Female
Athletic Triad
When Three Key Factors Fall Out of Balance
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In
the vast majority of sports, men and women compete on a level field. For the
most part, both sexes use the same timers, same distances, same rules, etc.
Thus, coaches of women’s teams adopt
many of the training procedures used for men. The problem is that while the
games and rules are the same, the physiology of each sex is different, and what
works for a man might not be as effective for a woman — or worse, the
training might actually lead to injuries in women.
Concern for just this problem has been an
interest of many researchers, coaches and athletes when it became apparent that
women athletes suffered many more stress fractures of certain bones (typically
tibia and foot bones) than men.
So, if the training was the same, why were
women suffering these injuries? The result lead to an understanding of the
interaction of three factors — the female athletic triad unique to
training women: nutrition, menstruation and bone health.
The general assumption is that the lighter
an athlete, the faster they will be. So in sports were speed is an issue,
carrying excess body fat is a liability. Therefore, many women athletes will
try to lose body fat to become more efficient. The problem is that women tend
to try to lose weight during the time of year of greatest workload — in
season. In addition, to speed up weight loss, they will limit their dietary
intake.
Both factors are happening at the wrong
time — in season (if weight loss is needed or desired, do it in the
offseason). As a result, they end up in a negative calorie balance — they
expend more calories (exercise) then they take in (dieting).
A second factor that happens during some
women's training is a disruption of the normal menstrual pattern. This can be
due to training overloads, caloric deficits, or a host of clinical problems.
(Never assume that menstrual irregularities are due to training. Always consult
a physician.) When this happens, the normal cycling of estrogen is upset, and
estrogen is an important hormone for more than just reproductive health.
The third factor is bone density. Normally,
bones become denser (stronger) with weight bearing (i.e. running). There is
another factor that is necessary for improving bone density. That’s right:
estrogen. In the absence of estrogen, bone density decreases to the point where
excessive loads (training) actually cause the bone to break down. Normally,
such problems don’t start happening until menopause, but women athletes
with the triad may have bones with the density of a woman many years older.
What appears to be happening is that when a
training female athlete limits her caloric intact, the body has to make some
decisions. Does it continue to channel the limited fuel intake to menstrual
function, or to the muscles for training? If the body chooses the muscles, then
reproductive health is pushed into the background, leading to a disruption of
normal menstruation and a decline in estrogen levels.
This then leads to a decrease in bone
density, with the results being stress fractures. This concept has been
referred to as the "energy drain hypothesis."
So how do women avoid the triad? First and
foremost is to maintain a healthy diet and don’t try to lose weight during
the season. Second, ramp up training slowly. A rapid increase in training is a
quick path to injury.
But there is more to this than just stress
fractures of bones.
Next: Cardiovascular and neurological problems of low
estrogen |
