Sasha Kolbeck, DPT, OCS, COMT
The Female Athlete Triad is a continuum of interconnected health issues of low energy availability, menstrual dysfunction, and decreased bone health. An imbalance of nutritional fueling with increased exercise energy expenditure can lead to bone health risk resulting in bone stress reactions or stress fracture. The syndrome Relative Energy Deficiency in Sport (RED-S) expands on the triad to include males and increases the number of health consequences. The causes of RED-S mirrors the female athlete triad. Awareness and knowledge of the Female Athlete Triad and RED-S are crucial for the health and performance of athletes.
Sixty percent of high-performance athletes experience at least one of the three Female Athlete Triad symptoms. Low energy can be due to disordered eating, intentional weight loss, inadvertent undereating, or a clinical eating disorder. Inadequate fueling, along with excess energy expenditure, can lead to menstrual dysfunction. Athletes who do not have regular menstrual cycles are at two to four times the risk for bone stress fractures. Bone density is related to hormones and nutrition. The especially crucial time for gaining bone density is the teen years, as 90% of female peak bone mass occurs by 18 years old. Physically active girls around puberty achieve 17% greater bone mineral density than their inactive peers. Warren and Chua reported that osteoporosis is a disease of adolescence that manifests in the elderly. They state any fracture, aside from one caused during a motor vehicle accident sustained between 20 and 50 years old, is associated with an increased fracture risk after 50 years old. There is no cure for osteoporosis, so prevention is crucial.
Feel free to contact our highly trained physical therapist at Rose City Physical Therapy.
“osteoporosis is a disease of adolescence
that manifests in the elderly.
The expansion to the RED-S syndrome shows far-reaching effects for female and male athletes, including hematologic, growth and development, psychologic, cardiovascular, gastrointestinal, immunologic, menstrual, bone, endocrine, and metabolic problems. The International Olympic Committee Consensus Statement from 2018 has three risk categories: 1) Red light (high risk), 2) Yellow light (moderate risk), and 3) Green light (low risk). Red indicates to cease training due to serious health risks, yellow to proceed with caution, and green indicates to proceed with training. An increasing body of evidence shows that male athletes are at risk, especially in sports such as cyclists, rowers, runners, jockeys, and athletes in weight class combat sports. Risk factors for males and females are addressed by recognizing and treating gradual or sudden symptoms or frequent injury, load modification, nutrition education and guidance by a sports dietician, training and exercise modification, and rest and recovery.
We are in a unique year of both the Summer and Winter Olympics, and athletes are even more so in a performance mindset after not being able to compete last year with having the summer Olympic games postponed to this year. Performance consequences of RED-S include decreased endurance, increased injury, decreased training response, impaired judgment, decreased coordination, decreased concentration, irritability, depression, decreased glycogen stores, and reduced strength. These consequences can have a significant impact on competition. Our trained physical therapists are dedicated toward helping you achieve a pain-free life.
Physical therapy is part of the medical team to address athletes at risk. Our evaluation at Rose City Physical Therapy includes assessing orthopedic injuries with a clear understanding of bone stress injury and keeping that top-of-mind. Treatment includes manual therapy for soft tissue, nerves, and joints, load modification and management using the Alter G treadmill, progressive functional exercise, and collaboration with the athletes’ other medical practitioners (sports medicine physician, sports dietician, sports psychologist) and coaches.
Some of the indications of a bone stress reaction that an athlete might notice include a reported “tightness,” swelling, aching, pinpoint pain, and pain with hopping or other load-bearing activity.
If you, as an athlete, parent, physician, or coach, feel physical therapy may be beneficial, Contact our physical therapy office today!