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

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

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  • 1University of Wisconsin School of Medicine and Public Health, Madison, WI 53706, USA.



Retrospective cohort study.


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


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.


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).


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.


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.


Prognosis, level 2b.

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