Female Athlete Program | Research & Innovation

Experts in the Female Athlete Program are dedicated to conducting research and developing innovations for athletes of all ages. Our primary areas of focus include relative energy deficiency in sport, sports injuries, ACL/knee injury, bone health, and concussions.

Published research

International Olympic Committee and relative energy deficiency in sport

Having the necessary energy to participate in sports while also supporting a growing body is imperative to an athlete’s overall health. The female athlete triad, a result of not taking in enough calories to sustain rigorous training, can result in menstrual dysfunction and decreased bone mineral density. In recent years, clinicians have adopted a more inclusive term, relative energy deficiency in sport, or RED-S. In addition to menstrual dysfunction and bone health in females, RED-S includes additional health and performance consequences that can also affect male athletes.

With the goal of protecting athletes’ health, the International Olympic Committee (IOC) developed two RED-S models that include 10 health consequences and 10 performance consequences. To determine the viability of these models, our medical director Kathryn Ackerman, MD, conducted a 1,000-patient study examining the association between low energy availability and the health and performance consequences of RED-S in female athletes. Drawing on the insights from this study, Dr. Ackerman contributed to a 2018 update of the IOC consensus statement on relative energy deficiency in sport.

Menstrual cycle and bone health

Missed periods, also known as amenorrhea, have long been considered normal for female athletes. We have conducted numerous studies showing that missed periods are a sign that an athlete is not eating enough to fuel her body after intense training and can have long-term health consequences, weaken athletic performance, and increase the risk for stress fractures.

An innovative method of repairing a common knee injury

Girls are five times more likely than boys to tear an anterior cruciate ligament (ACL), a ligament inside the knee that stabilizes the joint. Though the reasons for the increased risk are a matter of research and debate, the common theories include differences in girls’ anatomies, body mechanics and muscles.

Typically, a torn ACL requires reconstruction surgery. During an ACL reconstruction, an orthopedic surgeon removes the ends of the torn ACL and replaces them with a graft, usually from two of the patient's hamstring tendons. Although most patients are able to return to sports, the ACL re-tear rate can be as high as 20 percent for teens.

Orthopedic surgeon, Martha Murray, MD, has developed a promising new technique called bridge-enhanced® ACL repair (BEAR®) that could replace traditional ACL surgery. Using stitches and a bridging scaffold (a sponge injected with the patient's blood), this technique stimulates healing of the torn ACL. This technique is currently being tested in clinical trials at Boston Children’s as well as several orthopedic centers around the country.

Psychological response to injury and its impact on recovery

A torn ACL can take an athlete out of their game for a season or longer. Surgery can repair torn ACL but even when their knees are strong and functional again, many athletes do not return to their sport. We looked at psychological factors like self-esteem and feelings of control to determine how both physical and emotional factors affect an athlete’s recovery. 

Current research

Our current research projects include:

  • concussion in female athletes, in collaboration with investigators at the University of North Carolina
  • bone density and changes in high-level dancers, in partnership with the Boston Ballet
  • performance consequences of missed periods (amenorrhea) and relative energy deficiency in sport in female athletes 
  • incidence of relative energy deficiency in sport in different race, ethnic, and socioeconomic groups across Boston 
  • performance and hormonal effects of dietary changes in endurance athletes, in partnership with investigators in Australia
  • frequency of relative energy deficiency in sport in male athletes, follow up to an earlier study on the performance consequences of relative energy deficiency in sport in female athletes