From The New England Journal of Medicine
Women's participation in sports worldwide has increased dramatically during the past 30 years. In the United States, the pivotal event was passage of Title IX of the Education Amendments of 1972, which mandated equal opportunities for girls and women to participate in federally funded sports programs. Today, approximately one third of all high-school, collegiate, and professional athletes are women. The health benefits of athletic participation are unquestioned. Female athletes are, however, at risk for a number of medical problems not shared by their male counterparts. The Female Athlete, edited by Mary Lloyd Ireland and Aurelia Nattiv, is the first comprehensive textbook written for the professional who provides health care to the female athlete. At last we have an informative resource under a single cover. The editors have assembled an impressive group of experts to share their knowledge, and the book is extremely well written. The Female Athlete celebrates the achievements of women on the sports field. It stresses the importance of physical fitness for all women and proudly shows that "women can play the game" -- and play it well. The effect of an athlete's sex on participation in sports is a recurring theme, not only from the point of view of differences in physical strength, endurance, and predisposition to certain types of injury, but also with respect to the motivation to win. The most notable feature of The Female Athlete is its comprehensiveness. The wealth of scientific research conducted by exercise physiologists, psychologists, physical therapists, nutritionists, sports-medicine physicians, and other medical subspecialists has been synthesized into a state-of-the-art textbook that discusses in detail the medical, gynecologic, and orthopedic aspects of women's participation in sports. In addition, there are excellent chapters on the history of women's sports, the use of ergogenic aids by female athletes, and the epidemic of eating disorders. The Female Athlete challenges old notions that amenorrhea in athletes is caused by changes in body weight or the percentage of body fat; it provides recent evidence that amenorrhea in athletes may be due to reduced energy availability and describes the role of leptin in that process. Prolonged amenorrhea in athletes is associated with osteoporosis and an increased risk of fracture -- the "female-athlete triad" of disordered eating, amenorrhea, and osteoporosis. An important message of this book is that menstrual irregularities and amenorrhea should be taken seriously by coaches and health care providers and not merely dismissed as a normal consequence of training. Treatment should be aimed at restoring energy availability by improving dietary intake and not necessarily by limiting the intensity of training. Not surprisingly, since Ireland is an orthopedic surgeon, almost half the book is devoted to orthopedic conditions. Injuries to the hip, knee, ankle, foot, head, shoulder, elbow, and wrist are covered in well-illustrated chapters that are easy to read, even for the nonorthopedist. What is particularly useful for the clinician, however, is the section on sports-specific injuries and the chapters on strength training and rehabilitation after an injury. Although the contents of the book are excellent, I do take issue with the photograph chosen for the cover: the athlete shown seems to be undernourished and does not convey the appearance of a healthy, regularly menstruating woman. Otherwise, this is an impressive book that is an excellent resource for the practicing clinician. It should be part of the library of every professional who provides health care to female athletes.
Neville H. Golden, M.D.Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
About the Author
Mary Lloyd Ireland, MD, Assistant Professor, Department of Surgery (Orthopaedics) and Family Practice, University of Kentucky College of Medicine, Lexington, KY; and Aurelia Nattiv, MD, Assistant Clinical Professor, Division of Family Practice and Department of Orthopaedic Surgery, UCLA School of Medicine, Los Angeles, CA
