Girl Athletes

All girls need to exercise regularly.


At a minimum, a girl should participate in aerobic exercise for at least 45 minutes, four times per week and strength-training exercise as often as possible.


The earlier a girl begins this on a regular basis, the more positive the results will be later in life..


Exercise is the single best thing a girl can do to improve her health.


Exercise can restore proper skeletal alignment, improve the oxygen carrying capacity of the blood, reduce blood pressure, lower the concentration of LDL-cholesterol and instill a more positive attitude in life.


An exercise program that includes stretching is recommended because intense exercise and aging contributes to the progressive shortening of muscle fibers.


Stretching therefore delays aging by better resisting the forces of gravity


Muscles and ligaments should be stretched only after adequate warming has occurred in order to maintain elasticity.


Functional exercise returns an aging adult's skeletons to positions that were once a part of their young life.

Doing this while young, prevents the skeleton from being deformed.




The female musculoskeletal system evolved along the same lines as males.

They each developed their muscles to allow the movement of limbs needed to become hunters and gathers.


They walked, ran, jumped, bent, climbed and crawled their way through life.


The muscles that moved these limbs were regularly used.


This activity maintained strength and increased the density of their bones.


Lucky young girls today crawl, stretch, jump, leap and shake their way through infancy and childhood.

The not so lucky ones grow-older, confined to playpens and pampered by nannies.

They are pacified with food, TV and video games.

This is the origin of many of the nutritional chronic diseases that these girls will experience as adults later in life.


Parents need to instill a love and understanding of the importance of exercise and activity and its effect on health.


Children need to move.


Parents who depend on nannies to guide their children may need to tale a closer look at that practice.

Nannies don’t bother with exercise too much because their social life with the other nannies would suffer.

When infancy ends, these children are unprepared for the strains of middle childhood.


Having raised two daughters, I saw first hand the consequences of nannie-ism.

I was a good father to my kids.

To me this meant instilling the love of movement and the joy of being active.

I taught them to love the outdoors and encouraged them to bike, rollerblade, swim, golf, hike and play team sports. 

I think it has paid off as they have grown into health concious young women.


Young girls who who were instead sedated with food as infants, suffered from neglect.

While my kids exercised and played sports, other adolescent girls ate second lunches.

Now, they yo-yo diet, follow unhealthy practices to loose weight or are already on pharmaceutical drugs to manage their symptoms.


Is it merely a coincidence that Attention Deficit Disorder (ADD), and Attention Deficit Hyperactive Disorder (ADHD) are more than four times more likely in sedentary children?



Demands of Exercise


A girl's metabolic demands are much higher  than those of sedentary girls.  


This is best illustrated by exercise. During exercise, a girl is exposed to a level of stress that has no equal in life.


To illustrate this extreme internal condition, consider a high fever of 105 degrees, the core temperature that is near death.

These conditions increase the metabolic rate by 100 per cent.


By comparison, during a marathon, a female athlete’s metabolic rate climbs to an astounding 2000 percent of normal.


Intense exercise is the most important component in this program and is far more important and outweighs any contribution from any food, supplement or drug in achieving health.


The success of this program depends on the biological adaptations that result from exercise.

This Diet predicts a positive response to exercise and uses it as a natural form of metabolic enhancement and will contribute to prolonged youth.



Exercise produces unhealthy consequences such as muscle strains, sprains, tears and pulls with inflammation, the body's response.



The most important molecular consequence is the enormous amount of free radicals produced following exercise.

These events need to be anticipated and countered with proper exercise nutrition.


The increased demand for antioxidants and the need to repress the predicted inflammation associated with exercise is accomplished with colorful foods that contain a huge arsenal of phytochemicals. These foods are described here.



Exercise is a traumatic event that produces enormous amounts of free radicals upon the completion of exercise.

This is due to the subsequent reoxygenation of muscle tissue.

The reoxygenation is needed to metabolize the lactic acid that accumulates as exercise progresses.


Any diet that promotes health must promote exercise and any diet that promotes exercise must provide the antioxidants, nutrients and fuel to support it.


Providing these nutrients is best achieved through a colorful, complex carbohydrate diet.

The rational in support of this diet and the metabolic consequences of following a high protein diet are discussed here.


While it is true that boys and girls generally observe the same dietary principals, there are nutritional and gynecological concerns that are unique to active girls.


These concerns include: eating disorders, osteoporosis, iron deficiency, amenorrhea, delayed puberty and premenstrual syndrome.


