Health, Happiness, Wellness and Women

Health, Happiness, Wellness and Women

Disclosures: Mulcahey reports she is a paid presenter or speaker for Arthrex.
January 11, 2021
5 min read

BLOG: Benefits of strength and conditioning programs for adolescent female athletes

Disclosures: Mulcahey reports she is a paid presenter or speaker for Arthrex.
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The number of female adolescents participating in school sports has increased significantly since Title IX was passed in 1972.

Although this landmark legislation can be broadly applied, it has had the most notable impact on sports programming in public high schools, allowing more female adolescent athletes to experience the positive effects of sports participation. Girls start participating in sports at a later age, and by age 14, drop out of sports at twice the rate of their male counterparts. Girls are thus more vulnerable to poor physical literacy, which is defined as both the ability and drive to be “physically active for life.”

Resistance training can protect against injury and help develop physical literacy for youth.
Resistance training can protect against injury and help develop physical literacy for youth.

Health-related concerns

There are numerous health-related concerns that are unique to the female athlete, including iron deficiency anemia, stress urinary incontinence, breast issues, amenorrhea, osteopenia and increased rates of certain musculoskeletal injuries. Additionally, girls experience several physical changes during puberty, such as increases in body mass and height, the onset of menstruation and decreased strength. These anatomical and physiological changes may impact sports participation and be a source of emotional stress. Female athletes are at higher risk for certain musculoskeletal injuries including ACL tears, patellofemoral pain syndrome, stress fractures and the female athlete triad.

Mary K. Mulcahey
Mary K. Mulcahey

The passage of Title IX dramatically improved access to sports participation for female athletes. However, there are still some sex-related inequalities in athletics, including the routine incorporation of strength and conditioning into training programs for male athletes, but not for their female counterparts. Previous studies have demonstrated that strength and conditioning programs have the potential to optimize performance and decrease the risk of injury.

Female athletes benefit most from strength and conditioning programs that are incorporated into training before the onset of puberty. Implementing programs during this stage of growth most effectively builds muscle mass, which can improve performance and minimize the risk of injuries. It is critical that an adequately trained professional supervise strength and conditioning programs to ensure appropriate technique.

Strength and conditioning programs

The decreased emphasis on implementing strength and conditioning programs for female athletes may be due to inaccurate views of sex and athleticism held by both coaches and athletes. In a previous survey study, a coach of male and female sports teams indicated that girls may not be challenged as much as the boys because of the perception that girls are dainty and should not sweat hard. Additionally, some female athletes may fear “bulking up.” However, these beliefs are likely no longer valid. Studies demonstrate that when trained appropriately, female athletes can improve significantly more than male athletes in their given sport.

The concept of “synergistic adaptation” is important to keep in mind when developing strength and conditioning programs for adolescent athletes. Based on this idea, exercises that are incorporated into a strength and conditioning (S&C) program should be based on the physiological adaptations occurring throughout childhood and adolescence. For example, plyometric training programs for children have the potential to facilitate the natural neural changes experienced before puberty. In contrast, combining strength training with plyometrics is more appropriate for post-pubescent adolescents, since strengthening influences structural body components. Incorporating some elements of strength and conditioning during childhood improves motor performance skills, which are highly adaptable before puberty, thus establishing a baseline of strength and power.

In an effort to create development-appropriate programs, coaches and athletic trainers should consider making and analyzing growth curves to pinpoint which athletes are undergoing growth spurts and thus are more susceptible to developmental injuries. Tailoring exercises to an athlete’s specific level of development will help create a strong foundation for athleticism, which can be enhanced as the athlete continues to grow and mature.

Resistance training

Resistance training and high-intensity load programs (eg, plyometrics) have been shown to benefit female athletes. Previous studies have demonstrated a significant improvement in bone mass with the incorporation of resistance and plyometric jump training during a period of 9 to 15 months. Compliance with these activities among adolescent athletes is higher when the strength and conditioning programs are incorporated into physical education as part of the school curriculum, rather than struggling with compliance during summer vacation. Strength and conditioning programs that combine motor skill, resistance and balance training with built-in periods of rest can decrease injury rates in adolescent athletes by as much as 50%.

The National Strength and Conditioning Association believes it is critical for youth athletes to have access to strength and conditioning programs that will adequately prepare them for their primary sport and that injury prevention training should be incorporated as a routine part of these programs. Injury prevention during adolescence is critical for female athletes participating in cutting and pivoting sports, such as soccer, basketball and volleyball, which places them at high risk for sustaining an ACL tear.

Strength and conditioning programs improve athletic performance, decrease injury rates and enhance lifelong fitness levels in female athletes. Strength and conditioning programs should, however, be tailored to the athlete’s sex and developmental level. Therefore, coaches should be encouraged to obtain the appropriate training and certification to be able to successfully design and implement S&C programs for both female and male athletes.

On a personal note, I played soccer and ran track in middle school and high school. In college, I elected to focus on track, specifically the long jump and sprinting. Although I always felt I had excellent coaches, strength and conditioning was not incorporated as a routine part of my training until I participated in collegiate track and field. At that point, all of my female and male teammates had equal access to and emphasis on S&C.

Now, as a sports medicine physician, I cover sports teams at several local high schools. In our geographic area, it is common for schools to have athletic physical education, during which female and male athletes participate in supervised S&C programs as part of their school curriculum.

Certainly, there has been good progress in terms of access to S&C at the collegiate level, but more can and should be done for our female athletes in middle school and high school. Middle school especially is the most critical time to instill a love for sports and to help girls understand what they can do to stay strong, perform at a high level and decrease the risk of sustaining a sports-related injury.


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