This is a post I wrote back in 2021 but I've decided to revisit it and make some additions. I've recently read some fantastic books by former pro female runners who have been in the trenches, trying their best to make the most of their talent on a timeline and in an environment that does not always suit the female runner. This is my story and what I've learned since.
If I knew then what I know now, I imagine things would look a bit different for me...
In my sophomore year of high school, I got my first stress fracture. I took 3 months off of running and then knew nothing better than to get right back to it. I had no one to tell me otherwise. The doctor cleared me and my coach was excited to have me back. However, I never really got back to the level I was before that stress fracture, which came right around the time I really started to develop as a female. If anything, over the next few years, I wondered hopelessly where my running talent and skill had gone. I was lucky enough to have been offered a DI scholarship, but I felt like an imposter. I had been to several doctors and a nutritionist with no real answers.
It wasn't until my Junior year of college, when I got really sick and passed out at practice, that I finally got some answers. I say "some," because I know now that the testing and resources offered to me at this time should have been way more comprehensive than they were. Nonetheless, I found out I had been severely anemic (iron deficient) and had mitral valve prolapse (typically benign but more significant with low iron and dehydration). Judging by the enormous personal bests I set after I started taking iron, I imagine I had probably been iron deficient since that first stress fracture.
I'm not big on regrets, but I do think about what could have been sometimes. If I had been treated like I would expect someone to be treated now, could I have done better in high school? Could I have run for a bigger DI school? What would my personal bests be? I tell myself that I learned to be tough because I had to work so hard for so long while every cell in my body begged for more oxygen during those tough workouts and 60-mile weeks.
The truth is, my body did take a toll. Like a lot of female runners, I stressed my body in ways the female body should not be stressed while it is at the peak of development. Many of us end up with athletic careers gone too soon or a constant battle with injuries.
At the time this happened to me, did anyone know any better? My parents? My coach? My doctor? Unfortunately, female athletes are still regularly mistreated in athletics. Some of it is intentional abuse and some of it is that the people who are supposed to be in our corner just don't know any better (yes, even doctors). I am thankful I was always in a team culture that focused on training, strength, and healthy habits, not body image and weight. I am also thankful that I was never in an abusive situation. Even still, I fell through the cracks.
This is why I am so passionate about helping injured runners in ways that go far beyond just getting rid of the pain. A stress fracture, for example, is more than just an injury. It can be the first sign of relative energy deficiency (RED-S), which comes when the body uses way more energy than you put back into it. RED-S can become a severe issue. This can be caused by many things:
Lack of sleep
Too little fuel
Too little of the right kind of fuel (protein, carbohydrates, iron, vitamin D)
This list is not all-inclusive and it is definitely not always intentional! Too many people just do not know what it takes to keep a female athlete healthy.
This is why I highly recommend that any female runner and anyone in their corner read the book "Roar" by Stacy Sims, PhD. As Stacy puts it, women are not tiny versions of men. There are so many sports performance studies out there, but most of them use healthy men between the ages of 20-30 as the subjects. This is because women's bodies are too variable for most of these studies due to their menstrual cycles and changing hormones. Dr. Sims has studied women and has shown us all how to take advantage of that cycle to perform our best and stay healthy while doing it. For example, did you know that female hormones are most similar to men during their period? Paula Radcliffe ran the marathon world record while suffering from menstrual cramps after she finally got someone in her corner who realized that intentionally skipping her period for a race was not helping her perform her best.
Speaking of hormones, not only can women not be expected to perform consistently throughout each month, but they cannot be held to the same timeline of success as men. For example, a female runner can have a very successful junior and senior year of high school that earns them the spot on the team they wanted to run for. During freshman year of college, they get frustrated with slower times and weight gain. Depending on the culture of the team, the coach, and the other people they are surrounded with, they may be pressured into trying to lose weight in order to regain their athletic performance. On the other hand, when surrounded by educated coaches and medical staff, they may be reassured that this is just a critical time of physical development in their life. Their bodies are laying the foundations of strong bone density and hormonal health. They may be slowing this year but, when managed well, they will thrive in future years.
This is hard when it comes to earning scholarships and pro sponsorships. It's also hard when you want to be successful on a certain timeline. Unfortunately, female bodies don't work on the same steady timeline of forward progress as men. That's where systemic change has to happen so we can thrive as female runners in healthy environments.
For females to excel with running and stay healthy, we need to arm ourselves with as much knowledge as possible!
Read Lauren Fleshman's book, "Good for a Girl: A Woman Running in a Man's World." for more on the topic of eating disorders, the timeline of success, and being a female runner in the professional setting.
I'd recommend Kara Goucher's book, "The Longest Race," for a look into the abuse that was going on within the Nike team.
Finally, check out this great article from Runner's World: "Is Highschool Running in Need of a Reckoning?"
In final words, if you or your female athlete has had a stress fracture or any other repeated health issues, here are some things that should happen before you/they return to running.
Are there red flags? I would argue that even one stress fracture in a young female runner is a red flag. Other red flags can include loss of menstruation, sleep disturbance, fatigue, decreased performance, and signs and symptoms of eating disorders (https://www.nationaleatingdisorders.org/warning-signs-and-symptoms).
Movement Screen/Gait Analysis - What biomechanical issue or movement dysfunction could have led to this issue?
Blood Work - Get blood work from someone who works consistently with high-level athletes. I cannot stress enough that most pediatricians and primary care doctors are not looking at blood work in the right way. "Within range" might be fine for most people but not fine for a high-performing athlete. Many athletes aren't even getting the right blood work ordered. Athletes often need more comprehensive blood work than what is usually prescribed by a PCP.
Training versus Recovery - What does training look like? Are there too many hard days? What does recovery look like? Are they getting enough sleep? Is school stressful?
Are you getting your period? - It is never OK or NORMAL for a young female athlete to not have her period! Loss of menstruation can lead to lifelong health issues, including infertility and osteoporosis. Seek medical advice before training is resumed.
A Return to Run Plan - When you are recovering from an injury, you are not getting stronger. The bones and muscles need strength training and a return-to-run plan to complete the healing process and allow for a healthy return to running.
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