by Jordan Rose
What is the Female Athlete Triad?
The female athlete triad is a condition most prevalent among high school and collegiate aged athletes that is characterized by three confounding factors including low bone mineral density, menstrual dysfunction, and low energy availability. Low bone mineral density is identified by a DEXA scan in which “T score” is developed from the amount of calcium measured in your bones. A T score of -1 to 1 is considered normal, while a score of -1 to -2.5 indicated low bone density or osteopenia, and a score of -2.5 or lower indicative of osteoporosis. Menstrual dysfunction can present in various different ways under the umbrella of the female athlete triad including primary and secondary amenorrhea, anovulation, luteal phase deficiency, and oligomenorrhea. The third factor of the triad being low energy availability which may or may not originate from disordered eating. Energy availability is the metabolic energy that remains after accounting for the metabolic cost of physiologic processes in addition to the energy expenditure from exercise. For many athletes, low energy availability may not be caused by disordered eating, but a lack of knowledge of the nutrient and caloric requirements the body needs to perform at high athletic levels. In cases where all of these factors are present with a female athlete, the implications of the triad may become very apparent.
How Can the Triad Impact Young Female Athletes?
The triad represents the risk factors that play a role in the incidence of sports injuries among young female athletes, most commonly bone stress injuries (BSI) or stress fractures. Stress fractures can make it very difficult for high performance athletes to continue to excel in their sport. For females in sport, common signs and symptoms to be aware of that may indicate development of the triad include:
• Low energy during school, work, or exercise
• Irregular or absent periods
• Stress-related bone injuries
• Trouble concentrating
• A drop in performance that the athlete can’t explain
• Changes in eating and/or sleeping habits
What Role Does Physical Therapy Play?
For patients who come to physical therapy and may be experiencing injuries resulting from the triad, your physical therapist can help to resolve the condition in addition to preventing future injuries by risk factor modification. In terms of menstrual dysfunction and low energy availability, it would be appropriate for the physical therapist to make referrals to other healthcare professionals such as a primary care physician and nutritionist to ensure the athlete has the best odds for a successful recovery. With the female athlete triad, a team approach is essential to ensuring healthy outcomes for these athletes. In physical therapy, a program can be developed to return to sport while promoting health and wellness in order to prevent future stress related injuries derived from the triad. A primary focus of physical therapy rehabilitation for athletes presenting with triad related risk factors will be weight bearing and higher load activities such as squats, lunges, jogging, etc. Weight bearing activities will improve the bone mineral density for these young female athletes as the greater stress that is placed on a bone, the stronger the bone becomes. In cases where athletes are able to address all relevant factors of the triad, the more likely a healthy return to sport becomes and prevention of future injury becomes a major focus.
References:
1. Nazem TG, Ackerman KE. The female athlete triad. Sports Health. 2012;4(4):302-311. doi:10.1177/1941738112439685.
2. Barrack MT, Gibbs JC, De Souza MJ, et al. Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: A prospective multisite study of exercising girls and women. AJSM. 2014;42(4):949-958. doi:10.1177/0363546513520295.
3. Bone densitometry. JHM. August 8, 2021. Accessed June 20, 2023. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/bone-densitometry.
4. GUIDE: Physical therapy guide to female athlete triad. Choose PT. June 8, 2022. Accessed June 20, 2023. https://www.choosept.com/guide/physical-therapy-guide-female-athlete-triad.
If you have been diagnosed with the female athlete triad, contact us today via our contact form, or call us directly at our physical therapy clinics in Malta, Saratoga or Queensbury at 518-289-5242 for a personal evaluation, and find out how we can get you feeling better!
