August 13, 2025 • 44 mins
Should we tailor training based on menstrual cycles? Are ACL tears more common during an athlete’s period? Dr. Kirsty Elliott-Sale, Professor of Female Endocrinology and Exercise Physiology, and Head of the Centre of Excellence for Women in Sport, joins Sarah to discuss the biggest misconceptions about female physiology in sport science and coaching, the connection between menstrual cycles and performance, and the push to understand why women athletes suffer more ACL injuries.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Good Game with Sarah Spain, where we just
found out menopause can cause itchy ears.
Speaker 2 (00:06):
Itchy ears.
Speaker 1 (00:08):
Man, add that to frozen shoulder, night sweats, weight gain,
joint pain, hot flashes. Damn, let's hurry up on these
women's hormone studies and find some solutions.
Speaker 2 (00:17):
I don't want to deal with any of that shit.
Speaker 1 (00:20):
It's Wednesday, August thirteenth, and on today's show, we'll be
skipping the need to know and jumping straight into my
conversation with doctor Kirsty Elliott Sayle, a professor of female
endo chronology and exercise physiology and head of the Center
of Excellence for Women in Sport. We discuss the biggest
misconceptions about female physiology that need to change in sports
science and coaching, the connection between menstrual cycles and performance
(00:41):
and injury risk, and the push to understand why women
athletes suffer more ACL injuries. That conversation's coming up right
after this.
Speaker 2 (00:56):
Joining us now.
Speaker 1 (00:57):
She's a professor of female endo chronology and ex exercise
physiology at Manchester Metropolitan University and the head of the
Center of Excellence for Women in Sport based at the
Institute of Sport In addition to her research on female athletes,
the menstrual cycle, hormonal contraceptives, and menopause, her work in
recent years has also involved designing and implementing exercise interventions
during and following pregnancy for women, including athletes. She's partnered
(01:20):
with everybody from Angel City to arsenal UWEFA, to the
Australian Institute of Sport and more. It's doctor Kirsty Elliott Sale.
Speaker 3 (01:27):
Hello, Hi Sarah, Thanks so much for having me on.
Speaker 2 (01:30):
So nice to talk to you.
Speaker 1 (01:32):
We spoke a couple of years ago here in Chicago
for a Gator eight Sports Science Institute event, and I
was blown away by all the things I learned that day,
and it felt particularly important to bring you back now
because finally we're having more mainstream conversations about women's physiology,
about menstrual cycles and their impact on sport. But every
(01:53):
once in a while someone will say something very confidently
and I'll be like, I'm pretty sure that's not what
doctor Kirsty said. Having you back to help us understand
what we know, what we don't know, what needs more research,
and of course we want folks to be interested, but
maybe not make such bold declarations If we don't have
enough science behind it yet. So can you just tell
(02:13):
us just generally what it is you do, what's the
scope of your work, and how did you get into
this field.
Speaker 2 (02:19):
What does your kind of day to day study look like.
Speaker 4 (02:21):
So I've been working in this area a long time,
so more than twenty years. I did my PhD in
this area. So I was really interested in varying hormon profiles.
So I looked at the mensia cycle pregnancy actually in
viet refertilization treatment, so you know, different hormonal profiles and
how they affect muscle strength. So that's where I started off,
(02:42):
sort of you know, musculo scaltal physiology, and then you
know varian hormon profiles, and and I've left.
Speaker 3 (02:49):
You know, so it's really unusual.
Speaker 4 (02:51):
I'm from a sports science background, and typically you know,
sports scientists might have a few studies on their CV
related to women.
Speaker 3 (02:58):
I'm the opposite.
Speaker 4 (02:59):
I probably, you know, have a handful if that, of
studies that I've conducted in men. So I've been in
this area a long time, and over the last twenty
or so years, I've made it my business to get
to learn all these different ovarian homeown profiles so I'd
say I have a good grasp at around fifty or
more of varian homeown profiles. So really again speaking to
(03:19):
that individualization that you mentioned earlier on, So, yeah, that's
what I do. I learned these different profiles and then
I basically use them to test different aspects of performance
against them. I've mostly stayed in muscular scaletal, but you know,
really gone into sort of more performance based testing as well.
