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Navigating the Female Athlete’s Movement
Navigating the Female Athlete’s Movement is written by Emmi Aguillard, a Doctor of Physical Therapy at Finish Line PT and Laura Gann, a nutritionist who works at the BALANCE eating disorder treatment center. Running has been a large part of both their lives; running during their adolescence, as D1 collegiate athletes, and in today’s NYC Running Community with the Dashing Whippets Running Team.
The following blog addresses the culture female athletes experience in sports today and sheds light on the physical and mental repercussions of gender differences in sport. The purpose behind this blog is to fuel a much-needed conversation around this topic and to create sustainable change across sport
When Mary Cain released a powerful video speaking out about the pressure put on female athletes, she bravely shared her personal journey with the world. She spoke about information that many female athletes are told from a young age that is widely accepted as an absolute: that you must be small to be successful and maintain this arbitrary weight. This assertion highlights gender differences that exist at the very core of our sport and that have been passed down for many years. Our goal is to share our own journeys with you all, and provide resources for anyone who may have struggled with this in the past. We are here for you!
Competing at a D1 level in college, I remember thinking that if I missed my period, it meant that I was pushing myself to my full potential. Amenorrhea, or the cessation of a woman’s menstrual cycle, was associated with success, and if I was still getting my period, that meant I wasn’t training hard enough. When I suffered stress fractures in college, I remember our athletic trainer suggesting that I go on birth control to better regulate my hormones. I was also given a pill that is given to women with osteoporosis, typically in their 60s and 70s, as an 18-year-old college freshman with the thought that it would improve my bone health. I could see that the goal was always optimizing current performance, and that was my goal too. Our head coach avoided the topic of weight with the women on our team because he didn’t want to “mess us up” – he had had negative experience discussing this with previous female athletes, so he avoided the topic all together.
I saw numerous friends and teammates fall victim to injury after injury. Many of these injuries – I can now look back and see – were stemming from inadequate nutrition, and the belief that being thin meant winning – without any comprehension on what affects this would have on their long term health or ability to sustain a running career. Close friends of mine were medically released from the team because they couldn’t stay healthy, couldn’t avoid stress fractures. And, the devastating reality is that most of these friends and teammates of mine who suffered from disordered eating are no longer running.
Weight was never something I thought about until I started running DI in college. I was always told that I was more of a “track person” in high school by coaches because I ran faster in the shorter races. In college, I was told the same thing for two years, but this time it was because “I wasn’t built to be a fast cross country runner.” That sentiment fueled me to prove them wrong – but I wasn’t willing to sacrifice my health to do so.
The culture of my team supported weight loss as an appropriate tool for success. I had a male cross country coach and a female head track coach, but I worked most closely with a female middle distance coach. The cross country girls who worked with the male coach were very divided from the middle distance group and as the 4 years passed, I realized how lucky I was to have worked with the middle distance coach. She always told us that one race or one PR was not worth the rest of our lives. Right after she started with us, she sat us down and provided a very honest and informative conversation about eating disorders in our sport and how to be successful in a healthy and sustainable way. The group of girls who worked with the male coach were not as fortunate. Many teammates developed eating disorders, most of the team had severe iron problems, many girls were called in for meetings to discuss their weight and we often had girls going to the emergency room after races from dehydration. Whenever we went out for a meal after a race, the team was on edge when ordering because we knew our coach was watching us. Our head track coach would even take desserts off of plates and we were told which foods were “not allowed.”
Depression, anxiety, self-harm and eating disorders were all so prevalent on my team, but we didn’t have appropriate resources to turn to. My coach could only do so much – she wasn’t a registered dietician or therapist. Most of my teammates no longer run because of injury or hate for the sport now. Many did not even come out of college with a faster time than high school. Having the support of at least one coach made such an impact in my collegiate running experience and I wish more of my teammates had been able to benefit from that same support system. Instead, they were met with negative messaging, encouraged to engage in harmful behaviors and had no resources to turn to for help.
Changing the Narrative
Compromising your health for immediate and short-term performance is not the answer. One common misconception that has become widely normalized for female athletes is that losing your period is a sign of peak fitness. Girls are afraid to get their period because they have been taught it is a sign they are not doing enough. This is false. We must change the narrative that eating less and losing your period is normal.
When a woman loses her period, it is a biological sign that her body is NOT working properly. Normalizing this mindset is both mentally and physically damaging. Amenorrhea, or the loss of at least three periods in a row, leads to a number of future health problems. Many have heard of the famous “Female Athlete Triad,” which includes disordered eating, osteoporosis and amenorrhea. However, these symptoms are constantly ignored by coaches, teammates, and even individuals themselves.
The Female Athlete Triad has been redefined as RED-s, or Relative Energy Deficiency in Sport. RED-s describes individuals whose dietary intake is too low to support energy expenditure (1). This means that the athlete is burning more calories than they are eating in a given day. In simplest terms, calories are purely energy for the body to use in order to properly function. Therefore, if an athlete does not consume enough calories, their body will begin to break down. Without adequate caloric intake, the body must rely on tissue and bone for essential nutrients to sustain life. Bones are broken in order to release calcium into the blood stream, because calcium is critical for proper muscle contraction, heart function, and nerve conduction. Bone density becomes compromised in order for the body to survive.
