The Female Athlete Triad: Prevention and Implications for Coaching

Female Athlete Triad Causes: A Brief Overview

The female athlete triad is one of the most common sports injuries among women athletes. It occurs when there are several repetitive stress fractures (RSBs) or other bone breaks in the same joint over time. These RSB’s may occur at any age but tend to peak between ages 15-25 years. The incidence rate of these injuries increases with increasing body weight, especially during adolescence and young adulthood.

Ribs, knees, ankles and feet are some of the joints most commonly affected. Most females with the female athlete triad suffer from multiple RSB’s in those specific areas. Many times it is not clear what caused each RSB break; however, there are certain risk factors which increase your odds of developing a RSB.

Most often, the cause of the RSB is unknown. However, there are many things that can contribute to them. They include:

Physical activity level – Athletes who participate in high levels of physical activity have a higher chance of sustaining an RSB than others. Physical inactivity and poor nutrition are two other risk factors associated with increased risk for RSB’s.

A rapid increase in exercise or physical activity can be a risk factor for RSB’s. If you are increasing your exercise level or starting a new sport, it’s important to do so gradually and with proper training.

Muscle weakness – Some of us are just born with naturally weaker muscles. This may make us more prone to RSBs than others. Muscle weakness places us at risk for RSBs not only during our sports or physical activities but also when performing day-to-day activities, such as walking up stairs or carrying your backpack.

Weight – The more weight you have to lift, the greater the stress on your bones, which places you at a higher risk for an RSB. Having a higher body mass index (BMI) has been shown to increase the chance of sustaining an RSB in girls ages 15 – 19.

Genetics – Some people are just more prone to RSBs than others. Being born to parents or grandparents who had repeated bone breaks may put us at greater risk for them as well.

Female athlete triad treatment should begin immediately after the first signs of an abnormality in the body’s hormonal system. The sooner treatment begins, the higher the chances of complete recovery from all three components of the female athlete triad.

The High School Female Athlete Triad

High school female athletes have been diagnosed with the triad at much higher rates than college and professional female athletes. The most common combination is OST, followed by PCOS, and lastly, eating disorders. It’s important to regularly monitor your daughter’s physical changes and her eating habits throughout high school.

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Educate your daughter about the female athlete triad so she knows the signs and symptoms of each condition. This is especially important for athletes who participate in sports where weight needs to be kept at a certain level, such as gymnastics or dance.

It’s important to remember that the high school years are stressful even without physical activity added into the mix. Puberty combined with rigorous training programs increases your daughter’s risk for developing a problem. It’s also important to note that sometimes RSBs occur without any history of physical activity or stress fracture.

The Female Athlete Triad and Competitive Dance

If your daughter dances competitively, she is at risk for the female athlete triad. If your daughter is a serious and dedicated dancer, make sure she gets adequate rest and nutrition. It’s common for dancers to skip meals or forget to eat in between classes and practices. Encourage her to eat nutritious meals and snacks, even if she doesn’t feel hungry.

There’s also the concern of weight with dancers. As a competitive dancer, your daughter will most likely be pressured by her instructors to keep her weight at a certain level. Educate your daughter about eating disorders and encourage her to eat healthy in order to fuel her workouts and growth.

If your daughter shows signs of developing a problem, it’s important to seek help immediately. Help her find a therapist who can help her work through issues with eating, weight, and body image. Helping your daughter now may prevent serious problems in the future.

The Female Athlete Triad and Sports

Participation in organized sports has been linked to higher rates of the female athlete triad. This isn’t just limited to women’s sports; it also applies to men’s sports as well. The NCAA (National Collegiate Athletic Association) has even made it part of their health initiatives in an attempt to educate student-athletes and coaches on the risks of the triad.

The increased risk may be a result of more intense training, weight concerns, or the desire to win. Unfortunately, some coaches foster an environment that promotes eating disorders and the desire to be thin. Some coaches also push their athletes to the point of injury in an effort to win at all costs.

It’s important for parents to remain involved in their children’s sports activities. Don’t allow your coaches or instructors to encourage your daughter to eat less or exercise more. Help your coaches and instructors understand the effects these things have on growing bodies.

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If you notice a change in your daughter’s physical appearance, weight, or behavior, talk to her about it. Let her know it’s okay to talk to you about such things. If you’re worried about being judgmental, let her know that you’re there to help and that you want to keep her healthy. Help her find the resources she needs to ensure that she stays in a healthy state of mind and body.