So what does day to day what does that look
(03:41):
like for me? You mentioned at the start that I
work with lots of different sports.
Speaker 3 (03:45):
I'm really lucky.
Speaker 4 (03:46):
I work with sports all around the world, so individual sports,
team sports, some big organizations, some individual athletes. I work
with women who are postmenopausal, women who are in their
reproductive years, some athletes with pregnancy or returning following pregnancy.
Of course, athletes that you mentioned thinking about potential challenges
(04:07):
or barriers that mental cycle or moral contraceptive use might
have all the way down into adolescents. So working with
teenage girls who are first starting you know, to menstrate
to get their first period, to incorporate this into you know,
their sporting lives.
Speaker 3 (04:22):
So a big remit.
Speaker 4 (04:25):
A lot of the work is athletes facing so a
lot of it's education. To be honest, there is so
having conversations with athletes directly. We don't know these things necessarily,
so trying to give them some knowledge so that they
can take ownership of this aspect of their sporting careers.
Often a lot of myth busting included within that education.
So many of the things that we've mentioned today. But
(04:47):
then I guess really sort of working then with more
practitioners and sports organizations to do some research, so you know,
looking at the challenges or the barriers or the questions
that they have for a particular sport, you know, related
to their female athletes, and trying to interrogate those in
a robust scientific way so that we can really give
(05:09):
them evidence to inform their practice.
Speaker 3 (05:12):
So, yeah, life is interesting.
Speaker 4 (05:14):
It's a real privilege to get to work with so
many great you know, athletes and clubs and organizations. But
as I say, it's all the way from education through
to you know, research, answering questions right up to sort
of making policies.
Speaker 1 (05:27):
What do you think some of the biggest misconceptions about
female physiology are that we need to change in sports
science and coaching.
Speaker 3 (05:33):
That's a great question.
Speaker 4 (05:36):
I think the biggest one is that the mental cycle,
for example, is the deciding factor for all aspects of
you know, women's performance in sport. That one sort of
sets my teeth on edge. It will be a contributing factor,
but it is really unlikely that it's going to be
the deciding factor. So let me give you one example
(05:57):
that I think has really sort of, you know, been
blown out.
Speaker 3 (06:00):
Of all proportion.
Speaker 4 (06:01):
So about two years ago, there were some headlines in
the in the I don't know if I should say, but.
Speaker 3 (06:06):
In a very well known international newspaper, and it was how.
Speaker 4 (06:12):
Female athletes might have a drops these phase of the
menstrual cycle. And I don't know about you, but drops
these doesn't really mean anything to me.
Speaker 3 (06:21):
It's quite a.
Speaker 4 (06:21):
Childish word, like upsie dropsy, and it's not a science
term at all. And the implication of this was the
suggestion was that for two phases of the menstu cycle
and female athletes, in particular female goalkeepers from soccer clubs,
would be unable to catch and hold and keep the ball.
Speaker 3 (06:39):
And that's just outrageous.
Speaker 4 (06:41):
So not only was it not backed by credible science,
it was also just a really childish way, a really
sort of patronizing sort of headline to describe, you know,
female athlete performance. So yeah, that's one of the ones
that really sort of, you know, gets me going. So yeah,
anything to do with the menstrual cycle dictating your success
or your ability to train or compete, that's that's a
(07:03):
really big misconception that we really need to put to bed.
Speaker 2 (07:07):
Let's talk about that a little more.
Speaker 1 (07:08):
And I want to start with some stuff that might
feel obvious, but I have to say, the more I
dig into my own body, the more I realize I
don't know shit about it, and we haven't learned a
lot about it. I remember I was watching a show
here in Chicago, a real estate woman who like flips houses,
and she said on camera, you know, I'm going through
the process of freezing my eggs in case I want
(07:30):
to have kids later because I'm getting older, so I'm.
