Female athlete triad (triad) refers to a medical syndrome that can manifest across a broad spectrum, but involves the interrelationship between 3 measurable factors:
Clinically, imbalances in any one of these areas can lead to
The prevalence of all 3 components of female athlete triad among high school, collegiate, and elite athletes in the United States can be as high as 16%; the prevalence of any one component of the triad in this population can be as high as 60%.
Female athlete triad is a medical syndrome that can involve both the physical and mental aspects of health. Typically develops in female athletes based on 3 factors: energy availability, bone mineral density, and the menstrual cycle.
1) Energy availability is calculated by how much energy you gain from dietary sources, minus the amount of energy you expend during activity. Typically, with triad poor energy availability is the driving force behind abnormal bone density and menstrual dysfunction.
Poor energy availability is caused by poor nutrition; it can occur with or even without the presence of an eating disorder. Nutrients act to provide the necessary source of fuel for bones and muscles.
Poor nutrition also can have a negative effect on the part of the brain that controls hormones that regulate the menstrual cycle. Optimal energy availability supports bone health specifically by maintaining estrogen levels.
Estrogen is an important hormone that has a protective effect on bone by supporting the balance between bone building and bone loss. Therefore, lack of estrogen can impact bone density and may increase the risk of bone stress injuries.
2) Bone mineral density (BMD) defines 1 aspect of bone health. When your bones are not supplied with necessary nutrients or are stressed too much through overexercising, they may begin to weaken.
This weakening can lead to osteopenia (lower than normal BMD) and if the condition remains untreated or worsens, the patient may develop osteoporosis (a loss of bone strength that predisposes a person to increased risk of fractures).
When a person has low BMD, she may be at an increased long-term risk of bone mineral loss and bone fractures as she ages.
3) Menstrual dysfunction refers to abnormal menstrual periods. This spectrum can range from oligomenorrhea (inconsistent menstrual cycles) to amenorrhea (absence of a menstrual period) in females who are of a reproductive age.
Female athletes are at an increased risk of developing triad due to the high demand that athletics place on the female body physically, as well as the increasing societal pressures for performance and image.
For example, a female runner may feel that altering or restricting caloric intake will make her a faster runner, therefore gaining an edge on the competition and earning greater success in her sport.
Triad can be present in any female athlete, from the elite athlete striving to reach high-performance goals, to the adolescent female whose body is going through normal changes related to puberty.
In any case, there are physical and psychological aspects of this syndrome that affect its extent, impact, and treatment.
Female athlete triad is not caused by a sudden traumatic injury; therefore, no immediate symptoms typically appear. Instead, symptoms related to the 3 components of triad may develop over time, ranging from months to years.
A female athlete may begin experiencing the following symptoms, conditions, or changes (separately or together) that may indicate she is developing female athlete triad:
A multidisciplinary team of medical providers typically diagnoses female athlete triad. The team may include medical doctors, nutritionists, physiotherapists, certified athletic trainers, and psychologists.
However, nonmedical individuals, such as parents, friends, coaches, teammates, teachers, and work colleagues can also be resources to help identify female athletes who demonstrate signs of triad, as these are all people who spend time with the athlete.
Often, the athlete does not realize that she has low energy availability or any of the symptoms of triad; therefore, therefore/that's why it often becomes the responsibility of a health care professional to educate a patient and her parents and coaches (sometimes it's even hard to convince patients/family too).
If it is suspected that an athlete may be demonstrating 1 or more components of triad, a proper screening interview can help identify the components, including questions about menstrual status and history, history of stress or bone injury, and eating disorder tendencies.
These questions may include:
To diagnose triad, a number of medical and psychological tests and consultations may be recommended, including:
Because triad involves multiple components of health, an athlete who is able to receive care from all relevant health care practitioners has the best chance of developing a comprehensive plan to return to good health and athletic participation/performance.
Our senior physiotherapists are trained to identify signs and symptoms of female athlete triad and initiate multidisciplinary care as appropriate and needed.
We can assist with prevention and the promotion of health, wellness, and fitness, in addition to providing rehabilitation following an injury.
Primary prevention includes proper screening of any female athlete for triad, asking questions such as those stated above, and referring the athlete to other appropriate health care professionals.
Our senior physiotherapists are also trained to understand the implications that triad may have on exercise prescription. For example, an athlete with a stress fracture due to low BMD should not perform jumping and running movements.
Once an athlete's symptoms are resolved, we can design an individualized return-to-activity program that encourages a safe, progressive level of activity. We also can identify if an athlete is at an increased risk of overuse injury or abnormal loading of the bone or a joint.
We're are trained to educate athletes and their families about triad, and work with athletes to prevent or resolve the condition—guiding them back to safe, optimal performance levels.
Our senior physiotherapist is a critical member of the healthcare team and works closely with a coach and athletic trainer. We may use a combination of the following treatments: