The research led by Australian Catholic University’s Ida Heikura, and a multi-institution team of academics including Prof. Louise Burke from the Australian Institute of Sport and Dr. Trent Stellingwerff from the Canadian Sport Institute Pacific, aimed to “investigate energy availability, metabolic/reproductive function, bone mineral density, and injury/illness rates in national/world-class female and male distance athletes”.

The athletes in the study were separated into groups by reproductive function, testosterone levels and energy availability. This was calculated from seven-day training and food diaries.

With many athletes continuing to open up about their experiences of the female athlete triad and RED-S, the results from the research provide alarming evidence of the link between energy availability, reproductive function, bone density and injury/illness rates in male and female athletes.

In fact, the findings reported that bone injuries were four and half times more prevalent in the amenorrheic and low testosterone groups compared with others, as well as both male and female athletes with low energy availability.

Amenorrhea

Amenorrhea is defined as the “cessation in periods for six months in a woman (whether athlete or not) with previously regular menstruation”. This was highlighted by Anna Boniface in her interview with Dr Nicky Keay on Fast Running. In Heikura’s study, they defined three consecutive missed periods as a definition.

Within elite sport, there has been a normalisation of amenorrhea, and some coaches still misinterpret amenorrhea as a (wanted) sign the athlete is training hard enough.

When both athlete and coach refuse to address the issue, the problem is only exacerbated. An athlete may fear being kicked from a team or made to reduce the training they love if they reveal that their periods have stopped.

Some coaches even cultivate the sporting environment where amenorrhea is an inevitability. The heavy pushing of the idea that ‘light is fast’ above all else, including the importance of health and consistency in training, is part of the problem.

RELATED: Female athlete health: conversation is only the start

Stress fractures, illness and long-term health complications are the consequences and certainly shouldn’t be seen as normal.

Alongside this, the team looked at the robustness of diagnostic criteria from tools used to diagnose low energy availability in athletes, including tools that help identify possible contributors to the female athlete triad and RED-S.

Looking at the results from the research it highlighted that bone injuries were ∼4.5 fold more prevalent in amenorrheic and low testosterone groups. So if a female athlete has stopped having periods then she is four and a half times more likely to suffer bone injuries. That’s a huge number.

The study also discovered that current reproductive function tests (questionnaires/blood hormone concentrations) appear to provide a more objective and accurate marker of optimal energy for health than the more error-prone and time-consuming dietary and training estimation of Energy Availability (EA).

Simply if an athlete is experiencing menstrual dysfunction, it is a very good indicator that they do not have optimal energy for health, are more at risk of bone injuries and it should not be seen as simply part of being an elite athlete.

Male athletes are also susceptible to the risk of RED-s, bone injuries and long-term consequences. But there is not as clear an indicator as the menstrual dysfunction and one wonders if the sporting world appreciates the problem is there for both genders?

Yet Heikura states that there was a “relatively high prevalence of physiological symptoms of low energy availability in both elite female (37%) and elite male (40%) middle/distance athletes”. The ~4.5 fold prevalence in bone injuries was found in both male and female athletes with low energy availability.

If RED-s is a contributing factor to bone injury then treating just the bone injury could be ignoring the underlying major issue. When complete rest is needed but ignored, then in some athletes we only see a cycle of injury, recovery, injury, recovery. Without looking at the cause, an athlete may never solve the problem.

What can we do?

As a male coach and athlete, it still feels strange to write about this subject and I am far from knowledgeable on amenorrhea, RED-s and even how to discuss the topic with female athletes. Often I will wait for an athlete to bring up the subject rather than put it forward or just awkwardly do so, probably making things worse.

Yet we all just need to talk. Talk to female athletes, coaches, researchers, doctors, anyone who might know more than yourself. I even had a great conversation with my mum about the menopause and how it might affect someone’s life, running and training. I figured if I can chat to her about it then it might be easier elsewhere.

Athlete, coach and parent education is something that Boniface herself has advocated and Heikura also realises that “educating not just the athletes, but also coaches, other team members (physios, physicians, etc) and parents, is crucial”.

The researcher added: “The athletes tend to listen to their coach more so than, say, a dietitian. Coaches can also make a massive difference in the way they talk to their athletes about nutrition, body weight/composition management, etc.”

Ideas such as athlete mentoring for those going through puberty and improved access to medical support are other key developments suggested by Boniface on in a recent post on Twitter.

In the same way that a coach should never ignore the physical impact of an athlete’s job or mental stress of family relationships, a coach shouldn’t be ignoring a major factor in female energy levels every month.

