Are you a female athlete or a coach who is involved with female athletes? Are you aware of the unique considerations that impact a female athlete’s health and performance?
In this blog post, we will delve into the topic of female athlete health and performance, exploring the unique considerations that women and their coaches should be aware of for optimal sports performance. From menstrual cycle management to bone health and injury prevention, it is crucial for individuals to be aware of these circumstances in order to reach their full potential.
We also share ideas of management strategies as outlined by our accredited Physiotherapists and Exercise Physiologists to help improve sports performance in female athletes.
Women’s sports health can be very complex, and every individual will have their own unique considerations. However, there are key trends that can be broken down into the following three areas:
- Energy Availability
- Bone Density
- Menstrual Cycle Changesof buying correctly fitted school shoes easier:
What Issues Do Female Athletes Face?
Energy availability is comparable to fueling a tank. Athletes need to be consuming enough “fuel” to complete their desired activity. It is common for a female athlete to under-fuel her body, which places her in a negative energy balance.
When this occurs, there is an elevated risk of injury and illness which has been associated with decreased sports performance. The term “Relative Energy Deficiency in Sport” or “RED-S” is used to describe this negative energy balance. RED-S has the potential to negatively affect both performance and health, further impacts including decreased training response, impaired judgement, decreased concentration and coordination, metabolic issues, and impacted menstrual function.
The full range of negative connotations driven by RED-S can be seen in Figures 1 and 2 below.
Figure 1: Potential performance implications of RED-S, adapted from RED-S Clinical Assessment Tool, British Journal of Sports Medicine, 2015.
Figure 2: Potential health implications of RED-S, adapted from RED-S Clinical Assessment Tool, British Journal of Sports Medicine, 2015.
A female athlete may be more susceptible to bone density issues. There are over 200 bones in the human body that have a range of jobs; they protect our vital organs, store minerals, produce blood cells and, of course, provide support to help us move.
Each bone has a specific shape and density to withstand the load of normal day-to-day life. Bone is a living tissue that can self-repair from micro-damage that occurs from daily activity. Bones love loading particularly fast multidirectional activities, however when the load (training stimulus) is irregular or excessive, the micro-damage can exceed the bone’s healing rate. This can place an individual at risk of a bone stress injury that can progress to a stress fracture.
So why are sportswomen more prone to bone density issues and related injuries than male athletes?
The hormone oestrogen, commonly known as the “female” hormone, helps build bone and protects against bone loss. During puberty there is a large increase in a female’s oestrogen, meaning a large amount of a female’s bone density is developed during her teenage years. Menopause is when a female’s ovaries are no longer producing oestrogen, and due to the decrease of oestrogen, a female’s bone density will start to decrease.
The absence of a menstrual cycle can be a sign of low oestrogen, which may mean the bones may be more susceptible to stress due to being weaker. It’s imperative to monitor your or your client’s cycle for changes, as these can be a first indicator of potential bone problems or injuries.
Menstrual Cycle Changes
A menstrual cycle is a repeating pattern of changes in hormones, with variations in oestrogen and progesterone ultimately leading to a menstrual period. As the menstrual cycle is influenced by hormones and energy availability, it can be an indicator of health issues or changes in tolerance of training.
Menstrual cycle changes are common in young females, however, it is important to know what’s normal and what is not, especially when considering female athletes. Timing, cycle length, period length and blood loss can vary between individuals. Fluctuations can also occur cycle to cycle within an athlete, meaning there are still some limits that are considered normal.
- Cycle Duration: between 21 to 35 days is considered normal, the average is 28 days.
- Period Duration & Flow: between 4 and 7 days and average flow is between 30-60mL.
What’s not normal
- Cycle Duration: considered abnormal if three or more periods are consecutively missed.
- Period Duration & Flow: soaking through one or more super pad(s) or tampon(s) more than once every hour is considered heavy menstrual flow.
- Pain: a period of pain that stops a female performing her desired activity, which could be attending school, work or training, is not normal. A doctor should be consulted for pain management options.
These menstrual abnormalities can result in a loss in training time, reduced performance, and health implications like reduced bone density. Once identified, however, these abnormalities are manageable and symptoms can be significantly improved.
If you have a question about your menstrual cycle, please do not hesitate to contact your healthcare provider.
Why Do Female Athletes Get Injured More?
One of the key reasons why a female athlete may be more prone to injury than a male athlete is due to differences in anatomy and musculoskeletal structure. Women naturally have wider hips and a different centre of gravity, which can increase the risk of injuries, such as ACL tears.
Hormonal fluctuations during the menstrual cycle can also affect a woman’s joint stability, making her more susceptible to injury. Females also tend to have less muscle mass and less powerful muscle contractions than males, which can contribute to a higher injury rate.
To prevent injury and maintain optimal performance it is crucial for sportswomen and their coaches to be aware of these factors and implement proper training and sports health & nutrition.
Management Strategies for Female Athlete Wellbeing
Early communication about general health, diet, and training load can assist your healthcare provider in developing a management plan to help symptoms and maximise performance. Prevention is a much better management strategy than curative. Being educated by your healthcare provider can empower an athlete and her coach to maximise health and performance outcomes.
Sports Health & Nutrition
A consultation with a Sports Dietitian can help athletes and coaches understand the fueling demands of the desired activity. Having adequate fuel will reduce the risk of the athlete developing RED-S symptoms, which can have a negative impact on health and performance.
A registered Sports Dietician can advise athletes on proper sports health & nutrition plans tailored to their exact sport, training style, and unique physical make-up.
Modifications in an athlete’s training load may be required to maximise their health and performance. Training load is multifactorial: frequency, volume, intensity, and timing within season, as well as accounting for external loads such as school and work.
Monitoring an athlete’s training load can be complex. A simple metric that can be used is training minutes x rating of perceived exertion (RPE). A consultation with your Physiotherapist can assist in determining what is an appropriate training load for you or your athlete.
A wonderful complement to adequate sports health & nutrition is strength training. This type of training should be completed alongside normal sports training to protect athletes against bone stress injuries and to maximise peak bone mass during the teenage years.
Muscle strength is associated with improved performance and can help prevent musculoskeletal injuries. It is important to have a strength program prescribed by your health professional or Physiotherapist to ensure correct technique, volume, and intensity.
Book a Consult with Coast Sport
At Coast Sport, we are well experienced in working with female athlete programs. Our experienced Physiotherapists and Exercise Physiologists have worked with many wonderful sportswomen, from grassroots to medal-winning Olympians.
If you’d like to address issues in your health, or you’re seeking to boost your sports career to the next level with optimised performance, sports health & nutrition planning, contact us today for a consult.