Associations between disordered eating, menstrual dysfunction, and musculoskeletal injury among high school athletes

J Orthop Sports Phys Ther. 2011 Feb;41(2):60-9. doi: 10.2519/jospt.2011.3312. Epub 2011 Jan 5.


Study design: Retrospective cohort study.

Objectives: To determine the prevalence of, and association between, disordered eating (DE), menstrual dysfunction (MD), and musculoskeletal injury (MI) among high school female athletes.

Background: Female athlete triad (Triad) syndrome is the interrelatedness of DE, MD, and low bone mass. Few studies have examined 2 or more Triad components simultaneously, or their relationship to injury, among female high school athletes.

Methods: The subject sample consisted of 311 female high school athletes competing on 33 interscholastic high school teams during the 2006-2007 school year. Athletes completed the Eating Disorder Examination Questionnaire (EDE-Q) and Healthy Wisconsin High School Female Athletes Survey (HWHSFAS). Athletes were classified by sport type as aesthetic (AES), endurance (END), or team/anaerobic (T/A).

Results: Of those surveyed, 35.4% reported DE, 18.8% reported MD, and 65.6% reported sustaining a sports-related musculoskeletal injury during the current sports season. Athletes reporting DE were twice as likely to be injured compared to those reporting normal eating behaviors (odds ratio [OR], 2.3; 95% confidence interval [CI]: 1.4, 4.0). Multivariate logistic regression analyses revealed that athletes who reported a history of DE (OR, 2.1; 95% CI: 1.1, 3.9) or prior injury (OR, 5.1; 95% CI: 2.9, 8.9) were more likely to be injured during the sports season.

Conclusion: A high prevalence of DE and MD exists among high school female athletes. Additionally, athletes with DE were over 2 times more likely to sustain a sports-related injury during a sports season. Screening and intervention programs designed to identify and decrease the prevalence of DE should be implemented with high school females.

Level of evidence: Prognosis, level 2b.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Athletes / statistics & numerical data*
  • Athletic Injuries / epidemiology*
  • Cohort Studies
  • Feeding and Eating Disorders / epidemiology*
  • Female
  • Humans
  • Menstruation Disturbances / epidemiology*
  • Multivariate Analysis
  • Retrospective Studies
  • Risk Factors
  • Surveys and Questionnaires
  • Wisconsin / epidemiology