The Female Athlete

6th April 2015

Over the years the population of female athletes has evidently increased. Not only are more women becoming more recreationally active, but they are also taking part in elite level individual and team sports. There has been a lot research presenting the benefits of recreational and professional level sports for the females body and mind. However, along with the various benefits comes a few risks.

Female Injury Risk

Research has shown that females are at more risk of injury than males. This risk is amplified in the sporting population. Firstly, women do not usually tend to have the strength that men have, however they endeavour to push themselves just as hard both physically and mentally, placing themselves at a higher risk of injury.

The woman’s pelvis in comparison to the male’s is greater in size, which increases what we call the Q-angle. Due o this the alignment, and thus the biomechanics, of the lower limbs are completely changed. This research has shown exposes the typical female athlete to an increased rate of injury in comparison to the typical male athlete.

Research has also presented that due to the hormonal changes that occur in all females during their life, women tend to have more lax ligaments in comparison to men. This means that their joints possess a reduced amount of static support and stability and thus put them at risk of joint injury. If not treated and rehabilitated, joint injury may lead to osteoarthritis in the long term.

It has been found that women lack general body coordination in comparison to men, which further puts them at higher risk of injury. This has been said to be related to hormones and to the time of their menstrual cycle. Research has found that concentration and coordination are reduced in the menstruating female.

Lastly, a lot of women take part in individual sports rather than team sports. individual sports tend to generate more pressure on the female athlete. Individual sports lack team support and team work which causes an increase in pressure that may cause the athlete to over train and thus predispose herself to injury. In the majority of these individual sports, such as ice skating and ballet dancing, pristine physical appearance and leanness is crucial. This puts an enormous demand on the female athlete, forcing the athlete to over-train and eat minimal amounts.

The Female Athlete Triad

The female athlete triad refers to the interrelationships among energy availability, menstrual function, and bone mineral density, which may have clinical manifestations including eating disorders, functional hypothalamic amenorrhea, and osteoporosis.

Energy availability is defined as dietary energy intake minus exercise energy expenditure. Low energy availability appears to be the factor that impairs reproductive and skeletal health in the triad, and it may be inadvertent, intentional, or  psychopathological.

Restrictive eating behaviours practiced by girls and women in sports or physical activities that emphasize leanness are of special concern. As discussed earlier, females taking part in sports requiring a very lean and tones physique tend to limit calorific intake (food) and increase calorific expenditure (over-training). This calorific shortage causes reduced levels of the very important hormone called oestrogen. Oestrogen regulates the female menstrual cycle and is also important for bone formation and strength. Therefore, due to nutritional deficits caused by the athlete herself, she becomes predisposed to ammenorhea (a disrupted menstrual cycle), and in turn osteoporosis (reduced bone mineral density). This is a vicious cycle that will continue to spiral into repeated injury, and in the long-term, life-threatening risks.


Prevention and Treatment for the Female Athlete Triad

This vicious cycle known as the Female Athlete Triad may harm the body permanently if not dealt with as soon as possible.

For prevention and early intervention, education of athletes, parents, coaches, trainers, judges, and administrators is a priority. Athletes should be assessed for the triad at the pre-participation physical and/or annual health screening exam, and whenever an athlete presents with any of the triad’s clinical conditions.

A multidisciplinary treatment team should include a physician or other health-care professional, a registered dietician, and, for athletes with eating disorders, a mental health practitioner. Additional valuable team members may include a certified athletic trainer, an exercise physiologist, sports rehabilitation therapists and the athlete’s coach, parents and other family members.

The first aim of treatment for any triad component is to increase energy availability by increasing energy intake and/or reducing exercise energy expenditure. Nutrition counselling and monitoring are sufficient interventions for many athletes, but eating disorders may warrant psychotherapy. Athletes with eating disorders should be required to meet established criteria to continue exercising, and their training and competition may need to be modified.

No pharmacological agent adequately restores bone loss or corrects metabolic abnormalities that impair health and performance in athletes with functional hypothalamic amenorrhea. Therefore, constant monitoring of female athletes at risk of the Female Athlete Triad is crucial in order to prevent serious physical and mental damage.


The Physiotherapists Role

When assessing a female athlete for a specific injury, it is crucial that the physiotherapists considers the athletes individual risks of the Female Athlete Triad. It is crucial that the therapists subjectively assesses the athlete around this area, asking questions about training, nutrition and the menstrual cycle. Some female athletes may not be willing to discuss these subjects, which may mean that the athlete is trying to hide some important information about their current health status.

If the therapist is worried that the athlete may be at risk of having symptoms related to the Female Athlete Triad it is necessary that the athlete is referred for X-rays to eliminate fracture from the diagnosis prior to administering treatment and rehabilitation. If there is a fracture that has not been caused by a high impact injury, the red flags are flying high and a bone density scan should be performed immediately. It is then up to the therapist to involve other professionals of the multidisciplinary team in order to address possible nutritional deficits, psychological involvement and menstrual dysfunction, alongside physical treatment and rehabilitation for the specific injury.

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