Research in the field is still young, but academics like Heikura and the rest of the team behind this study are doing excellent work. She said: “While our findings are certainly interesting and unique in this athlete population (largest cohort to date with truly high calibre athletes), similar outcomes have been reported previously with smaller sample sizes, younger athletes, and sub-elite cohorts.”

Information from apps like FitrWoman can help athletes, coaches and parents too. The app lets users track their menstrual cycle and provides personalised training and nutritional suggestions tailored to the changing hormone levels. Co-founder of the app, Georgie Bruinvels, a research Scientist at Orreco, who recently completed her PhD at UCL, is passionate about the app and said: “I really want to empower women by helping them train smarter.”

From my discussion with Bruinvels, it soon became clear that knowledge and education about the menstrual cycle can also be seen as an opportunity to really optimise your training.

“It’s not just training stress that can cause the hormonal imbalance that leads to amenorrhea, but all types of stress,” said the academic, who has run a 2:37 marathon. “Understanding the best way to train alongside your menstrual cycle is one way to reduce this and FitrWoman can help you track your period and train smarter.”

With indications from research like this that show a strong correlation between amenorrhea and the likelihood of bone injuries, as well as menstrual dysfunction being an objective and accurate measure for athlete health we cannot afford to ignore the subject.

It doesn’t need to be rocket science or something we only talk to females about. Heikura said: “When it comes to athlete education, I believe explaining (in simple terms) the importance of adequate energy availability would be more useful than just telling the athlete to eat enough.”

Having open discussion and education is the biggest step we need to take. Heikura felt very strongly that if an athlete understands the signs and consequences of low energy availability and “how this chain of events eventually has an influence on bone injury risk and training ability, they may be more motivated to pay attention to adequate energy availability”.

The post Health is more important than fast times appeared first on Fast Running.

Conversations about female reproductive health in sport have definitely started – that’s for sure. Athletes, coaches and governing bodies are getting involved in raising awareness of the risks of under eating, eating disorders and prolonged amenorrhoea.

What has become apparent is that it’s not just the occasional athlete who suffers the short and long-term effects of prolonged amenorrhoea on bone health; numerous athletic careers are being hijacked by repeated stress fractures.

But we need more than just conversations and awareness. The message is definitely getting out, but it’s not necessarily getting through.

Earlier this year, body shaming was again a feature of BBC athletics commentary; inappropriate race kit continues to make more than the occasional appearance; and, if social media is anything to go by, additional ‘punishment’ miles were yet again on the menu following Christmas indulgences.

If we are to truly get on top of the issues at hand, and break the cycle of energy deficit, amenorrhoea and bone injury, we absolutely need a cultural change. The solutions are both complex and difficult to implement. There is certainly no quick fix.

What follows are some ideas on where change can be implemented to improve prevention, diagnosis and treatment.

Remove barriers in the diagnosis and treatment of eating disorders

Imagine having severe insulin and blood sugar issues, but being told that you will only be diagnosed with diabetes once your foot needs to be amputated.

Imagine having coronary heart disease, but being told that you can only be treated once you’ve had your first heart attack.

Imagine suffering debilitating depression and anxiety and being told you don’t have an issue unless you’ve made at least one serious attempt on your life.

Now imagine having such a dysfunctional relationship with food, your body and your emotions, that you have essentially stopped eating. That you no longer feel hungry. That you have become obsessed with calories and ensuring that energy output is always higher than energy intake.

That even a single slice of bread means a punishing extra hour on the cross trainer. That you’ve got so used to lying about how much you’re eating (or not eating) that you don’t even notice you’re lying anymore.

That you’ve become skeletally thin, but keep thinking that you need to lose more weight. And then imagine being told that your BMI needs to fall even further for you to receive the medical attention you need.

Eating disorders are complex mental illnesses – albeit ones which are compounded by the physiological and biochemical effects of starvation – requiring psychological treatment, and not simply solved by a visit to the nutritionist.

With denial a major feature of anorexia in particular, each and every individual who seeks help for their eating disorder, must be treated with urgency, irrespective of whether or not their current weight places them in the ‘severe’ category, or whether or not their weight loss has been drastic enough to tick all boxes for diagnosis.

Diagnosis of anorexia, in the past, depended on weight loss leading to body weight at least 15% below that expected. That has changed in recent years, and there is no set weight listed in the most recent DSM criteria for anorexia, though BMI is still often used to classify severity.

