Are you the parent of a young female athlete? 10 things to know right now

Female athletes have a million awesome attributes that make us way cooler than boys. Girls rule and boys drool, right?

Even though we are sugarier (word invention), spicier, and everything nicer than our male counterparts, we have some unique considerations to worry over that sometimes make being a female athlete a challenge.

Maybe you were a female athlete from a young age. Think back to your first competition, meet, match, or game. For me, it was at age 6 in a summer league swim meet. I fell in love with the sport and the rest was history.

Dedicated to my sport, I raced through the rankings and ended up training 8-9 practices per week by 8th grade. Little did I know that the 2 fractures I had as a teenager were warning signs of a potentially bigger problem. Yikes. And little did I know that the “mental slump” I was in during high school and the depression that set in when I could not swim after shoulder surgery in college might catch up to me later.

How annoying is it that I can look back and see so many of these warning signs for things that became bigger issues later? How much more annoying is it that there’s nothing I can do with my current knowledge and skills to go back and help young athlete Julie? I guess that’s why I dedicate my career to doing that for everyone else.

If only it were that easy.

Parents and athletes often resist or fight against the education I so eagerly want to provide them and—perhaps most notably—that they are paying me to give them. I regularly hear or encounter phrases like these. Maybe you’ve heard them too, or said them yourself:

“Oh, that couldn’t possibly apply to my daughter”

“Injuries and burnout are ‘normal’ and expected for this particular sport”

“Of course she loves the sport! Look at how well she is doing!”

“She couldn’t possibly take time off or give up the sport. It’s the only thing we have getting her into college!”

I had a meeting with an awesome pediatric/adolescent sports medicine physician this morning and we commiserated over these phrases we so often hear, in addition to several other topics that young female athletes and parents just don’t love to discuss or address—but so desperately need to.

Yeah ok, I get it. Your daughter is flawless and invincible. She is actually an exception to the rules, statistics, and science behind health and wellness in young female athletes. And this is because of her natural talent and passion and of all the money and time you put into allowing her to succeed, right?

I will never fault a parent or loved one for doing what they think is the right thing to do. Most or all of these phrases and thought processes are 100 percent uttered out of caring, good intention, and well meaning. But sometimes—just sometimes—it’s possible people just don’t know any better. That’s what those of us who have personally been there as the athlete, and who now work in this field, are here to help you understand.

baseball should be fun

Regardless of what you believe or support, what we can all agree upon is that no parent or athlete has a crystal ball. None of us in the medical and sports medicine world can predict the future, either. BUT-we do have a little bit more gypsy skill than meets the eye. We can look back and use our clinical judgment to determine what types of behaviors and movements might lead to a problem in the future. And great news!!! We’re actually on your side! We want to help you and your daughter succeed! So just read and listen for a few minutes. Here are some key points you should know about how you can help her too.

  1. It’s not about you

This should go without saying, but unfortunately, I’m finding I still have to say it. This means it’s a real issue out there, folks. Susie’s gymnastics competition may, in fact, be a fashion competition for moms. You are convinced the only way for your 5 year old all star cheerleader will win a national championship is with her belly hanging out, 5 pounds of makeup and bling, and hair extensions. Maybe there’s an unwritten competition for which family provides the best, most organic, gluten free, Pinterest-worthy snacks after the baseball game. Or maybe you’re sure your 6th grader is going to be the next basketball star, just like you were in college. This means you have to be at every practice, on the edge of your seat, letting your blood pressure go through the roof and finding all the flaws in the referee calls because some other kid just outscored your kid. I get it. You mean well. And these are real things that actually happen. It’s likely that as parents, you get caught up in them. That’s fine. But do your daughter a favor: keep the attitudes and the behaviors to yourself. You may not realize it but she is watching you. Chances are, she is internalizing how YOU feel about her sport, and this could eventually backfire. Make her sport all about her.

baseball snack

Photo credit: Pinterest

  1. Milk: it does a body good

Disclaimer: Dairy allergies and sensitivities are real. I respect that. This is not actually about milk, but I needed something catchy to get your attention. Did you know that almost all of a young female’s bone health is built and stored before she reaches her 20’s? Flash back to teen Julie and her stress fractures. Did you know that the biggest risk for a stress fracture is a prior history of fracture? Bummer for me and my 30-something bones now. That’s what my allergist meant when she told me that being on inhaled steroids as a teen with asthma and participating in non-weight bearing exercise could adversely affect my bones. How are you ensuring that your daughter is getting the right amount of calcium, and the essential vitamin D to help her body absorb the calcium and build strong bones? Maybe let her play outside in the sun a little—with adequate sun protection but not so much that she doesn’t get the natural healthy effects of sun exposure. And maybe let her have that fro yo she’s been begging you for.

