Abstract
Background:
Low energy availability (LEA), a state that arises with inadequate energy intake to support exercise energy expenditure and normal physiological functioning, can have negative consequences on health and athletic performance, including sport-related injury risk.1 Associations have been reported between LEA and risk for musculoskeletal injuries, particularly bone stress injuries among endurance athletes.2 Our purpose was to prospectively examine the association between pre-season LEA risk and injury rates during the subsequent athletic season among adolescent female athletes participating in a variety of sports.
Hypothesis:
We hypothesized that higher LEA risk assessed pre-season would be associated with higher injury rates during the athletic season.
Methods:
Female athletes ages 13-18 years underwent a pre-season evaluation during which they completed the Low Energy Availability in Females Questionnaire (LEAF-Q) including questions related to LEA-indicators (injury history, gastrointestinal symptoms, menstrual function). LEAF-Q scores range from 0-25 with scores ≥8 indicating high risk for LEA. Participants then completed weekly surveys throughout the 9-week athletic season assessing subsequent injuries sustained and injury exposure (hours/week of sport/physical activity participation). We calculated an injury rate ratio using Poisson regression with LEAF-Q group (scores <8, ≥8) as the predictor, number of sport-related time-loss injuries sustained as the outcome, and adjusted for concussion history, BMI, and athletic exposures.
Results:
Fifty-nine female athletes completed the pre-season assessment and weekly surveys (age=15.9±1.43; LEAF-Q <8, N=40, 12% with a prior concussion; LEAF-Q ≥8, N=19, 37% with a prior concussion). During the athletic season, twelve participants sustained 14 injuries. Most injuries were musculoskeletal (93%; N=13), with knee strains (N=3) and ankle sprains (N=3) occurring most frequently (Table 1). After adjusting for covariates, those with LEAF-Q scores ≥8 had a higher injury rate per athletic exposure compared to those with LEAF-Q scores <8 (Table 2).
Conclusion:
Female athletes at high LEA risk were more likely to sustain an injury than those at low LEA risk during a 9-week athletic season. LEA represents a potentially modifiable factor for injury risk, as well as for overall health and performance, and education can play a key role in mitigating negative consequences associated with LEA. Pre-season LEA screening may identify some individuals at-risk for sustaining a sport/physical activity-related injury during the season, potentially providing an opportunity for educational and nutritional guidance to address LEA and decrease injury risk.