Extreme weight loss should be considered a consequence rather than a cause or characteristic feature of the illness. A mental illness shouldn’t depend on a physical outcome for treatment to begin, particularly when early intervention greatly improves the prognosis. An individual should never be told that they need to be thinner or weigh less in order to receive treatment.

Not all athletes at risk of menstrual dysfunction or bone loss have an eating disorder. And those with an eating disorder are not the only ones that require help. But until eating disorders are treated with some level of urgency – and until we stop justifying disordered eating as a normal feature of endurance running – we have very little hope of treatment in other cases.

Downgrade the role of cross training

Your life is an imbalance… you’re not eating enough… your endocrine system is under so much pressure that your periods have stopped… your bones are breaking down… your body has had enough… you’ve just been diagnosed with yet another stress fracture.

Why then is your first thought to start twice-a-day, soul-destroying, time-consuming cross training in an attempt to maintain fitness, and then to adjust your eating patterns to ensure you don’t put on a single ounce of ‘unwanted’ weight during your injury ‘layoff’.

Listening to your body? If you can’t hear its desperate screams for help, how are you ever going to learn to answer its subtle warning whispers?

Anna Boniface is one athlete who has shared her story about amenorrhoea, overtraining, under fuelling and the resulting stress fracture. Now she is progressing with her comeback and recently wrote specifically about cross-training saying: “retrospectively, I should have taken this initial period not training completely. My body was screaming for some R & R. Continuing to plough away, I was still in that energy deficit, stalling my recovery.”

This is not to say that cross training doesn’t have its place.

In fact, it could play a much bigger role than it does in adding variety and reducing impact in the regular training programme. It is vital in the return to training after injury, and, in some cases, it can allow individuals to overcome a badly timed injury and keep dreams on target.

It can allow athletes to keep their head ‘in the game’ during times of injury, and some level of maintenance is good. But, as Katie Kirk, among other athletes, has recently discovered, it’s not the be all and end all!

In fact, you may later come to resent all that extra time you’re spending in the pool and on the cross trainer. And this can leave you more likely to throw in the towel altogether the next time you get injured.

Perhaps it’s not just your bones that need a rest – your mind may benefit from some downtime too. Use your injury time to do the things that you never have time to do. And if you get some space away from running and gain a little bit of weight along the way, then maybe that’s a good thing. Listen to your body!

Ensure that there is a structured referral process

Even if you’re really clued up on the causes and consequences of undereating and menstrual dysfunction. Even if you can spot and raise issues, and even if you have an open relationship with your athletes.

You can still feel desperately hopeless when faced with an athlete who reports that they have not yet started their periods or are having real issues with food and body image.

That is not your fault. I did a PhD on the subject, know pretty much all I ever want to know about the endocrinology of the female reproductive cycle and the biochemistry of the bone remodelling process. And even I’m still not sure what the next steps are when faced with an athlete suffering from some or all the elements of the Female Athlete Triad/RED-S. We are all hopelessly unsure what to do. That, above all else, needs to change.

The issues leading to our communal sense of hopelessness are multifactorial. The logical next step with primary amenorrhoea, for example, is to send the athlete in question to see their GP where underlying issues can be ruled out.

But in many cases, the doctor will then say that there is nothing physically wrong; that the lack of periods is due to their training load, and that amenorrhoea is ‘normal’ for athletes.

Common, it may well be, but healthy it definitely is not. Worst case scenario, the athlete is sent away and told not to worry about it.

The best case scenario is they are prescribed the pill – a bit like sticking a small plaster on a 6-inch laceration – told to consider calcium supplements, and possibly sent for a DEXA scan.

In this situation, and especially if it’s a whole body scan, the results may be normal, not just because the issue hasn’t got that far yet, but because whole body scans can mask underlying issues in trabecular bone (the spongy bone where the real problems lie).

Addressing the cause

Treatment needs to start addressing the causes, not just deal with the consequences. Whether or not low body mass is considered an inevitable feature of the endurance athletes, the energy imbalance should be addressed. Menstrual function should be restored. And every effort should be made to increase bone mineral density to normal age-matched levels. But all this takes time. Time which an athlete doesn’t ever believe they have. But the alternative is far bleaker.

When an athlete seeks medical help, they shouldn’t accept a quick, sticky-plaster, solution. They shouldn’t be told that what they are going through is a normal consequence of sports participation.

