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The Female Athlete Triad...What is It?

Does your female athlete have low energy or a menstrual disorder?

In the past few years I have seen more young female runners with bone injury – stress reactions and stress fractures – than ever before. The youngest athlete was 15 years old. These bone injuries range from less serious stress reactions or stress fractures of the long bones (metatarsals) of the foot or the shin (tibia), to more serious stress fractures of the thigh (femur) at the hip joint, or at the low back/pelvis region (sacrum).

Each of these athletes had a clinical presentation of having at least two characteristics of the Female Athlete Triad Syndrome, which is a cluster of signs that include:

          Menstrual disorder – irregular or lack of menstruation 

          Reduced or low energy availability – with or without eating disorder 

          Low bone density or osteoporosis 
Not all signs are required to have Female Athlete Triad Syndrome. At an early age it’s typically menstrual disorder and/or reduced or low energy availability that prevail and become apparent. Low bone density or osteoporosis requires specialized medical imaging to identify so it’s not one you can detect otherwise. However, an onset of a stress reaction or stress fracture accompanied by one or both of the other two signs, and more so a history of multiple stress reactions or stress fractures, should lead to clinical diagnostic tests to measure bone density. And a young female athlete presenting with suspicion of bone injury is commonly the initial presentation that leads me to suspect the Female Athlete Triad. 
Another behavior to be alerted to is high volume or compulsive exercise. Currently it’s commonplace for a young athlete to focus on early specialization in sport and play that sport year round. It’s well documented that there is a higher rate of injury as a result. This will be discussed in greater detail in my next installment, as well as reasons as to why the Female Athlete Triad can occur. 
In the meantime, coaches and parents...please be aware of this condition and the above signs in your kids. 

Karl Kolbeck, PT has been practicing for 26 years and is dual board-certified in orthopedic and

sports physical therapy. He is co-owner of Rose City Physical Therapy ( in

Portland, OR and treats runners of all ages and skills from the weekend warrior to club-based

runners, adolescent and high school runners, and elite and professional World and Olympic class