There are also differences in physical characteristics, which affect performance and the risk of incurring repetitive stress or acute injuries. This disparity in performance and injury patterns is less pronounced as women have become more involved in sports at a younger age.


The training and conditioning of girl athletes has advanced a great deal but the number of coaches and doctors of sports medicine committed to girls remains lower than it should be.

For this reason, girls need to become more involved with their own health.





The revolution that began in the 1970’s has resulted in an increased participation by girls in sports.

The lack of conditioning in girls is responsible for the increased injuries experienced by women later in life.

Overuse injuries and stress fractures are especially high in female athletes.

Shoulder injuries are also common as is knee pain and damaged anterior cruciate ligaments (ACL).

Women, who improve their training and nutrition regimen, will lower their risk of injury.

Foot pain is a common complaint among girls.

It is possible that this due to their shoes being designed too narrowly.  

The high-heeled dress shoes women wear in the real world may also cause problems.

These shoes causes a tightening of the Achilles tendon and increases the load on the forefoot.

The increased load causes injury over time.




Despite a widespread misconception, the musculoskeletal system of a male is really no different from that of a male.


The only real anatomical difference between the sexes is the area of the pelvis.


Those difference makes a girl more dependent on proper posture and skeletal alignment than a boy.


The spine’s ‘S’ shape rests on the pelvis and allows girls to move and twist their bodies in many directions.

Their back is composed of layers of muscle with the spinal erectors responsible for maintaining erect posture.

When their body is properly aligned, all the joints line up so that lines formed between the shoulders, hips, knees, wrists, elbows, and ankles are horizontally parallel and vertically perpendicular to each other.



This alignment resists the forces of gravity and inactivity hinders this ability.

When these forces exceed the girl's ability to resist, misalignment occurs.

This is a type of dysfunctional stress that damages the underlying bone and muscles.


Functional exercises that are designed to restore misalignment.

In addition, girls who properly perform exercise will prevent misalignment by strengthening the core muscle groups responsible for proper posture.


Movement, together with breathing, circulation of blood and the metabolic breakdown of nutrients are the essential functions of life.

A girl's ability to carry out these processes is based on the coordinated interplay of hormones, nerve impulses, enzymes and nutrition.

Good health is the culmination of events that result in a more efficient coordination of those processes.


Illness results when dysfunction controls the events.


Exercise promotes good health in females.



The purpose of functional exercises are to restore proper function to muscles.


Proper functioning muscles forces the joints and bones that they are connected to, into proper alignment.


Exercises are grouped according to the position of the spine in space.

Some exercise place the spine in a horizontal position, parallel to the floor while others require the spine on the floor.

There are also exercises that begin with the spine in a vertical position.


Exercises that involve the act of limb extension should engage and strengthen a girl's muscles through their full range of motions.


The strengthening of postural muscles improves health.


Exercises are designed to improve core muscles and restore the alignment of bones in the skeleton.  

A girl's skeleton, like its male counterpart, is designed to best resist the forces of gravity.

Incorrect movement causes misalignment and produces injuries.


Pregnancy produces different strains on different muscles, which require other exercises to correct.


Pregnant athletes should seek out trainers qualified in evaluating their needs.



Inactive Girls



For many girls activity ends when they enter the educational system.

They now are required to walk, carry books, listen and learn.

Exercise may be required by school but fitness is not.



Today’s girls exercise far less than they should and are subjected to more stress than any generation before them.

This despite all the advances made under Title IX.


Girls that are sedentary eliminate many functional movements.


Sedentary girls suffer more injuries than active ones because their inactivity causes dysfunction in functional movements. 

When these movements are not executed properly, injuries develop.

The muscles that produce movement include the small muscles of the back and abdomen.

These muscle atrophy because of inactivity.


The inner core of muscles suffers the most from inactivity.

The larger peripheral muscles become overused to compensate for the lack of core contribution.

The overall lack of movement in a girl’s daily life causes more compensation, which causes pain and dysfunction.


Proper exercises can correct dysfunction and relieve pain from poor posture and improper movement, which have created compensations.

The proper alignment of bones and joints allows women to exercise their muscles through the full range of motion without incurring pains and strains.


Athletic success depends on proper movement and minimal injury.



The Pregnant Athlete



Pregnancy produces stress and places increased demands on a woman's body.  


Any girls who is contemplating having a child, should undergo a fitness program first.

The amount of aerobic exercise that a pregnant woman can participate in is based on their conditioning and fitness level before before conception.



The changes that occur during normal pregnancy include a change and distribution of weight and an increased need for more nutrients.