They may well have to fight for the support they need. And in many cases, the medical support required may lie outside of the public health service. Their fight would be immeasurably easier if a list of suitable practitioners was available, and not just of NGB sports medics which a select number of high-performance athletes have access too. But also other practitioners – dietitians, nutritionists, psychologists and counsellors – who will help in their return to help.

Education and research have improved greatly in recent years, and a lot more is known about treatment than a decade or two ago. It’s time now to put the final jigsaw pieces in place.

RELATED: Broken dreams: why we need to break the cycle

Make Long Term Athlete Development something more than a romantic ideal

We talk about Long Term Athlete Development. We know what it is, we understand the importance of it, and we like the idea of it in theory.

In practice, however, we continue to push athletes too young, entertain their ideas of trying to qualify for every international championship going, and cut the end of season break short to get ready for the next major championship, which is only ever a few weeks away.

We’ve become obsessed with endurance, without any consideration for age appropriateness, and uncovering the next child star. We behave like the next big competition is the only one left in the life of young athletes, and we are so desperate for success that we attach the same glory to underage medals as we do to senior success.

Then we place clearly unhealthy young athletes on the front covers of our athletics magazines, where the image a lot of their aspiring peers see, is that in order to win, you need to be thin too.

That’s not to say that we shouldn’t encourage competition at a junior level, that we don’t get excited about junior records, nor that we discourage aspiration. But underage success should never come at the expense of developing the skills and capacity for success later in life, or, more importantly, at the expense of future health.

Junior competition should ultimately be a stepping stone along the way, not a destination in itself. It should be about getting an athlete to the best possible position to train at a senior level, without draining them of their physical and psychological reserves. Athletes should be gliding into senior competition, ready to up the ante, not reaching 20 already drained of their physical and psychological reserves.

There’s no doubt but that Olympic champions are constantly pushing the limits of human health and performance. But in most cases, they are fully grown adults who have a sound training base, built over a long period of time.

Their health matters too, of course, but there’s a big difference in pushing the limits for a few years in your twenties and depriving a teenager of reaching peak maturation.

In many ways applying long-term athlete development requires guts.

It definitely won’t make you popular in the short term. But taking a long-term approach will, absolutely, help prevent many of the health issues faced by young endurance athletes. It’s time to start putting ideology into practice.

The post Female athlete health: conversation is only the start appeared first on Fast Running.

Relative Energy Deficiency in Sport (REDs) has been widely discussed of late and Anna hopes to help others avoid the same mistakes.

I came away from the London Marathon on an absolute high. Almost a nine minute PB in my second marathon. Finishing first in the mass race. Earning my first England vest. Teaming up with Saucony and signing with Forte Sports Management. All these doors started to fling open. It was exciting. All my aspirations were finally starting to happen.

Before I knew it, the summer turned into Autumn and October had arrived. I started to feel fit after a less than smooth build up. However, I was beginning to realise that cracks were starting to appear on the thin ice I was treading.

My England debut ended on the kerbside of Toronto. The pain in my ankle could no longer tolerate weight bearing by 16.5k and all was over. Not finishing my first race in an England vest has certainly been the biggest disappointment of my running career. All though it was a valuable experience, it wasn’t how I envisaged representing my country.

It should have been my big break.

Instead, it was the race that broke me.

Becoming “that athlete”

A good athlete forgets and moves on from failure. A great athlete is able to reflect and learn from their mistakes. I’ve had a great deal of time to reflect on Toronto. What went well. What’s caused and contributed to the injury resulting in that DNF.

As Bobby Clay described when sharing her account, I became “that athlete”. Naively, or maybe even arrogantly, I seemed to think I was the exception to female physiology. I thought I was invincible. All the signs were there, which I brushed under the carpet.

The excuse? “I’ve never had a stress fracture”. The classic “It won’t happen to me”.

I was able to keep my head above water. In fact, my running was rapidly improving. So I ignored my years of amenorrhoea – “periods are bothersome” was my attitude.

My demands and aspirations both at work and running increased. As a high achiever, I wanted the best in both.

Looking back, I don’t know how I managed to train for my first marathon. Training alone, stressed at work, and fuelled by diet coke. I was living off the adrenaline of my success.

The desire to run fast energised me, whilst running on empty.

I got through my first marathon in 2:45 realising my potential.

Everything inside me knew how good I could be. I had to be prepared to make some changes to behave like a “proper athlete”.

I told myself to run faster, I needed to train harder. To fuel better.