If your daughter starts pushing herself too hard or engaging in disordered eating habits, watch for signs of the female athlete triad. Help her find a therapist in your area. Encourage her to get help if she suffers from the triad.

The female athlete triad may seem rare, but it does occur. Help your daughter understand the risks involved and encourage her to seek help if necessary. It may save her life.

What to Do If You’re Concerned About a Girl

If you suspect that a friend, relative, or co-worker is suffering from the female athlete triad, it’s important to pay attention to your concerns. If you’re not sure, look out for the signs of weight loss, overexercising, menstrual cycle problems, and low energy.

If you think that someone you know is suffering from the female athlete triad, there are things you should do immediately.

Eating disorders are very serious. They can lead to long-term, life-threatening effects if left untreated. It’s important to take action immediately to help your loved one get the treatment she needs without shame or judgment.

If you think a female friend or family member may be suffering from an eating disorder, there are steps you can take to help:

1. Offer your support.

Be there for her. Let her know that you’re there to listen and help. Don’t be judgmental or condescending. Let her know that you want to help her get better.

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Help her find a therapist, nutritionist, and exercise professional who can treat her without judgement.

2. Encourage action.

If she refuses to get help, take charge. Address the problem directly with her by letting her know that you’re worried about her health. Be supportive in your approach while being firm about getting her help. If she still refuses to get help, tell her there will be consequences.

Talk to her parents or another adult you trust. Let them know the situation and enlist their help.

If you need help finding resources such as therapists, nutritionists, and exercise professionals, contact your local chapter of the National Eating Disorder Association (NEDA).

Menstruation is a natural event which all women experience. It’s completely normal for menstrual cycles to be irregular at times. If you’re concerned about your daughter’s periods, there are a few signs which may indicate a problem. These include:

1. Lack of three or more consecutive periods

2. Excessive bleeding

3. Severe lower abdominal pain

4. Heavy blood clots

If any of these symptoms are present, it is likely that your daughter may be suffering from a condition known as hypothalamic amenorrhea. If you believe your daughter is suffering from hypothalamic amenorrhea, the best thing you can do is help her.

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Seek out a professional specializing in eating disorder recovery. Help your daughter find a female therapist, nutritionist, and exercise professional to assist in her treatment.

Encourage your daughter to eat more healthily and exercise in a safe manner. It’s important that she does not engage in any type of crash dieting or excessive exercising during treatment.

It’s important to seek out treatment immediately, as hypothalamic amenorrhea can lead to infertility if left untreated.

Once you have found a treating professional, there are things you can do at home to help your daughter with her condition. It’s important that she receives all the necessary nutrients she needs for recovery. Here are some suggestions:

1. Encourage your daughter to eat small meals six times a day.

2. Recommend that your daughter eats foods high in carbohydrates and protein.

Try encouraging foods such as low-fat dairy, oatmeal, whole grain breads, lean meats, and beans.

3. Encourage your daughter to eat fresh fruits and vegetables.

Try to steer clear of processed foods and junk foods.

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4. Recommend that your daughter consumes at least three liters of water a day.

5. Talk to your daughter about getting fifty minutes of exercise a day.

This can be done in intervals of ten minutes. Encourage your daughter to participate in activities she enjoys such as walking, running, swimming, biking, hiking, and dancing.

6. Talk to your daughter about the benefits of yoga.

Yoga has been known to help people suffering from eating disorders because it helps builds self-esteem and body image, while also helping with breathing techniques to alleviate stress and anxiety.

When your daughter begins treatment for hypothalamic amenorrhea, it’s important that she does not engage in any type of crash dieting or excessive exercising. Make sure she knows that it is not necessary to maintain an unrealistic weight, as this can lead to relapse.

Seek out a nutritionist and exercise professional to help your daughter during her treatment.

If you have any questions about hypothalamic amenorrhea, feel free to call the National Association of Anorexia Nervosa and Associated Disorders at 1-888-236-1188.

This message was brought to you by the courtesy of the Eating Disorder Hope Awareness Foundation.

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You turn your head to see a girl who looks about thirteen staring at you.

Sources & references used in this article:

Knowledge of the female athlete triad, and prevalence of triad risk factors among female high school athletes and their coaches by KN Brown, HJ Wengreen, KA Beals – Journal of pediatric and adolescent …, 2014 – Elsevier

The female athlete triad by JA Hobart, DR Smucker – American family physician, 2000 – aafp.org

Gender differences in high school coaches’ knowledge, attitudes, and communication about the female athlete triad by E Kroshus, RT Sherman, RA Thompson, K Sossin… – Eating …, 2014 – Taylor & Francis