#6 - 5 Considerations to Promote Performance in the Female Athlete, with Dr. Melissa MacDonald - Part 2

Factor, spelled F-A-K-T-R, stands for Functional and Kinetic Treatment with Rehabilitation. Over the past decade, this unique approach to treating pain and dysfunction has been utilized by healthcare providers on 6 continents, serving as a framework that guides clinical decision-making in patient visits around the globe on a daily basis. With this podcast, our goal is simple: to bring the best and brightest in clinical education to the forefront and empower practitioners with cutting-edge, evidence-based content that improves patient outcomes and inspires healthcare providers to continually evolve their approach to treatment. In each episode, we will feature a training or interview with some of the top minds in healthcare in a short format that is easy to digest with actionable information that you can implement into practice right away. Let's get started. Hi guys, welcome to a new episode of The Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome and thanks for listening. If you have not yet listened to episode 5, I strongly suggest that you listen to part 1 of today's training, which is in episode 5, first before diving into today's episode. Now today we'll be covering part 2 of our 2-episode training called 5 Considerations to Promote Performance in the Female Athlete with Dr. Melissa McDonald. Dr. McDonald is a graduate of Northwestern Health Sciences University, where she earned her Doctor of Chiropractic degree. She then spent 2 years of specialty training in the Human Performance Center, where she focused her research and clinical skills on specific testing and treatment protocols. Dr. Mack, as she's known locally, has served as a team clinician for a professional women's football team and Minnesota roller derby, and has achieved both international and national certification as a chiropractic sports provider. She's also a speaker on sports chiropractic issues in the United States as well as abroad. So today's episode has a wealth of information in today's training. In episode 5, we talked a lot about hormones and their effect on performance, as well as topics like body image concerns and athletes who are performing at a constant caloric deficit. In today's training, we'll continue the discussion of the effects of Red S and go over how to build a baseline for your athletes in regard to their strength and endurance. Dr. Mack will also talk through some performance tests that can be done to assess potential injury risk and how to build an injury prevention program. As always, if you have questions as you're listening to today's training, you can submit your questions in the Q&A link in our show notes. We will have our instructor back on for a future special Q&A episode so that we can cover all of your burning questions. With that being said, let's get started with today's training.

Now, for prevention of RED-S, we want to look at the nutrition for the athlete. And I know with talking with some of my collegiate athletes, some have actually had to get on the scale before going to practice to determine whether they would be a starter or not. So we need to put a huge emphasis on nutrition and not on the weight of the athlete. And And when possible, we want to use a comprehensive integrative care team to take care of our athletes. And a sports physician, nutritionist, a psychologist, a physiotherapist, and a physiologist are kind of like a great basis for working with your people. Now, female athletes inherently compared to their male counterparts have a greater knowledge of nutrition. They're almost hyper-aware of it. They are better at eating healthier foods. But they are more likely while eating the healthy foods to avoid eating their calorically dense foods. The other thing is, is to potentially look at the hormones, again, back to the cycle, and how we can best feed them based on what their body needs. So during the beginning follicular phase, female athletes are better at Burning carbohydrates. So it might be a time to do some carb cycling. And the digestive system runs better. They have more consistent bowel movements. They absorb the nutrients better versus in the luteal phase, they're more fatigued. They actually need more calories per day. Digestion can completely slow down, but they're better at burning fats. So you kind of have to look at these 2 things to create a better understanding. So playing with protein, so pacing it out through the day, figuring out what is the lean protein of the athlete and making sure they're eating at least their lean protein mass per day and dividing it equally over 4 to 6 meals to make it more consumable. And then carbohydrate cycling, so rotating the different carbs from up to 200 grams down to 50 grams of carbs per day, playing with that macro to kind of keep their system running a little bit better. So the general findings are you're working with a slower metabolic rate. These athletes work better on fats. They don't function as well on carbohydrates. But again, all the diet research out there has been done on the male body because scientists recognize that female hormones would mess with their numbers. So we need to play with and understand that there isn't a lot of research specifically on nutrition for So this has just been the— with working with a female-specified nutritionist, these are the findings that have worked best for getting the best performance. Again, calculate that mean muscle mass. I personally don't care which equation you utilize for calculating out your lean muscle mass. They all come up with basically the same number, but this is the number— this is the bare minimum amount of protein an athlete needs to maintain muscle mass. If they are trying to go through a hypertrophy and put on muscle, they're going to need to increase their amount of protein. Because think of what a female body is designed for. They're designed to store fat and make baby. So when we start to train and build muscle, we can actually freak the body out into going into a fat storage phase. Some other general recommendations are general. They need vitamin D. They need calcium. You gotta make sure they're getting their iron, and it is best if it's consumed with vitamin C since that helps with absorption. Magnesium to help keep the digestive system moving well. So keep that in mind when working with them from a nutritional perspective for how to manage them.

