Disordered Eating in Female Athletes

Unlike most people with anorexia or bulimia, athletes who have disordered eating appear normal because of the muscle mass they carry. They typically fall into the disordered eating category when there is an imbalance in caloric intake and energy expenditure. The resulting imbalance results in significant deficits in vitamin and mineral intake and absorption required for musculoskeletal integrity and alteration in menstruation. This is particularly aggravated by the demands of training and competition, adding stress to the muscles and bones. Below are a few examples of metabolic dysfunction and musculoskeletal injuries associated with the "female athlete triad."

Electrolyte imbalances alter neuromuscular control and coordination, resulting in abnormal skeletal muscle contraction causing cramping and muscle strain. Such an imbalance can impede healing, resulting in a prolonged rehabilitation course. Performance is reduced because of iron deficient anemia, causing early fatigue and lack of energy. Protein deficits in those restricting their protein/meat intake force the body into "starvation mode". The body responds by releasing Cortisol, which causes skeletal muscle breakdown-atrophy. Atrophy of muscles translates into decreased strength, power, and resistance to fatigue. Excessive training and nutritional deficits can alter female hormone levels. Severe alterations can result in a decreased number of menstrual cycles (oligomenorrhea) or no menstrual cycles (amenorrhea). Prolonged amenorrhea results in significantly reduced estrogen production from the ovaries. Estrogen plays an important role in bone growth. Loss of this input can result in rapid bone loss. The consequences set the stage for recurrent stress fractures and major injury of muscles and joints.

Bone is regularly replaced through a process balancing break down (resorption) and repair. As re-absorption exceeds repair, bone failure is likely, resulting in a stress fracture and the possibility of a complete fracture. Stress fractures occur particularly in weight bearing sports and during cross training in non weight bearing sports — i.e., swimming. Stress fractures usually appear in a gradual way but can appear with sudden symptoms. Stress fractures are most often seen in the lower extremity in the tibia (shin), metatarsals (foot) and ankle, and less frequently the femoral neck (near the hip joint). The area of injury is often sports specific.

Treatment requires treating the athlete as a whole, not only addressing the orthopaedic concerns with an orthopaedic provider, but also enlisting the help of a dietician, psychologist, and physical therapist.

Andrea Wilson, PA