Screening Female Athletes

Can you list the three components of the female athlete triad? In an article published in a physical therapy sports journal 205 physical therapists were asked this same question, and only 21% of the therapists could list all components. These components are disordered eating (not to be confused with "eating disorder" because that is a more narrow description), menstrual dysfunction, and lowered bone density. The study further describes the strategies that surveyed physical therapists utilize to treat and/or prevent the female athlete triad.

Pantano, the author of this study, points out that "...therapists must be responsible for recognizing, treating and preventing the female athlete triad." Nearly 25% of the respondents surveyed described involvement in treatment via education (to include the patient, family, physician, or coach) or referral of the athlete, screening of the athlete, and nearly 50% reported efforts at prevention of the disorder. It is interesting to note that the surveys were sent to members of either the Orthopedic or the Sports Physical Therapy Specialty groups of the American Physical Therapy Association (APTA), and many of the PT's who participated in the study were also certified in athletic training and interfaced often with female athletes.

Regardless of how often we work with athletes, it is crucial for pelvic rehabilitation providers to be globally aware of the signs, risks, and treatments for female athlete triad. In the National Athletic Trainers' Association (NATA) position statement on the management of disordered eating in athletes, it is pointed out that disordered eating (DE) can not only impair health and function, but DE can be fatal. This article that you can access in full text contains excellent screening tools, advice for referrals to nutrition experts, and information about current treatment.

At a minimum, we must be aware that adolescent females can suffer from disordered eating that leads to poor energy availability in the body, with increased risk of menstrual dysfunction, and decreased bone density and risk for fractures in athletes. Knowing how to ask the right questions, provide education and communicate with a team of providers can improve the lives of athletes who are at risk for female athlete triad symptoms. The NATA guidelines suggest that female athletes should be evaluated within the first 3 months of amenorrhea so that aggressive screening and treatment can be implemented. It is common for an athlete to have one or two of the components, such as disordered eating and amenorrhea without bone loss. The guidelines also point out that males can suffer equally from disordered eating and a high suspicion should be in place for male athletes who are reluctant to discuss their eating patterns, regardless of the sport in which he participates.

Most of us, regardless of treatment setting, can make use of this information to maximize our awareness of the profound affects that athletics and improper diet can have on our female patients. Opportunities are available in our communities as well as in the clinical setting for educating others about the risks and about the available treatments.