Being in a training group doing marathon specific work, whilst improving how I fuelled, my performance rocketed. With every race, I got fitter and faster. But I wanted more. More miles, more racing, more gym work. I became completely obsessed with weekly mileage. I often ventured off-piste from my training schedule that had been carefully planned by my coach. A few innocent extra miles wouldn’t hurt.

It’s easy to hide all the training behind the defence “But I’m running a marathon”. People expect you to be running loads. No one would blink an eye, particularly with the way I was improving. Why would anyone question my accomplishments?

I was running the best I ever had resulting in a 2.37 marathon performance. Again, I walked the tightrope unscathed.

Impatient for success

Following London, I was so hungry for improvement. I wanted to train harder than ever for Toronto. I was impatient and greedy for more, so I set myself high expectations.

My desire blindsided my rational judgement and the extra training continued. However, respiratory tract infections, fatigue and iron deficiency plagued my build up.

I was showing classic symptoms of Relative Energy Deficiency in Sport (REDs). But I blamed the iron deficiency for my tiredness, reduced performance and irritability.

I made the start line. I didn’t make the finish.

I see Toronto as a huge step in my running career. Without my Canadian kerbside experience, I would have again “got away with it” and continued to bury my head in the sand.

I have to face up to that my fibula stress fracture is because of my low bone density from years of no periods, overtraining and under fuelling.

Unfortunately, this all caught up with me as my dreams started to come true, which quickly cascaded into a nightmare.

The only person who can take responsibility for that is me.

The elephant in the room

This is clearly a topical issue within our sport and I am yet another victim of REDs or “the female athlete triad”. Since Bobby Clay’s revelation of her osteoporosis, I have been shocked how common these stories are. It’s almost become normalised. This drastically needs to change to stop talented athletes from disappearing out of our incredible sport.

I will come back with stronger bones, healthier and with a better mindset on training. It’s longevity in the marathon I strive for. Getting through this injury will teach me the much needed lesson of patience. I now understand that to be truly successful, it takes years of consistency and a gradual rise to the top. I’m in this for the long run (quite literally).

I know that when everything falls into place, I will achieve my marathon dreams.

I hope to look back in a few years and think “I’m glad that happened in Toronto”. That DNF may have been the failure that saved my running career.

I want to share my experience of going through and coming out the other side of RED’s swell as discussing the highs and the lows of coming back from an injury. I hope this will encourage others to make changes before its too late, but also show that you can come back from this as a stronger, healthier runner.

Don’t be like me. Don’t be naive. Don’t think it won’t happen to me.

Don’t wait for it to be your breakthrough that breaks you.

Anna Boniface is part of the ‘fast runners: class of 2018’ and will share her running journey every month throughout 2018. More information can be found here.

The post Anna Boniface: The break in breakthrough appeared first on Fast Running.

The Female Athlete Triad is a term, first coined in the late 1990s, to describe the co-existence and interrelated pathologies of eating disorders, amenorrhoea (absence of periods), and osteoporosis (brittle bones) in a not-insignificant number of female athletes, especially those who participate in endurance and aesthetic sports. Low energy availability (and low-fat mass) has been shown to lower reproductive hormone levels, which in turn affects bone density (just like at menopause).

The effects of low oestrogen levels on short and long-term bone health is further compounded in those who don’t eat enough by inadequate intake of the nutrients necessary for laying down bone. Considering that females have a lower bone density than their male counterparts, and that the resistance provided by body mass also has a role to play in bone formation, it’s easy to see how slim young female athletes, who may be restricting their energy intake, are susceptible to poor bone health and, in turn, to the dreaded stress fractures.

However, it’s not just females and those that have some form of disordered eating that are susceptible to low bone mineral density. In recognition of this, what was formally known as the Female Athlete Triad has, in recent years, been expanded and redefined as Relative Energy Deficiency in Sport (RED-S).

RED-S takes into the account the physiological complexity involved, considers other factors that contribute to bone loss, and incorporates other direct and indirect consequences of low energy availability. While it is fast becoming the preferred model for researchers in the area, the Female Athletes Triad, and its three components, continue to be used for its simplicity and directness, particularly in the practical setting.

Peak bone mass and why it is so important

From the age of about 30, whether we are male, female, active or sedentary, we all start to lose bone. In healthy individuals, this loss is gradual in the beginning with, before becoming more sudden in females when they reach menopause. If we live long enough, we will all eventually reach the point of osteoporosis, but the higher the bone mass and bone density to begin with, the longer osteoporosis will be delayed.