  1. Don’t be afraid to discuss menstruation. Period.

You wouldn’t believe how many people I freak out when I ask them about menstrual history. What’s the deal here people? You are female. You are over age 9 or 10. It’s part of your life, or soon to be part of it. So much a part of your life—that if it is NOT happening—we have some reasons to be majorly concerned. So let’s talk about it! While the age of menarche-the onset of menstruation-varies widely from girl to girl, it’s important as parents and medical providers to be having conversations about it BEFORE it’s time for her to begin menstruating. Why? Did you know that being an active female affects estrogen and progesterone levels and exercise in excess can lead to irregular menstrual cycles? Add on stress, rigors of school, and possibly inadequate nutrition: and those young girls’ periods are at risk of being jeopardized. Problems with hormone fluctuation are often seen by young girls in certain sports as “cool”–as in–you’re not cool unless you’re skipping periods. Why are they learning this and from whom did they learn it? Sure, not having to deal with the hassle each month sounds awfully appealing from time to time. However, knowing the lasting effects this phenomenon has on reproductive, bone, endocrine, mental, and physical health is important. We need to teach each girl that menstrual irregularity is just as concerning as discovering a bad zit on her chin the morning of school pictures.

  1. She CAN be a Disney Princess: preferably Sleeping Beauty

Why are girls skipping periods? There are lots of reasons. One of them is too much energy spent for the amount of rest provided. This is called a RED-S, or relative energy deficiency in sport. You may have heard of this concept referred to as the Female Athlete Triad before. It’s all about energy. Energy is a math problem (sorry if you hate math). It is the sum of rest (physical, mental, and emotional) and nutrition minus the energy lost during exercise and daily life. See the equation:

Energy = (Rest (physical, mental, emotional) + Nutrition/Calorie Intake) – Caloric Expenditure (energy lost during exercise/daily activity/metabolic activity)

The body is smart. If energy is lacking, it will steal it from the energy used to do other things, notably that which is used to produce hormones and run the reproductive system. You may think “Susie is not going to reproduce for another 15-25 years, what’s the big deal? Hello! This is NO BUENO people! Lack of estrogen has a strong correlation to later infertility, poor bone health (read: osteoporosis), in addition to problems with the adrenals (stress hormone producers). She needs those stress hormones to build adrenaline, stay awake in school, take an exam, and participate in her sport! This can have a dramatic effect on her later in life. So for that young female who is practicing 40 hours per week, she needs to get just as much energy input through nutrition (see point below), but also through sleep. To add insult to injury—she probably isn’t sleeping as much for education and social reasons. Isn’t it every kid’s dream to stay up late? That’s a normal part of childhood/teen rebellion. Not to mention she may be up all night doing homework for her 37 AP classes and SAT/ACT/MCAT prep classes (MCAT? Isn’t that an exam for college students? Of course it is! But Susie will start studying at 14 for it!) If she truly loves her sport, she needs to learn that sleep will help her jump higher, run faster, and shoot better. And help her make her 4.5 GPA and ace the MCAT. Sleep hygiene is a habit to address when she is 6, not when she is 26 and running ragged in medical residency.

  1. The drama llama: Kid problems are REAL problems

For the next paragraph, we’ll completely flip the situation and blame little Susie for all of her problems. This means you’re off the hook mom & dad, right? Wrong. Susie’s brain is NOT like yours, mine, or her older college age brother’s. This means that it is completely normal for her to be a dramatic, rollercoaster riding, irrational and emotional kid/teen. Why? Because she is a growing kid/ teen and we can’t stop that! The female brain processes and responds to information very differently than the male brain. In addition, she’s growing. Just because she is good at her sport and makes good grades, that does not mean her developing brain is equipped to handle the real problems of childhood, ‘tween-hood, and teenage life. You know what I’m talking about here: how that swimsuit looks on spring break, who she will dance with at the 7th grade dance, if she will try beer at the 9th grade birthday party (or if she will get invited), how many instagram “likes” and emoji tag-backs she got yesterday, and how to talk to YOU (her parents) about the fears and anxieties she faces as a young woman, including her opinion on how you parent her. Those are the real problems that often preoccupy her mind and affect her performance in her sport and her schoolwork. Plenty of scientific evidence supports the fact that a young female’s brain does not fully develop emotionally and cognitively (IE, the ability to feel, think and process) until her mid-20’s. She cannot process, communicate, and understand things the same way you and I do. And even then, some brains never develop those skills. Every girl needs a valuable mentor to help her navigate through all of her perceived life-or-death problems. Make sure she has that.

  1. The apple does not fall far from the tree

Speaking of role models, it’s important to remember the old adage I wrote above. Girls learn how to act from their parents. If you’re a 2 times-a-day gym rat, she will think that is normal and the right thing to do. If you eat the whole box of Samoas while stressing over the girl drama you face at work, what do you think she will do when she is faced with drama among her peers? What happens if you are the overachieving parent who fills his or her plate with 300 (Well-meaning) activities with little down time? What do you think she will do with her spare time? Fill it! Some of the biggest predictors of problems in young girls are the problems faced by their parents. These could be medical, social, emotional, or financial problems. That is not anything to be afraid of. It’s important to be aware of your own vulnerabilities, acknowledge them and most importantly-model that you are taking a stand to take care of them yourself. If you take care of yourself, she will be taken care of too.

