A few weeks ago I went in to see my massage therapist. As always, we chatted about a variety of things- then, the topic of periods came up. I currently struggle with an irregular cycle and ovarian cysts so needless to say, my cycle has been a mess since can I remember. She told me I might like this app called Flo that allows you to track your period and makes suggestions for you based on which phase of the cycle you are in. I downloaded it and immediately fell in love with it. One of the features that intrigued me was the one that suggested different types of exercise (HIIT, restorative yoga, etc.) for each phase of your cycle. This got me thinking- with the overwhelming amount of changes that puberty brings- hormonal changes, body changes, growth related pain/injuries, etc., maybe there are changes we can make in gymnastics training to better work with the gymnast’s body. Today I discuss the idea of exercise in relation to the female menstrual cycle, along with other aspects of puberty and how we can best support our athletes.
A rundown of the cycle: the basics and what you need to know
As noted by the popular app Clue, the menstrual cycle is composed of six general parts- menstruation, the follicular phase, the proliferative phase, ovulation, the luteal phase and the secretory phase.
Menstruation: aka: the period- shedding of the uterine lining, estrogen and progesterone levels low.
Follicular phase: time of the period between menstruation and ovulation- uterine lining slowly starts to build back up again and as this happens, estrogen production occurs.
Ovulation: release of egg from ovary mid-cycle. Estrogen peaks just beforehand and drops right afterwards.
Luteal phase: Time between ovulation and before start of menstruation. Progesterone is produced, peaks, then drops.
Secretory phase: Uterine lining produces chemicals that will either help support an early pregnancy or will help prepare the lining to break down and shed if no pregnancy occurs.
Then, you are back to the beginning.
A cycle typically lasts 24-38 days (though cycle lengths can vary/be irregular, especially during puberty). Changes after the onset of menstruation can not only include changes in the body (hair, skin, weight, etc.), but also psychological impacts such as migraine headaches and decreased mental health.
Om for the flow?
There are few studies that examine exercise for distinct phases of the cycle and virtually none that include gymnastics. However, a few related to general exercise do exist. For example, this study examined the use of yoga and determining its effects on heart rate and blood pressure pre and post cycle. Historically, these parameters are higher in the pre-menstrual phase of the cycle and are correlated with increased levels of anxiety, depression, mood swings, irritability, etc. Yoga was found to decrease blood pressure and heart rate in both the pre and post menstrual phases of the cycle. In gymnastics specifically, my first thought is that use of yoga in training may increase performance, especially on an event like balance beam where controlled nerves and a positive mindset are so important. We all have those girls that hit 12/13 and start experiencing increased emotions due to puberty, and yoga may be a coping mechanism we can use to help regulate emotions and in turn improve performance.
Cycle research in relation to sport is lacking
When researching for this article, overall I was disappointed to find that there were very limited studies surrounding menstruation and exercise, and virtually none in relation to gymnastics. One 2020 study did say that that there was no performance change in relation to the cycle for distance covered in matches in female soccer players. While I have no doubt that athletes are capable of playing throughs aches and pains and are mentally tough, I wonder what research would say in terms of maximizing performance in sport. This study looked at current game performance and how it was affected, but I would be more interested in seeing studies done that investigate optimizing training to facilitate high performance. While we cannot control the days competitions occur, we can control when we introduce certain training techniques such as learning new skills, working on strength/conditioning and when we ease off. We periodize our schedules to account for off-season, pre-season, season, etc., so why can’t we partially periodize the training for bodies? You may think I am out to lunch on this (which is completely fair), but the female is so under researched in the science community (specifically in relation to sport) that I can only imagine what is left to discover.
The female athlete triad: what it is and what we can do to help
This is something we’ve known about for quite a long time. While not directly relevant to physical programming, I thought it was important to include. If you’ve never heard of it before, the female athlete triad is a combination of disordered eating, osteoporosis and amenorrhea (loss of period). It is important to note that all three factors are related to each other, as disordered eating can lead to amenorrhea, which in turn is associated with osteoporosis. In a sport that has a history of all three of these factors, this is definitely something we need to keep in mind when coaching our athletes. Though we are making improvements, the journey to positive body image and healthy bodies is far from over. This is especially important for our sport as we deal with high impact loading and dangerous skills on a regular basis. A 2017 study suggested some effective treatment/prevention strategies in terms of the female athlete triad from a multidisciplinary team. Below are some roles and responsibilities I extracted from a table in the article that I think coaches need to be informed about.