Speaker 2 (07:32):
Making fewer and fewer every year. And I was like,
that's not right.
Speaker 1 (07:36):
Not only do you not know that going through the process,
but none of your producers, nobody in the editing room,
not a single person knows that we're born with all
of our eggs and we lose them it's not a
matter of not producing anymore, it's a matter of not
having as many left. And it was kind of shocking
but also in some ways not surprising how little we
know about this stuff. So take us through the menstrual
(07:58):
cycle and performance. What are the three phase is what's
happening to us and in us during.
Speaker 4 (08:02):
Each Okay, but firstly, let me say, you're so right.
There's so much misinformation out there or we just don't know.
And I think it's been assumed that because you're a girl,
because you're a woman, you will know these things. But
it's like everything else, we need to be taught these
and I don't know what it's like in the US there,
but in the UK we don't get a lot of
education on this, either at school or even at university,
(08:23):
you say, when you're doing a sports science degree. So
let me try and sort of be brief and make
it digestible so that everybody can understand. So we know
that the mental cycle is the body's way of preparing
for pregnancy, and so what happens is that the two
ovarian hormones esogen progesterone change across the cycle. So phase
(08:45):
one is when you're ment tuating, so when you're bleeding,
and that's when estrogen or progesterone are low. So that's
phase one. Then estrogen starts to rise. Sarah's probably laughing.
Speaker 3 (08:56):
I know this is a notable thing.
Speaker 4 (08:58):
So I'm starting to a diagram in the in the air,
but it doesn't help. Okay, So after phase one, when
esogen progesterone low, esogen starts to rise and it peaks
almost around the halfway point of the cycle. And this
peak in estrogen occurs just before ovulation happens. Now, progesterone
stays low at that point, so we're moving into the
second phase with a peak in estrogen. Pogesterone is low,
(09:21):
so it's a significantly different hormonal environment. Then when ovulation occurs,
estrogen drops again and it sort of has a secondary peak.
It's not as big as the first one, but this
time around, when it's having that secondary peak, we have
a peak in progesterone. So this is really the first
time pogesterone is rising. It's increasing it at its highest concentration,
(09:41):
and that's the sort of third really sort of significantly
different phase of the menstra cycle. Then both of those
homones start to drop again and it's when they drop
and they become low that then the woman the athlete
gets her period again. So really this sort of menstrual cycle,
it sort of represents fluctuations in these two hormones over time,
last roughly around twenty one to thirty five days, so
(10:03):
there's quite a big window variability there. So you know,
when different women are talking, you might hear one say, yeah,
I get my period every twenty six days, and another
woman might say I get mine every thirty one days.
So yeah, that's sort of I think it in a nutshell.
If hopefully that was simplistic enough.
Speaker 1 (10:18):
Yeah, Well, before we get into the athletes side of it, two,
just more basic questions. If all those hormonal changes are happening,
should we be intentional about when we schedule doctor's appointments,
if they're going to take blood or if they're going
to look at levels of things. Are there times in
our cycle where we're more likely to test for things
that might look problematic or be indicators of something that
(10:41):
are actually just natural during that phase?
Speaker 2 (10:43):
Yeah?
Speaker 3 (10:43):
Absolutely.
Speaker 4 (10:44):
I mean, you know, if you have a blood sample
take and during the mental cycle, it really is a snapshot.
It's like taking a photograph. You don't know what's happening
five minutes before or five minutes after, So yeah, it
should absolutely be intentional. If you're interested in a particular
outcome or aspect of health that's linked to low hormones,
of course, target that in phase one when you've.
Speaker 3 (11:05):
Got your period.
Speaker 4 (11:06):
But equally, if you're interested in ovulation, whether you're not
you're releasing an egg, then of course then it would
be timely to target that blood sample when we expect
that peak and estrogen. So absolutely it's really important. If
we take a blood sample on Monday, it really wouldn't
represent what was happening on Friday.
Speaker 2 (11:25):
And does that change it all or matter at all
if you're on birth.
