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If you’ve trained for a marathon or half marathon, you’re well acquainted with the dangers of shin splints, pulled muscles, and joint injuries.

And you probably take deliberate care to avoid them.

But it may surprise you to learn female distance runners face a little-known health risk that can have serious, even permanent, consequences.

I’m talking about Female Athlete Triad (FAT).

A recent article in the Journal Of Women’s Health Physical Therapy defines the condition by its three components: “low energy availability, menstrual dysfunction, and low bone density”. Those components form a chain reaction of problems that build on each other. Unchecked, each one can lead to long-term health issues from hormonal imbalance to lowered metabolism and immunities, to osteoporosis. But it’s easily ignored by those who suffer from it, and misdiagnosed by their doctors.

Low energy availability often triggers the chain reaction; but how many people, including doctors, would describe a woman who fits a 5am training run into her busy schedule as ‘low energy’? Reread the description. ‘Low energy’ and ‘low available energy’ aren’t the same thing. According to researchers, low available energy is “the amount of dietary energy remaining for other body functions… after exercise training”. You can look, and even feel, fantastic; but if your training regimen or diet is too demanding, your body will slow or shut down other systems to conserve energy.

Often, the reproductive system is the first to go offline; and that process usually starts with menstrual irregularities. Sadly, many female athletes believe the myth that irregular or missed periods are just part of the game. Of course, there are a number of other reasons a runner’s period might be irregular, from pregnancy to perimenopause to a perfectly healthy personal cycle. But if you’re skipping periods, it’s important to find out why. Regardless of the cause, untreated menstrual dysfunction can lead to the third part of the triad, low bone density, setting you up for osteoporosis and other problems.

What’s a distance runner to do?

Start by examining your diet. Endurance training and low calorie or fad eating plans do NOT go together, ladies! Whether or not it’s intentional (and 80% of the distance runners in one FAT study expressed weight loss goals), running on fumes is the fastest route to Female Athlete Triad. And although you don’t have to give up your quest for a medal, you may need to adjust your training regimen, too.

If you’re skipping periods or have hormonal issues, it’s definitely time to schedule an appointment with your doctor. Be ready to talk with them about your symptoms and overall risk for Female Athlete Triad. This is especially important if you’re taking contraceptives for previously reported irregular periods. This commonly prescribed quick fix for athletic women can mask the other components while also contributing to them.

If you aren’t sure how to begin the conversation, take this article with you. Better yet, start treating yourself like the serious athlete you are and surround yourself with the team of professionals you deserve. In addition to a medical doctor, consider at least one session with a dietitian, as well as a women’s health physical therapist like someone at Femina Physical Therapy. In addition to our trusted referral network of specialists, we’re happy to discuss Female Athlete Triad and your entire training regimen with you. Physical therapy isn’t just for injuries; you’d be surprised by all the ways we can help you stay in the race toward optimal health and fitness.

Citation

Rothschild C., Schellhase, K. 2020. Considerations For The Adult Female Endurance Runner: A Survey Analysis. Journal Of Women’s Health Physical Therapy 44:1 3-8.

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I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

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I had tried Pelvic Floor Physical Therapy before (with another PT) and I had a really bad (painful) experience. A friend of mine and fellow patient, told me about Heather, Laureen and Femina PT (née Fusion Wellness & Physical Therapy) and I decided to try again. I am so happy I did! Femina PT have, literally, changed my life. I was able to do again things I couldn't do for over 10 years!! Their bedside manners are impeccable, their knowledge and understanding make me feel comfortable to recommend this place to anyone in pain. Specially if you have Endometriosis. 100% recommended!!

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Heather is the best! I saw her today for terrible hip/groin pain. I was so impressed with the safety measures in place and felt completely safe . Thanks for the healing hands.

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My last appointment with Heather was over 6 years ago but I still think of her every day. I don’t take for granted that I can easily get out of bed, care for my two active and busy young boys, run, play tennis, clean my house, or sit at a desk for several hours at a time. None of these tasks were easy for me before meeting Heather. Eight years ago my car was struck from behind by a tractor trailer that was estimated to have been speeding. I spent 3 years working with different PTs and Drs trying to heal and move on with my life. When I became pregnant and the hormone relaxin that “relaxes” all the joints of the body and the additional weight gain erased all my progress and I was suddenly in a lot of pain again. My OB sent me to Heather for one last try.

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I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

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Testimonial by Jackie W.

I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

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