE CREEK PHYSICAL THERAPY at LANTANA SQUARE
“I came in on crutches and a ‘boot’. I was unable to walk without them. After the first week (3 visits & home exercises), I was no longer using the crutches or the boot. I was encouraged to try new exercises and given advice on what shoes to wear, etc. Each week I could see real improvement. My first goal was to be able to walk down stairs normally. I couldn’t raise my left heel. With the exercises and encouragement of the staff, I am now able to walk down a flight of steps! It has been a very good experience and I am thankful for their caring and skill.” ~R. LUCAS
“In the beginning, I was not able to perform regular household chores, a lot of which require bending. Now my abilities are unlimited throughout my day after only 4 weeks of therapy.” ~N. MOYER