The cardiovascular, metabolic and hormonal changes that result from impregnation are all directed towards promoting the natural growth of the developing fetus.


Pregnancy requires a significant increase in blood to feed the developing fetus.  

This is accomplished via an increase in cardiac output.  

Increased cardiac output occurs due to an increase in blood volume as well as  an increase in stroke volume.



Aerobic exercise also leads to an increase in cardiac output, which is proportional to the level and intensity of the exercise.


Aerobic exercise produces an increase in VO2 max, which is the best measurement of cardiovascular fitness.


Cardiac output during exercise in pregnant athletes is thus very high and pregnant women should consult with their obstetrician regarding their exercise program to insure they are not endangering their health.



Many female athletes, after delivering their child are often in a hurry to return their bodies to their pre-pregnant state.


They are advised to once again consult with their obstetricians before doing so.


The body female

The major difference between female and male athletes center on a female’s anatomy and the hormones responsible for its maintenance.

The following will briefly describe normal anatomy and physiology and the effects the menstrual cycle has on training.



The pre-pubertal female has the same strength, aerobic power, heart size, fat content and weight of similar aged males.


With the onset of puberty, the female body undergoes changes due to the influence of the female sex hormones.


These hormones affect bone mass, lean body mass, circulation, and metabolism.


With the onset of puberty boys gain muscle mass and lose body fat under the influence of androgens, while girls gain both lean mass and fat mass.


The metabolic rate of females is less because of this difference.


Once females achieve adulthood, they generally have ten percent more body fat than males.

They also have fifteen percent less muscle mass, smaller bones, and shorter leg length in proportion to height.


These characteristics make a girl's movements less powerful than boys and more prone to injury.


Female athletes also have smaller lungs and hearts, and their blood has less oxygen-carrying capacity.

This results in decreased effectiveness in anaerobic and aerobic activities.

Better training and improved conditioning is needed by female athletes in order to overcome these factors and achieve gender equity.


Female athletes have varying amounts of hormones circulating at any given moment.

The relative amounts is based on the stage of their monthly cycle.


The presence of both estrogen and progesterone hormones promotes a greater reliance on fat metabolism and enhances glucose uptake and storage.


In addition, estrogen alone decreases collagen content thereby reducing ligament strength, and increasing joint elasticity. Progesterone alone produces the opposite effect and increases the amount of collagen in joints.


Exercise reverses the combined effects of estrogen and progesterone by allowing females to better use their glycogen stores and reduce the amount of fat they carry or store.


Exercise also stimulates protein synthesis, which builds lean muscle and collagen and leads to increased bone density.


Women improve their bone density by exercising on a regular basis.


Title IX legislation, passed in 1972, mandated equal opportunity for females in all areas of education in all institutions receiving federal funds. This included athletic scholarships. This act produced a paradigm shift in the number of opportunities for women to participate in sports.

Women now participate in resistance and strength training exercise, rock climbing, hiking, river rafting, tennis, basketball, soccer,  biking golf, skiing and softball. In addition they make up the major part of yoga, Pilates and aerobic classes. Female athletes unfortunately receive little mention in scientific studies related to nutrition.




Menstrual Cycle



Menstruation is the cyclic discharge of blood and tissue through the vagina from a non-pregnant uterus.


The average menstrual cycle lasts 28 days, although a range of 24 to 32 days is normal. The length of the cycle varies during reproductive life. The cycle is most regular between the ages of 20 and 40.The average female experiences approximately 400 cycles in the course of their lives.


The hormonal changes that occur in the course of a female’s life begins in puberty and ends with menopause.

Menarche is the first menstrual bleeding. A girl’s first expression of blood typically begins around the age of 13 or 14.

Puberty is the stage of adolescence during which girls and boys become capable of sexual reproduction. Puberty is the awakening of the hypothalamic-pituitary-gonadal axis. It is a time when a female’s pulse generator takes control of hormone secretion and growth.

The biochemical consequence of puberty is a dramatic increase in body fat production indicating the beginning of reproductive maturity. Reproductive maturity is due to the increase in sex hormone secretion (estrogen) that occurs during this period of growth. Hormone secretion is initiated at the age of 9 or 10.


Female puberty is initiated by increased pituitary output of the gonadotropins (follicle stimulating hormone and luteinizing hormone). These two hormones are secreted by the pituitary gland, travel via the circulation to the ovaries where the hormone binds with receptors. Once bound, they trigger ovulation and stimulate ovarian production of the hormones estrogen and progesterone.


