Since April is “All About Adolescents,” we thought we would dive into an important topic that affects injury recovery in our young female population. Have you or an adolescent female you know had a difficult time recovering from an overuse injury? This young woman may be suffering from a phenomenon know as “Female Athlete Triad.”   This condition is the culmination of 3 main factors including:

Energy Deficiency

  • Disordered Eating
  • Decreased Caloric Intake
  • Insufficient protein intake
  • Disruption of hormone levels
  • Decreased micronutrient levels (iron/zinc) = anemia

Disruption in Menstrual Cycle

  • Irregular menstrual periods
  • Amenorrhea: Complete cessation of menstrual periods

Decreased Bone Mineral Density

  • Osteopenia
  • Osteoporosis



Low energy availability for a prolonged period of time will ultimately lead to a decrease in a person’s basal metabolic rate (BMR). This BMR reduction will result in higher levels of blood cortisol (stress hormone) and decreased levels of estrogen. This decrease in estrogen will lead to irregularity or complete absence of the menstrual period. The lack of estrogen and increased cortisol will finally result in decreased bone mineral density and ultimately osteopenia (osteoporosis in severe cases).

When this energy deficit becomes a chronic issue and leads to the other precipitating factors, the young woman may experience symptoms including increased fatigue, difficulty recovering from training, delayed healing, cardiac arrhythmia, difficulty gaining muscle mass, stress fractures, as well as difficulty concentrating and cognitive issues.

As physical therapists, we are trained to recognize the signs and symptoms of the female athlete triad and treat accordingly. As part of our integrative treatment approach, we may counsel the young woman on proper nutrition, incorporating adequate rest into the training schedule, and injury prevention methods. If your daughter, sister, friend, etc., may be suffering from the female athlete triad, have them schedule an appointment at IP to begin their road to a successful recovery!