Dance and the Female Athlete Triad

by JP Chan, DPT

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Dancers use their bodies as mediums to perform physically challenging feats and precise visuals. As a result, dancers, particularly female dancers, are pressured to cultivate their bodies to fulfill specific aesthetics. For example, ballet has historically valued leaner bodies. And while the dance world has made strides in opening its doors to all body shapes and sizes, that unspoken pressure continues to lurk in the corners of studios and stages.

For female dancers, the pressure to achieve or maintain a lower weight or smaller size can result in the phenomenon of Female Athlete Triad.

What is the Female Athlete Triad?

The Female Athlete Triad (FT) describes the close connection between:

  1. Energy deficiency in the body
  2. Amenorrhea: disruption in the menstrual cycle
  3. Osteopenia or osteoporosis: decrease in the bone mineral density

Female athlete triad can have serious health consequences for dancers, including stress fractures, hospitalization and other adverse events.

Who is at risk?

Participants of any activity or sport that focuses heavily on body image are at risk for developing this. FT can affect ANY age group, not just adolescents or teens. College and professional dancers can also develop signs and symptoms of FT.

In 2005, the International Olympic Committee issued a consensus statement describing Relative Energy Deficiency in Sport (RED-S) to recognize that yes, even males can exhibit a similar occurrence.

What are some warning signs?

Signs and symptoms may include, but are not limited to, any of the following:

  • Amenorrhea: irregularity in menstrual cycle
  • Sudden or significant weight loss
  • Stress fractures
  • Weakness and fatigue
  • Significant and unhealthy changes in diet/eating behavior
  • Body dysmorphia
  • Burnout
  • Anxiety and depression
  • Overtraining or overexercising
  • Longer recovery from injuries

Having or experiencing one of these does not automatically diagnose a dancer as having FT/RED-S. It’s recommended that you consult a healthcare professional if you have concerns.

What can I put into practice?

If you or anyone you know exhibit signs or symptoms of FT/RED-S, please seek professional guidance. Recovery should be addressed by a multidisciplinary team, such as a doctor, registered dietician, physical therapist and psychologist.

To reduce risk, build healthy habits!

  1. Eating sufficient and healthy food fuels the body! The body needs food to generate the energy for dance.
  2. Strength training conditions the body for optimal performance.
  3. Sleeping and resting helps avoid overtaxing the body.
  4. Maintaining good relationships with family and friends builds a strong support system.

If you have any questions, please don’t hesitate to ask your physical therapist at Evolution.

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The hotline for the National Eating Disorder is: 1-800-931-2237. For 24/7 support, you may also text ‘NEDA’ to 741741.

Mountjoy M, Sundgot-Borgen J, Burke L, et alThe IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S)British Journal of Sports Medicine 2014;48:491-497.

Hoch, A. Z., Papanek, P., Szabo, A., Widlansky, M. E., Schimke, J. E., & Gutterman, D. D. (2011). Association between the female athlete triad and endothelial dysfunction in dancers. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 21(2), 119–125.

Doyle-Lucas AF, Akers JD, Davy BM. Energetic efficiency, menstrual irregularity, and bone mineral density in elite professional female ballet dancers. J Dance Med Sci. 2010;14(4):146‐154.

Hincapié CA, Cassidy JD. Disordered eating, menstrual disturbances, and low bone mineral density in dancers: a systematic review. Arch Phys Med Rehabil. 2010;91(11):1777‐1789.e1. doi:10.1016/j.apmr.2010.07.230

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