Credit: http://1.bp.blogspot.com/_Mn5Un4rHQlk/TEBkIdwVK_I/AAAAAAAAAtM/_0Qd01jV7Ds/s1600/appletreecp.gif

  1. You are what you eat

I’ve already touched on this several times throughout this post. An athlete is only as good as the fuel she provides for her body. My colleague Mandy says “You wouldn’t try and drive across the country without putting gas in your tank and checking your oil, would you?” The same goes for the body. Most athletes and their families underestimate how many calories they burn throughout the day in addition to during a sport. This means they also underestimate just how many calories they need to be taking in. It’s all about energy availability for a healthy athlete. Consult a pediatrician and sports dietician for the best advice.

  1. Variety is the spice of life

Believe it or not, Susie likely has interests outside of horseback riding. She may have her room decorated with posters of horses, ribbons, and ask for a horseshoe-shaped birthday cake. Problem is, she may not know what those interests actually are. Why? Let’s pretend she began to specialize in equestrian at age 8. She was so good at it that it’s all she wanted to do. You’re thinking “I just want her to be happy and do what she loves” and maybe “sweet! College scholarship in the making,” so naturally, you reinforce this behavior. Why wouldn’t or shouldn’t you, after all, that is good parenting. I agree. There is more to it, though. What happens when Susie gets hurt at age 13 and can’t ride for a few months? Maybe she has school to fall back on. But maybe not. Equestrian has been so rooted in her identity that she may begin to experience symptoms of anxiety and depression when she cannot participate. She has no idea who she is or how to define her successes and failures. Everything feels like a failure if it’s not equestrian. Compound that with the fact that she may have been so dedicated to her sport that she cannot identify several other interests to keep her busy, and you now have a snowball effect. As adults, we know that this does not make logical sense. However, to a teen-this can be world ending for them. We have to protect them and give them skills and mentoring to honor themselves and their passions-whatever those may be. Girls don’t have to be the all star at 50 different activities, but it’s important to have other activities on which to fall back. After all, remember that when she is an adult, she may not have the time or money to ride horses anymore. Make sure she has other things to keep her engaged and enthusiastic about life. It will pay off in the long run.

  1. No pain no gain

Ah, finally. A moment to write about the “PT” part of this post. Playing through pain and injury is not, I repeat, is NOT admirable! With the exception of Kerri Strug in the 1996 Olympics, nobody is going to look back on their life as a young athlete and say “wow! I am so glad I played on that sprained ankle! Look at all the fame and admiration it brought me.” Pain in a young athlete is most often not anything majorly serious, but it is a sign that something is going awry in how they are moving, that they are not getting enough rest, or that their tissues are not able to heal. This means those same tissues will not help them perform as well. Their performance will suffer.  Pain is not just “growing pains” that they will “grow out of.” A brace and some KT tape will not fix the problem. At a very minimum, get them checked by a pediatric/adolescent sports medicine physical therapist or physician and make sure you’re not ignoring an issue that could rear its ugly head months or years down the line. The small investment in time and money doing that for your young female athlete will make a world of difference in the repercussions it may cost her later.

If your kid gets through sports with all sorts of colorful adornments you picked up at the local CVS, it's probably time to call a medical provider.

If your kid gets through sports with all sorts of colorful adornments you picked up at the local CVS, it’s probably time to call a medical provider.

  1. Have a Plan B, C, and D

Lastly—college scholarships, professional sports, or whatever end game result you’re looking for may not ultimately happen. There are thousands of reasons that it could all work out, and thousands more that it may not. It’s important for every young athlete to have an adult facilitate for them a plan B, C, and/or D. It’s important to be active and healthy (the repercussions of not being active are far worse), but it’s important to balance that with being a kid, being healthy, and going about it the right way. Nobody is perfect. Even if you followed all of this advice (which, admittedly, is far from comprehensive), something still may go wrong. Be there for her when it does and help her unleash her plan B.

In summary:

You may have noticed a habit or behavior you’ve done at some point along the way–either to yourself or your young athlete. We’ve all done them! That’s ok! Nobody is perfect, and nobody has all of the answers. But now that you’re armed with some information and tools, you can start to pave the way to a healthy, successful, athletic life for your young female athlete. These things are arguably more important than any practice, costume, Pinterest snack, hair extensions, or $400 swimsuit you could possibly provide. That’s what we call “sponsoring” your athlete. Nike is a sponsor to sports teams and provides all of those things-but you better believe they don’t consider themselves parents of the same athletes. Girls need your awesome sponsorship, but also your awesome parenting skills. This means support, guidance, and unconditional love regardless of how well they perform or how much they truly love their sports. It’s our job as grown-ups to give that to them–and most importantly, ensure that the number one priority for all athletes is that they are having fun.

Navigating These Reimbursement Waters

Young athletes deserve the highest quality of care. They may be young, active, and often have fewer complicated impairments as their adult counterparts. However, this does not mean that they deserve to be seen at the same time as more than one patient or by any provider other than a PT. Kids and teens have special needs that differentiate them from adults–their cognitive processing and ability to understand movement and exercise concepts often requires more attention than the average adult. Read this great post from my colleague, friend and boss about the ever changing waters and defnitions of what is “quality” physical therapy.