The Female Athlete Triad: A Case Report on the Evaluation and Therapeutic Prognosis

Background: Many female athletes may believe several myths and stigmas about optimal health surrounding women in sports that can adversely impact performance and contribute to the development of the female athlete triad. The female athlete triad is defined as an interrelationship between three parts: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction, and (3) low bone mineral density.¹ This case report outlines the clinical decision-making associated with the evaluation and prognosis of a patient with female athlete triad. Case Description: A 15-year-old patient presented to the clinic with left foot pain and a diagnosis of stress reaction fractures of her second and fifth metatarsal limiting her ability to run. The patient had a history of bilateral tibial stress reaction fractures and amenorrhea with additional notable findings of low vitamin D, obsessive-compulsive disorder (OCD), and generalized anxiety disorder GAD. Intervention: The patient’s physical therapy interventions were set up to address her underlying strength issues while allowing adequate time for nutritional and caloric intake rebound, bone healing, and underlying causes to be ruled in or out by the physician with an end goal of building up to a return to run progression. Outcome Measures: Outcome measures utilized in this case were the lower extremity functional scale (LEFS), the patient specific functional scale (PSFS), the global rating of change scale (GROC), successful passing of the readiness to run protocol, and the patient’s ability to run pain-free. Discussion: As physical therapists are often sought out for musculoskeletal disorders; we may be the best member of the health care team to recognize risks for the female triad. It is important to address the many myths and physical expectations society places on women in sports, as the recovery from musculoskeletal problems, such stress reaction fractures, are complicated by the female athlete triad. As such, if not properly addressed, it could continue to affect healing and overall prognosis of the patient for years to come.