This is where the symptoms of RED-s become apparent. Bone density diminishes, muscle repair and recovery are impaired, brain functioning is reduced and risk for cardiac abnormalities and osteoporosis greatly increases. In the short term, athletes sometimes see small gains in performance, but at a cost. The athlete is not able to recover from the small microtraumas to the bones and muscles that occur during training. There is a constant breakdown, with no opportunity to rebuild. In order to fuel itself, the body literally has to turn inward for energy. The effects of RED-s on the body soon lead to musculoskeletal injuries like stress fractures that force the athlete to put their career on pause. For many young women, this pause becomes permanent.
As we age, it becomes very, very difficult to improve bone density, and our timeframe for recovering and rebuilding also slows down. When women experience RED-s at a young age for a prolonged period of time, by the time they reach their late twenties or early thirties, their bone density is equivalent to that of a post-menopausal woman.
Remember – losing your period is a sign of stress, of over-training, of under-fueling, NOT improved performance. Your period is a sign of HEALTH. It is critical to understand how deeply health, injury, healing, and performance are linked with nutrition and mental health. When it comes to proper recovery and “prehab” nutrition and mental health are arguably THE most important factors.
Reframing Inner Dialogue
It is essential to separate our relationship with food from our relationship with exercise. Sentiments such as “burning it off,” or “earning this meal” have made their way into everyday conversations amongst many runners. However, this mindset is so damaging to young athletes. Exercise is NOT to negate calories from food. Compensatory exercise, or the idea that we must “burn off” what we ate, will oftentimes manifest as disordered eating after enough exposure to this thinking. It doesn’t matter how much you weigh, whether or not you worked out, or if you’ll be able to “burn it off.” Those should never be indicators for what or if you should eat. Tuning into hunger and fullness cues and considering taste preference are more appropriate indicators.
We have been told a dialogue around which foods are healthy and which to avoid that has no nutritional background to validate such claims. Labeling food components or entire food groups as “good,” “safe,” “clean,” or “bad,” implies moral connotations that contribute to the development of rigid food rules rooted in restriction. Food does not have morality. At the end of the day, all foods should be viewed as neutral – a calorie is a calorie. Your body needs nutrients and vitamins that come from protein, fat and carbohydrates every single day. There are no conditions that “allow you to eat.”
Another very important concept to keep in mind is that if we are injured, and healing from injury, we must avoid the mindset of “I didn’t work out today, therefore I don’t need to fuel.” When dealing with injury, proper nutrition is equally as important as when we are training. Our body works really hard to heal (just like it works hard to run), so you need nutritional resources to fuel that hard work. Everyone’s bodies have different nutritional needs, much like how everyone responds differently to training. What works for one person may not work for another. Therefore, there is no place for rules in nutrition.
We must change our inner dialogue around exercise and running – instead of “burning it off,” our reasons to exercise might look something like this:
- Stress relief: I need to blow off some steam!
- Socializing: I love spending time with my friends and being active
- Self-care: This is my “me time;” I find it meditative, energizing, and mood-boosting
- Commuting: It’s faster and more efficient than the subway
- Appreciating our potential: I want to work towards a goal and compete
- Because it’s fun!
We are so very lucky to be a part of this sport, and a part of this community, at a time where issues like this are at the forefront, and there are many voices working together to promote change. We are part of a community filled with STRONG women, women like Mary Cain, Allie Kieffer, Kelly Roberts, Lizzo – who are promoting body positivity among young women.
We are passionate about Women’s healthcare. For a long time in the lense of our healthcare system, and in sport, women were treated as “small men.” But the fact is – women are NOT tiny men. And in the past few decades, women have fought hard for gender equality in sport. It is important that we develop a system where men and women’s bodies are NOT treated equally, because they work very, very differently. What is needed is a system that understands and embraces the physiological differences between men and women.
If this is something that you have struggled with in the past, or are struggling with now – it’s important to know that you are not alone. There are many, many wonderful women (and men) out there who have been where you are, who can help.
Laura and Emmi
If you are looking to learn more about the importance of differentiating training and nutrition needs for female athletes and how we can change this culture for the better, please consider joining us for the #FixWomensSports panel tomorrow, Tuesday, December 3rd starting at 6:30pm here at Finish Line PT.
National Eating Disorder Association (NEDA)
National Suicide Hotline: 1-800-273-8255
Balance Eating Disorder Treatment Center: https://balancedtx.
Outpatient Groups include: Body Image, Monthly Contemplating Recovery Free, Support Group, Emotional Eating, RO-DBT, Men’s Group, Supporting a Loved One, and Eating Disorder Relapse Prevention
Podcast: The Appetite
Emmi (physical therapist)i: firstname.lastname@example.org
Laura (nutritionist): email@example.com
- Marcason, Wendy. (2016). “Female Athlete Triad or Relative Energy Deficiency in Sports (RED-S): Is There a Difference?” Eat Right. The Academy of Nutrition and Dietetics. https://jandonline.org/