Female Athlete Triad FAQs

The female athlete triad is a condition seen across all ages and sports in active females.  It can occur in female athletes at any level, recreational to elite.  This condition can include both physiological and psychosocial components. Often, female athletes may only exhibit 1or 2 conditions of the triad.  

What are the factors associated with the female athlete triad?

Dysfunction related to the following:

  1. Energy availability
  2. Menstrual cycle
  3. Bone MIneral Density

What are common symptoms associated with the female athlete triad?

Energy Availability: 

Feelings of fatigue or tiredness not just related to sports activities, decline in performance level, mood changes, signs of body dysmorphia, frequent illness

Menstrual Cycle: 

Dysfunction of the menstrual cycle ranging from delayed onset to absence of the menstrual cycle 

Bone Mineral Density: 

Stress reactions or stress fractures in bones, frequent injury, osteopenia, osteoporosis

Can the female athlete triad be prevented?

The Female Athlete Triad is both preventable and treatable. Education is the KEY to prevention. Proper nutrition, proper sleep, education on proper body weight especially in “lean” sports (ballet, gymnastics, endurance running).    

Is it treatable? 

Treatment requires a multi-disciplinary approach to determine the underlying causes of poor nutrition and/or overexercising resulting in decreased energy availability, menstrual dysfunction, and bone mineral density alterations.  It is important to include the PCP, physical therapist, nutritionist, coaches, and family in treatment.  

What age ranges does it predominantly affect? 

High school, college, and elite level athletes – most predominant in figure skaters, gymnasts, ballerinas, and endurance runners

What role does PT play in the female athlete triad?

Physical therapy plays a strong role in both identifying and treating the Female Athlete Triad.  

Pre-participation Evaluations: 

All female athletes should participate in a PPE to help determine the risk for the Female Athlete Triad.  The PPE should be done prior to participation in any sport and ideally should be repeated yearly.  This will help to identify athletes with potential issues.  It should include a screening questionnaire to assess for risk factors for an eating disorder, psychological status, menstrual history, BMD risk factors as well as a physical exam.

Treatment of Orthopedic Injuries: 

Physical assessment of ROM, strength, balance, and function to determine deficits.  Patient education regarding proper nutrition and hydration, sleep, and adequate recovery periods following exercise.

Patient, Family & Coach Education: 

The importance of educating the athlete, the family, and the coaches is paramount.  Often the Female Athlete Triad will be missed if the athlete only exhibits one or two of the conditions yet the likelihood of the athlete developing the third condition is high.  

 

By Marianne Arild, PT, MPT | Therapydia SF – One Embarcadero

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