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The female athlete triad: an emerging role for physical therapy. J Orthop Sports Phys Ther 2003 Oct;33(10):594-614 PMID: 14620789

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Over the last thirty years, participation by girls and women in organized athletics has increased dramatically. This presents unique challenges in the area of sports medicine, orthopaedics, and pediatrics. While the benefits of participation in sports and exercise vastly outweigh the risks of permanent injury, an evolving concern is the number of stress fractures in active women. The female athlete triad ("triad") describes the coexistence of 3 distinct medical conditions that may occur in athletic girls and women. Originally, the triad included eating disorders, amenorrhea, and osteoporosis. Presently, it includes eating disorders/disordered eating behavior, amenorrhea/oligomenorrhea, and decreased bone mineral density (osteoporosis and osteopenia). Briefly, when coupled with inadequate nutrition, the high caloric expenditure of exercise training resultsin a sustained negative caloric balance or low energy availability, which is exquisitely sensed by the hypothalamus, initiating a complex neuroendocrine adaptive cascade. This cascade is associated with changes in the hypothalamic-pituitary-ovarian axis, such that estrogen levels are decreased, resulting in reproductive dysfunction that may include amenorrhea, oligomenorrhea, or anovulation. Low estrogen in otherwise young healthy women, like menopause, is associated with decreased bone mineral density and increased risk of fractures. The triad is not an inevitable consequence of participation in sports or physical activity at any level, however, exercise may contribute to the disruption of caloric balance. The triad is a complex disorder that requires intervention by a multidisciplinary team. Physical therapists bring a unique expertise to the team. The present review summarizes each component of the triad, component linkage, and the role of physical therapy in prevention, assessment, and intervention.

Author List

Papanek PE


Paula Papanek PhD, MPT, LAT, FACSM Associate Professor & Director of Exercise Science in the Exercise Science & Physical Therapy department at Marquette University


2-s2.0-0942287853   25 Citations

MESH terms used to index this publication - Major topics in bold

Body Composition
Bone Density
Energy Intake
Feeding and Eating Disorders
Physical Therapy Specialty
Professional Role
Sports Medicine
Water-Electrolyte Balance
jenkins-FCD Prod-332 f92a19b0ec5e8e1eff783fac390ec127e367c2b5