A number of factors determine peak bone mass, including genetics, nutrition and hormones, but the late teens and early 20s are particularly crucial in determining peak bone mass. Those who fail to lay down bone density at this stage will never reach adequate peak bone mass and will be at a serious disadvantage in terms of long-term bone health.

And it’s not just long-term bone health that concerns athletes. Recent research that will be published in International Journal of Sport Nutrition and Exercise Metabolism showed that world-class female athletes who are amenorrhoeic or males who have low testosterone levels have 4.5 times more bone injuries and loose up to 10 times more training days than controls.

Seeking help

Thanks to recent articles by a number of young sufferers of amenorrhoea, disordered eating or low energy availability and resultant bone injuries, most notably a recent article and interviews with Bobby Clay, the risks faced by athletes are now being discussed in the public domain.

Athletes have responded, with those who are experiencing delayed menarche (the onset of periods; also known as primary amenorrhoea) or have had their periods disappear (secondary amenorrhoea), seeking help and advice. Seeking help is the first step, but actually finding the right sort of help can be more difficult.

Female athletes who, in their late teens, like Bobby Clay, have not yet started their periods, are often reassured by their GP that it is probably because they are an athlete. This is not wrong. But just because their sporting participation explains their missing periods, it does not justify their absence or mean that no intervention is required.

And when it’s time to intervene, then using the oral contraceptive pill to initiate or regulate the menstrual cycle is the most common course of action. But the value of the pill is debatable.

Research has shown that the pill can stop further bone loss, but it is unlikely to enhance bone density to normal levels. In other words, it does not replace the bone that has already been lost (or not laid down to begin with). It does not address the underlying cause of the amenorrhoea, and it may mask an underlying issue. At the very least it should not be the only course of action.

In the vast majority of cases, energy availability (through reduced expenditure, or, more preferably, through increased intake) will need to be redressed.

It’s worth remembering that not all inadequate energy availability is intentional. Student-athletes, stressed for both time and money, may inadvertently fail to meet their energy demands. A lack of knowledge in relation to energy requirements is also a factor. And at the other end of the scale lies the complicated and difficult-to-solve world of irrational thoughts and behaviours relating to food and body image.

One size does not, therefore, fit all when it comes to treatment. And the solutions will involve more than just educating coaches and parents as to the causes. Though that’s a very good start.

What can we do?

No endurance coach, male or female, should be ignorant of the triad and/or RED-S and its components. They should understand the importance of meeting energy requirements and the risks of amenorrhoea. Those with eating disorders and prolonged amenorrhoea should be treated as ‘particularly high risk’, and athletes should be encouraged to seek help immediately.

Coaches (and clubs) may have to develop their own network, from an empathetic coach, parent or official within the club that athletes can raise their concerns with, to trusted doctors and eating disorder specialists that can help athletes further.

National Governing Bodies, too, could be doing more to educate, support and signpost those affected.

Prevention is better than cure

As with everything and particularly this case, prevention is far better than cure. Those who have established, regular periods are less likely to become amenorrhoeic. Those who reach an adequate peak bone mass are less likely to develop osteoporosis.

Those with a healthy body image are less likely to engage in destructive eating patterns. Those who understand the value of food as a fuel are less likely to neglect this important part of their training lifestyle. Those surrounded by a system which values their welfare are more likely to take control of their own health.

By contrast, a sport which promotes, values and reinforces junior success, unhealthy lean physiques, low body mass and performance above all else can only end in tears. The commercial world in which we live is full of negative body image pressures, the emphasis of unrealistic physiques, and unhealthy nutritional information. The sporting environment should be an escape from that, not a replication of it. Long-term health should be treated with the same level of importance as performance.

We can blame the media, governing bodies, particular coaches and pushy parents all we want, but in truth, we all have a responsibility both for the athlete’s ability to progress within the sport and for their long-term health. Sport should not be breaking individuals, but the solutions are unlikely to go down well in a world where medals are everything.

Put simply, safeguarding the health of athletes, particularly the health of vulnerable young females, is likely to result in a short-term performance hit. We know the risks, and we know the consequences, but until we start measuring success at the junior level as; having normal bone mass, a healthy weight, regular periods and a positive body image, rather than by times recorded and medals won, we are unlikely to ever fix the problem. We all understand the importance of a long-term athlete development approach. It’s about time we started enacting it.

Only when athletes are healthy can they truly reach their performance potential. We all have a role to play in breaking the heartbreakingly repetitive refrain of ‘imagine what I could have achieved if only I hadn’t always been injured’.

The post Broken dreams: why we need to break the cycle appeared first on Fast Running.