Abstract
Background: If not recognized early, low energy availability, along with overtraining, may result in stress fractures and significant time lost from sports participation for athletes at any level. Objective/Aim: The multidisciplinary collegiate medical team plays a key role in early identification of Female Athlete Triad (Triad) and Relative Energy Density in Sport (RED-S). To help with early identification, which may in turn lead to fewer stress fractures and less time missed from sports participation, this study’s objective was to implement the use of the 2014 Female Athlete Triad Cumulative Risk Assessment (FACTRA) and test early identification. The first research question (RQ1) is does the use of the FATCRA in pre-participation physical examination with female athletes decrease the number of stress fractures and missed participation days? The second and third research questions assessed if nutritional consultation and education by a registered dietitian nutritionist (RDN) increased nutritional risk factor knowledge (RQ2) and understanding (RQ3) for a female athlete that has been identified as at risk by the FACTRA. The overall goal was to add FACTRA as a screening tool to pre-participation physicals. Methods: A quasi-experimental study was designed to include 234 collegiate female student athletes (ages 18-23) across nine sports teams at a Midwestern NCAA Division I university. Athletic Trainers (ATs) and researchers assisted collegiate female student athletes in completing the FATCRA. All athletes with a FACTRA score of >1 were required to participate in nutrition education and consultation with team RDN with emphasis on energy availability. Subsequent referrals were made to the team physician, athletic trainer, and team psychologist, when appropriate. A pre/posttest survey design was utilized to assess if knowledge and understanding of Triad/RED-S improved with nutritional consult and intervention. Final analysis of data examined the incidence of pre-study stress fractures and missed participation days compared to post-study. Results: A 95% reduction in stress fractures and a 94.6% reduction in missed participation days were found as compared to the year prior due to screening, education, and intervention (RQ1). Two Paired Samples t-Tests revealed a statistically significant difference between pre/posttest knowledge t(53) = -9.04, p< .001, d = -1.23 (RQ2) and understanding t(53) = -16.21, p< .001, d = -2.21 (RQ3) of nutrition risk factors. Conclusion: Early identification of at-risk female athletes utilizing the Female Athlete Triad Cumulative Risk Assessment (FACTRA) proved successful. When the full athletic medical team was involved in early identification, screening, and education, this assessment tool, in addition to collaboration and education, proved to be a successful piece of the healthcare team’s goal of reducing stress fractures and missed participation days.
Acknowledgements
The authors wish to acknowledge the athletic training staff at Missouri State University Athletic Medical and Rehabilitation Services for their participation in this study. Also, Jessica Willis, RStats Coordinator at RStats Institute at Missouri State University for assistance with statistical calculations.
Recommended Citation
Allen NB, Penkalski MR, Hauschildt SM, Paloncy-Patel KA. Strategies for Optimizing Female Athlete Health: A Multidisciplinary Approach to Mitigate Stress Fractures and Minimize Missed Participation in Collegiate Sports. The Internet Journal of Allied Health Sciences and Practice. 2025 Jan 17;23(1), Article 15.
Included in
Dietetics and Clinical Nutrition Commons, Quality Improvement Commons, Sports Medicine Commons