Follicle stimulating hormone and luteinizing hormone (the two gonadotropins) are released from the pituitary gland when the hypothalamus secretes a releasing factor(gonadotrophin releasing hormone).


The secretion of gonadotrophin releasing hormone by the hypothalamus initiates the process of puberty. gonadotrophin releasing hormone activates the pituitary-ovarian axis. gonadotrophin-releasing hormone is secreted at night, in rhythmic bursts under the control of the pulse generator (a group of nerve cells in the hypothalamus).


gonadotrophin-releasing hormone, a decapeptide (ten amino acid chain) is secreted in a pulsative manner in the hypothalamus.

gonadotrophin-releasing hormone promotes the release of follicle stimulating hormone  and luteinizing hormone.

The pulse generator is sensitive to stress and metabolism. Weight loss and severe stress (excessive exercise) can shut the pulse generator down completely or delay the onset of puberty.


Menstrual-related disorders including amenorrhea and other hormonal irregularities are associated with intense exercise, poor nutrition and low caloric intake.



Menstrual Cycle Regulation

Menstrual Cycle Regulation

The female reproductive system is under the control of the brain. The  hypothalamus and pituitary gland, collectively known as the master gland, is located at the base of the brain. The master gland regulates, among other things, the ovaries.


This grouping of gland cells, nerves and sex organ makes up the female hypothalamic–pituitary–gonadal axis.



The proper functioning of a woman’s cycle is contingent on the balanced interaction of hormonal and neuronal signals directing the growth of the uterine lining or endometrium. These signals originate and emanate from the central nervous system (the pituitary-hypothalamic gland) and target the ovaries.

The endometrial blood supply is unlike any other vascular bed due to its cyclic remodeling during the menstrual cycle. The blood vessels or capillaries that feed the uterus and a potential fetus are very sensitive to changes in gonadal steroid levels.

At the end of a cycle, when the gonadal steroids are at their lowest level, the major part of the endometrium disintegrates dies. The necrotic material is then discarded along with the blood.  The monthly remodeling and discarding of tissue and blood is the menstrual cycle.


In the event of pregnancy, the endometrium does not disintegrate but instead is used to provide nutrients to the developing embryo.



There are unique aspects of a woman’s health that relate to the female athlete’s menstrual cycle. This cycle is under the control and is dependent upon the interplay of a fem ale’s hormones. Female hormones are responsible for sex determination, growth, puberty, reproduction, lactation and finally menopause.

Irregular menstrual cycles occur much more frequently in athletes than in non-athletes. In many cases the irregularities are sport dependent with runners and dancers being more affected. This is due to their low body fat and high aerobic activity.  Female athletes therefore need to balance their exercise with better nutrition. This will help them maintain proper hormonal balance and correct fat levels. This is not the case in male athletes whose poor dietary habits often go unnoticed and may not become apparent till much later in life.

Irregular periods are also more common among athletes than among sedentary females. Irregular periods may be caused by a malfunction of the pulse generator in the hypothalamus.

This type of hypothalamic dysfunction is more common in individuals with low body weight (athletes who participate in endurance sports, marathon runners, dancers, gymnasts, and figure skaters).



Amenorrhea is the absence of periods. As defined, amenorrhea is the lack of discharge for a period of least 6 months. This is not unusual for active females and occurs in twenty percent of exercising women and up to fifty percent in elite athletes and professional dancers.


Amenorrhea is the result of a blending of genetics and a host of controllable factors (nutrition, exercise, weight loss, stress, hormones).


Amenorrhea is more common in younger athletes who engage in intense training. Female athletes who follow a vegetarian diet also have a higher incidence of amenorrhea.


Low body fat is the primary cause of amenorrhea. Twenty-two percent body fat is recommended for proper maintenance of an athlete’s regular menstrual cycles. This is a good set point but may be unrealistic for active athletes.


Active athletes need to consume more food to fuel exercise and promote normal vaginal discharge.

Healthy athletes focus on activity, not weight.


The high-energy requirements of training and exercise may be responsible for the low levels of body fat seen among elite female athletes.

Elite athletes have an increased metabolic efficiency.  This may actually work to a disadvantage  interferes with the functioning of the hypothalamus either in the pulse generator nuclei, or by stimulating the release of corticotrophin releasing factor, which stimulates the adrenal cortex to release adrenocorticotrophic hormone (ACTH). ACTH is released in response to the stress of intense exercise.


The term dysmenorrhea is derived from Ancient Greek and originally was meant to convey a difficult monthly blood flow. It is now understood to mean painful menstruation.  The pain, is sometimes incapacitating and is believed caused by an increase in prostaglandins.

