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Writer's pictureKate Driscoll, PT DPT CSCS

Dear Coaches of Middle School and High School Female Athletes

You need to be doing more.

You signed up to be the coach and mentor, you have a responsibility to do better for your athletes. You need to guide them to be the best, strongest version of themselves. Which means you need to be doing more.


I've played sports for as long as I can remember. In high school, I rowed all four years. My junior year I was on the lightweight boat, which meant at my height (5'6") I had to be under 130lbs. It was a lot of pressure, but it was what I wanted. I have great support from my family. My mom helped me plan out lighter meals full of protein to maintain my weight. But between eater fewer calories and training six days a week, I lost my period for months.


At the time, I thought it was awesome. This stressful time of the month was not something I had to worry about. So I didn't mention it to anyone. Looking back, that was not smart of me, but how was I supposed to know better?


It should the role of any athletic influence in a female's life to make sure they are properly educated, empowered, advocated for and supported. That means coaches need to step up. They need to teach athletes the importance of strength training for improving athletic performance, decreasing injury risk and improving body confidence. They need to be taught to lift heavy. And that strength training won't make them bulky and it won't injure them, it will make them resilient and unstoppable. Female athletes are at SIX times the risk of males for an ACL injury. People have tried to blame that injury risk on having a wider pelvis and estrogen causing looser ligaments, but the vast majority of physical therapist I know relate it to not being pushed into the weight room as much as males. As for strength training making you bulky, it takes YEARS of targeted strength training with the intent to bulk for that to happen. Teach them proper nutrition and how to fuel their body. Don't let them chronically under-eat, restrict themselves, see food as something they have to earn or exercise as something they need to do to make up for eating. Eating disorders are a huge risk for these age group. In fact the prevalence of ED is about 20% and 13% among adult and adolescent female elite athletes. It is theorized that it is due to specific constraints of sports including:

  • Dieting to enhance performance

  • Personality factors

  • Pressure to lose weight

  • Frequent weight cycling

  • Early start of sport-specific training

  • Overtraining

  • Recurrent and non-healing injuries

  • Inappropriate coaching behavior

  • Regulations in some sports

Just focus on instructing them to get plenty of protein, carbohydrates, fats, veggies and fruits. Tell them to eat when they're hungry and how to eat around their practice and competition times.



Graph describing interaction between RED-S and different immune systems; further described in text below

You need to know and instruct on the cost of undereating and over-exercising. Reduced energy deficiency in sports (RED-S) is a huge issue with female and male athletes at all levels. You might have also heard it called female athletic triad. It causes:

  • Low energy

  • Amenorrhea (skipping period): body is at such a low enrgy point that it is diverting fuel away from reproductive system

    • Low bone density: putting them at rism for stress fractures

  • Alters levels of metabolic hormones and substrates: insulin, cortisol, growth hormone, insulin-like growth factor-I (IGF-I), 3,3,5-triiodothyronine, grehlin, leptin, peptide tyrosine–tyrosine, glucose, fatty acids and ketones.

  • Athletes who suffer from long-term low EA may develop nutrient deficiencies (including anaemia), chronic fatigue and increased risk of infections and illnesses, all of which have the potential to harm health and performance.

  • Physiological and medical complications involve the cardiovascular, gastrointestinal, endocrine, reproductive, skeletal, renal and central nervous systems.

  • Psychological stress and/or depression

  • Reduced muscle protein synthesis: poor recovery, higher injury risk

  • Unfavourable lipid profiles and endothelial dysfunction, thereby increasing cardiovascular risk

  • Hormonal and metabolic abnormalities caused by RED-S and carbohydrate deficiency can result in a reduction in glucose utilisation, mobilisation of fat stores, slowing of metabolic rate and a decreased production of growth hormone.

Signs you should look for:

  • Hasn’t had her first period by age 16 or who has missed three cycles not due to pregnancy

  • Has repeated stress fractures, shin splits or persistent hip pain

  • Low BMI and body fat


Don't run them into the ground. Pay attention to training volume and allow for proper recovery. You should probably also be paying attention to their outside stressors. High school and middle school are stressful times. Don't be a part of the problem. Don't follow dumb stereotypes. Don't call kneeling pushups girl pushups. Honestly, I prefer elevated (on a bench or step) pushups anyway. Don't enforce the idea of "strong for a girl" or "fast for a girl." They have the potential to kick the ass of male athletes, help them understand that and help them get there. If you feel uncomfortable with these topics: pull in a strength coach, an RD and/or an athletic trainer. If you’re in Massachusetts, message me. I’ll be glad to come and have this conversation with your athletes free of charge.

We need to do better.


References:

1. Mountjoy M, Sundgot-Borgen J, Burke L, et al The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine 2014;48:491-497.

2. Lin CY, Casey E, Herman DC, Katz N, Tenforde AS. Sex Differences in Common Sports Injuries.PM R. 2018;10(10):1073-1082. doi:10.1016/j.pmrj.2018.03.008

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