|Athlete||– Abides by the guidelines established with other team members|
– Communicates concerns (and successes) with team members
– Keeps lines of communication open
|Family members (parents, siblings)||– Support and encourage athlete|
– Create a positive environment for the athlete
– Provide an environment for success (purchase healthy food choices, set a good example by making good food and exercise choices
|Registered dietician/nutritionist||– Educates the athlete regarding general health, good choices and sport-specific food choices (training and competition)|
– Oversees restoration of positive energy balance (refuelling)
|Physical therapist||– Provides rehab guidelines for injury management (stress fractures, overuse injuries) and recovery |
– Make exercise recommendations to promote bone acquisition
|Psychologist/psychiatrist||– Determines if there is an underlying diagnosis (anxiety, depression) that may be triggering|
– Triad-related conditions, psychiatrist prescribes medication when necessary
– Provides support and management strategies for coping with the condition
While it is not our job as coaches to act as a nutritionist or psychologist, I think it is important to be informed of potential risks for developing the female athlete triad, and then being able to refer gymnasts and parents to the appropriate practitioner. Risks associated with the development of the female athlete triad include weight loss, difficulty concentrating and irregular or absence of periods. Catching potential problems early is key in protecting our athletes.
Not scientific, but I think it is also important that we as coaches are careful to how we discuss appearance, and how we frame an athlete’s health in the gym. In the past, I have walked by and heard coaches discussing how so and so gained weight, or how someone else needs to lose five pounds. Sometimes, this has even been in the ear shot of the gymnasts. In my personal experience, 9/10 times these discussions occurred around an athlete who was in the midst of hitting puberty. While I understand that gymnastics is a strength to weight ratio-based sport, I think it is important we focus on our athlete’s happiness and health in the gym. You cannot control what they do at home, what they eat or what happens when nature takes control, but you can help them become strong and independent athletes with healthy mindsets and boundaries.
Preventing stress fractures
One of the main types of injuries seen in gymnastics are stress fractures. In a sport with high loading and high repetition, it is no wonder that we struggle with broken bones. My opinion stands that as coaches, we need to design our programs intelligently to effectively manage the load on our gymnasts’ bodies. In terms of preventing spinal stress fractures, we need to make sure we are teaching gymnasts to use their deep core muscles to keep the spine protected (you can find the information in last week’s article here). Along with muscular control, it is important to generally understand the changes bone undergoes through puberty. When speaking of bone, we refer to bone mineral density (BMD) as a measure of bone strength. According to Bone Mass Gain and Adolescence, bone remodelling rate is highest in girls from ages 11-14. In a sport where girls are learning double backs at age 10, we are teaching them skills that have astronomical force on their joints, when they haven’t even come close to hitting their peak BMD (females usually achieve 98% of their peak BMD by age 16). Keeping this in mind, it may be that we need to adjust our training plans in terms of teaching extremely difficult skills. Perhaps we should stick to drills, softer landings and longer periods of training a skill before we introduce it into competition. How many of the top level junior gymnasts competing double twisting double backs at age 12 make it to the senior elite ranks? Not many.
In my research for this piece, I found in this article published in 2019 that discusses different injuries and their prevalence in gymnastics. One of the most common wrist injuries this paper named was a stress fracture of the scaphoid bone. The scaphoid bone is a tiny little bone in your wrist found near your thumb right above the radius bone. The mechanism for this injury is repetitive wrist extension (position the hand is in in a handstand) with compressive axial forces. The comment in the article I found most interesting was that this type of wrist injury is “particularly seen in gymnasts who have rapidly increased their level of training”. This is a serious injury that leaves a gymnast out 8-12 weeks in a cast with no weight bearing, so my thought is that the rapid increase in training is NOT worth it if you are then sidelined three months with an injury. While I am completely cognizant that gymnastic requires lots of hours of training, I think the evidence demonstrates that what we are currently doing is not working for us. Evidence of BMD and injuries further reinforces the idea that we need to pace our gymnasts better. Training them for longevity with an end goal in mind- may that be completing a gymnastics career relatively healthy or competing in college- is crucial in helping them achieve their goals.
Overall, I wrote this article to open a discussion about the best training practices through puberty. While I am no gymnastics expert by any means, my experiences coaching in the sport have taught me that the teenage years are crucial in developing a healthy athlete. Not only do we want to keep them physically healthy, but we also want to help them develop a positive mindset and high self-esteem. In the future I would like to see increased studies on female gymnasts, specifically in terms of quantifying load and effects of certain skills on pre-pubertal bones/joints.
Leave me a comment below and let me know what you think!
You can also follow me on Twitter @levelupmvmtsci.