Prostaglandins are inflammatory mediators that produce vasoconstriction of the small vessels in the uterine wall causing forceful uterine contractions.

Dysmenorrhea produces lower abdominal pain that radiates to the back and legs and is often accompanied by gastrointestinal and neurological disturbances. 40% of American women are affected by dysmenorrhea. Pharmaceutical treatment of dysmenorrhea is with anti-prostaglandin drugs.

Non-steroidal anti-inflammatory agents (NSAIDs) are the most often used to treat this condition, including selective cyclooxygenase 2 (COX-2) inhibitors.

Women who are obese and smoke are at greater risk of experiencing painful menses than healthy athletes are.





Many females that engage in exercise began doing so late in life. Many begin after childbirth and others wait even longer. All females will ultimately find themselves entering the phase in life that is known as menopause. This state produces a myriad of changes, which cause unique concerns for the menopausal athlete.

Menopause is defined as the cessation of ovulation by the ovaries, and occurs at an average age of 52 in the United States. Menopause is caused by the failure of the ovaries to produce eggs and the subsequent inability to prepare the uterus for a fertilized egg.

The most important feature of menopause is the reduced levels of hormones that result from the cessation of reproductive activity. The major problem for women as they enter menopause is the initiation of osteoporosis.


Menopause is the end of ovarian estrogen production.


The current view of menopause treats it more as a disease rather than a normal physiological process that occurs with aging. Current pharmaceutical treatment of menopause primarily involves the use of hormone replacement therapy featuring the combination of estrogen and progesterone.

The combination is recommended by doctors because there is a well-established fact that estrogen increases the risk of endometrial cancer. The combination of estrogen with progesterone (progestin) appears to have reduced the risk of endometrial cancer, but still causes other  cancers.

The cancer-causing potential of hormone replacement therapy is a serious concern for female athletes. Despite numerous studies and investigations. the bottom line remains that no one really knows for sure what impact hormone replacement therapy has on cancer.

Common symptoms associated with menopause include: hot flashes, thinning of the vaginal lining, and psychological symptoms such as depression, anxiety, forgetfulness and sleep deprivation.


Chaste berry, Dong Quai and Black Cohosh are botanicals that have successfully been used to alleviate the symptoms of menopause. In addition, omega-3 fatty acids, evening primrose oil and flax seed may help women cope with the hormonal changes that occur during this period in life.


One million fractures or more are attributed to osteoporosis, which weakens bone. This bone has undergone demineralization and is known as osteoporotic bone. Osteoporosis causes a thinning of skeletal bone and increases a woman’s risk for fractures. Osteoporosis is caused by a lack of estrogen in menopausal women, which stimulate osteoclast cells to remove calcium from bone.

The maximum mineral content of bone is achieved during the second decade of life and active women have greater bone density than inactive women.


Females who exercise regularly can maintain their bone mass well into their third and possibly fourth decade. Athletic females can also expect to experience a slower rate of decline thereafter.

Intense exercise in early post-menopausal athletes causes an increase in lean muscle mass. By increasing the mass of the muscle the amount of force or load it applies to the bones also increases. The increased load on bones helps athletes retain bone mass. The improvement in bone density however, remains only as long as the individual continue to exercise, since it is observed that the gains in bone mass quickly decay with disuse.

Aging and Fat

One of the unfortunate changes that accompany aging is an increase in body fat.

Increased body fat prompts many women of all ages to diet. The diets they follow were discussed in the section entitled Diets.


Abdominal fat increases the risk for cardiovascular disease and diabetes.


Aerobic exercise promotes the loss of abdominal fat more readily in women compared to men. Women tend to deposit fat more easily in the femoral (thigh and hips) region. These particular areas are resistant to removal since lipolysis is severely limited. Lipolysis is the breaking down of fat stores and is dependent on the presence of hormones and fat cell receptors.


Exercise promotes fat loss.


By exercising, athletes increase their energy expenditure, and to meet these demands, the athlete’s cell machinery must increase its metabolic rate. This increase in metabolic rate produces growth in muscles. The increase in lean muscle tissue at the expense of fat further increases the athlete’s metabolic rate since muscle is a more active metabolic tissue than fat.


Adipose tissue is a metabolically active organ, which, depending on it location can be susceptible to lipolysis.  Lipolysis can be stimulated by catecholamines, alpha-blockers and beta-agonists. There are also gender differences in the rate of lipolysis.