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Now I've seen we had a bunch of questions. We're going to start going through those. So otherwise I'll start with Samuel's. So for a team sport, you're wanting to track prior for a few months and then track during each individual offseason. I can see working with the menstrual cycle, but in season I see that as challenging. Here's something that's really kind of nice is most smartphones actually have a menstrual tracking app, and I simply ask for my athletes to utilize that, and then I have months of data. They actually really like it because if they have an irregular cycle, this gives me some great base information. So I just have them send me their printed log sheet of where they're at in their cycle And we just track each individual. It seems cumbersome, but it gets to a point where the athletes just automatically know, oh, this is where I'm at, this is what's going on. And they understand why we are doing that activity. It's got to the point where I had injuries and they would automatically go, I'm on day 16, I'm good to go. Another question is, in my experience, are body image issues self-imposed or externally driven by coach or parent? I'm gonna say it's generally self-imposed, but if there is any external source, it exacerbates it 1,000 times over. But when it comes to body image, females are their own worst enemy. And I personally have had issues with it, so I know exactly where athletes can come from. And I think at any given point, especially in the prepubescent years in high schools, oh my goodness, It is horrific the amount of mental horror females will put themselves through to look a certain way because they feel that they have to. Yes, Taryn, the FIFA The Eleven booklet. Yes, it also is beneficial to concussions. Another question is the role of oral contraceptive usage by athletes. There is some research in it. Most athletes are actually using some form of oral contraceptive. But the actual injury rate hasn't been tracked. There was one study that showed that it actually, for an athlete that has oligomenorrhea, so when they have that over 35-day cycling, when taking an oral contraceptive, it can slightly be protective and actually decrease the risk of injuries from ACLs. But when it comes to performance, I haven't seen any research on whether it actually creates promotion actually creates better performance, better muscle growth. They haven't broken it down to looking at, is it an estrogen-based, is it a progesterone-based oral contraceptive, is it an injection, is it a pill, is it an implant? They just said this person is on a hormonal contraceptive when looking at the research. So I think there's some significant specificity that needs to be broken down to within that realm. Sadly, I don't have a direct answer for that. All right, next question. What to consider in pre- or menopausal female athletes? I wish I had a direct answer to that. It is challenging. There hasn't been a lot of good research on it that I have found. And granted, I was looking at more the 20 to 35 range because that was the athlete population I was heavily training at the time. I think you definitely have to look at the fact that even though they are no longer cycling due to menopause, there still is some residual hormonal rotation, which is why they'll have hot flashes worse some parts of the month and then better the next month. The other issue is bone density. You want to make sure you're getting the strength training on pre- and postmenopausal females to make sure that they're building the bone density to not have as much osteopenia and osteoporosis. I hope that answers your question. Next one. Any recommendations for a female athlete that doesn't have a good strength and conditioning resource? Oh, that, that is a challenge. And I was one of those athletes growing up. Females were not allowed in our high school gym during any time that the boys' sports were in there. So if football was in there or basketball was in there, Or track, female athletes were not allowed to utilize the gym, which meant that I didn't get into a weight room until college. So it's definitely a considerable risk. I think nowadays there are more resources available to female athletes. There is definitely online programs that they can access to utilize at a local gym, maybe an Anytime Fitness. They can also start training at home. I know right now with all the gyms being closed, I've been releasing daily workouts and some of them use modifications of packing a backpack full of books or a suitcase full of books to do some weight training. So you can do some weighted squats that way. It really comes up to the imagination and hopefully getting them a motivated coach to help them. Next question, what are your protocols for rehabbing or retraining bilateral Achilles non-insertional tendinopathy? In a female athlete, that really could be a presentation unto itself. But the basics for it would be, because it's a tendinopathy, would be to load in isometrics initially with maybe using FACTOR protocol with some instrument-assisted soft tissue mobilization or cupping while they're performing the task, loading to tolerance, wanting to make sure we're not exceeding their pain level. And making sure they're getting appropriate nutrition to recover. So there would definitely be some loading involved there. There would be some activity modification to prevent further injury, but I would not want to just stop and rest them. Tendons don't heal at rest. Tendons heal with loading. Next, what will be the recovery period once an athlete ends up in Red S? It can be months to years to fully recover depending upon the length of time an athlete is in RED-S. Research has shown even after an athlete has fully recovered, there's always a chance that they can quickly slip back into the process of RED-S simply by starting to increase their activity without increasing their caloric load. So it's more about tracking and assisting the athlete with modifying and being aware of it. When looking at osteophyte production and actually getting the bone density back to where it is, I mean, we're looking at 6 months to fully recover for an athlete if they have reached a point that they're getting stress fractures. Are there— this was really fun for me to do, to just get some information. I'm putting together a more comprehensive hormonal effect and injury patterning that'll be on The Factor or on the Southeast Sports Seminar website to have access at for anybody who's interested. If you do come up with any questions, please go ahead, feel free to email me. Simply put it in the title of the email. What you're asking about, and I will happily email you back. I'm glad everyone enjoyed, and hopefully I'll get to do another one soon.

All right guys, that's it for today's training. Be sure to tune in for episode 7 where we will be kicking off a new training with Dr. Kelsey DeMello titled What Grad School Didn't Teach You: Unlocking the Pelvic Floor. In this new 2-episode training, Dr. DeMello will discuss how pelvic floor weakness and dysfunction can wreak havoc on both female and male patients. Topics include how to examine biomechanics related to the pelvic floor for core stability and breathing, pelvic floor health for all patients, not just pre- and postnatal moms, and general musculoskeletal complaints that can be improved by healing the pelvic floor. You won't want to miss it. Episode 7 drops in 2 weeks, or 1 for our Patreon subscribers. You can subscribe to The Factor Podcast on Apple, Spotify, iHeartRadio, or the podcast app that works best for you. Be sure to give us a 5-star rating to help us grow the show. Every little bit helps. Also, be sure to look for our Patreon link in the show notes to access additional bonus content, early release episodes, and an ad-free listening experience. Along with bonus content and special offers that we throw in from time to time. We're constantly adding more benefits for our patrons, so get in early for maximum value. And of course, finally, remember to visit the show notes for a link to download the PDF of today's full presentation. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R hyphen store dot com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your. friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.