Speaker 4 (11:28):
Control, Yeah, so absolutely so if you're using hormonal birth control,
so any type of birth control that changes your homone concentrations,
then yet you have an entirely different profile. And I
guess that's another really big misconception. I hear women and
athletes talking about their cycle when, for example, they're taking
the contraceptive pill, they don't have that cycle, they don't
(11:50):
have that menstrul cycle.
Speaker 3 (11:51):
And that makes sense.
Speaker 4 (11:52):
Because birth control is there to prevent pregnancy, so it's
there to prevent ovulation, because if you don't release the egg,
then of course you can't get pre So, yeah, there
are lots of different profiles and that relate to issues
and progesterone depending on which type of hormonal birth control
you're on. So again, if you are trying to get
an indication of what your homonne profile is and you're
(12:13):
on birth control, then again you have to be targeted.
So for example, you might get a blood sample taken
on one of the days that you're taking your pill
versus it could be different. Of course, it will be
different if you're on a pill free day or acebo
pill day.
Speaker 2 (12:27):
Yeah.
Speaker 1 (12:29):
Okay, now I have one complete random question. This is
going back to my college days because there were no
answers at the time, and maybe you have them now.
I was in a human bonding class and it talked
about pheromones and the sort of unspoken chemical connection that
we have to people that we might be physically attracted to,
and that oftentimes our attraction is a reflection of having
(12:50):
different bodily makeups that would best allow for our children
to survive. We're attracted to people who have a different
set of things that they would bring to the genetic
makeup of our child and most likely produced a child
that would go on to survive, you know, birth in
the world and everything else. But that when women were
on birth control, their reactions to the pheromones in sweaty
(13:14):
T shirts and things that they smelled were the opposite
of what they were when they weren't. So I'm wondering
if every woman out there who has a bad picker
and is making bad choices is making those choices because
of birth control. And if we're looking for our quote
unquote soulmate or someone that we're forever going to be
attracted to, do we have to go looking for them
when we're not on birth control.
Speaker 2 (13:33):
I love that question.
Speaker 3 (13:34):
I have never been asked that question before.
Speaker 4 (13:37):
Quite honestly, I don't think anybody has the answer to
that question.
Speaker 3 (13:41):
I'm unaware of research in this area. But I'm going
to go for a big fat no on that one.
Speaker 2 (13:47):
Okay, so we might be all right. I go out
a courtin on the pith.
Speaker 1 (13:52):
Absolutely good news for my husband. It's been it's been
sixteen years together, but I could finally rest Jesus.
Speaker 2 (14:01):
We got to take a quick break.
Speaker 1 (14:02):
When we come back more with doctor Kirsty Elliott sale,
don't move a muscle. Let's get back to the phases
that you were talking about, because one of the things
that has gotten attention is this idea that could you
(14:22):
potentially change your training for elite athletes based on the
time of their cycle. First, I don't know how you
do that for a team, do you first have to
try to sync them all up, or even for individual athletes.
Is there any science yet that tells us we should
be adjusting training based on the time of a cycle.
Speaker 4 (14:41):
Brilliant question. So let's go for the science first. No,
there isn't a significant body of credible evidence that would
suggest that we need to change our training in order
to sink with different phases of the menstrual cycle. Now,
of course, somebody listening to this is going to say,
but I saw a paper, I read a paper, I've
seen on social media this evidence. Yep, there's evidence out there,
(15:04):
for sure, But there's I guess the nuance to research evidence.
Not all research evidence is created equally, so we have
high quality evidence, and of course that means we have
low quality evidence. So right now, the evidence that exists,
it's small.
Speaker 3 (15:20):
In its quantity, so we're not overwhelmed.
Speaker 4 (15:22):
You know, we don't see this sort of big consensus.
You know, so lots of different labs, lots of different
independent as scientists showing the same things. So firstly there's
little of it, and then secondly it tends to be
sort of lower moderate quality, meaning that we don't have
the scientific community don't have confidence in those findings.
Speaker 3 (15:40):
So right now we're saying there's not enough credible evidence
to suggest that you need to.
Speaker 1 (15:45):
Do this well, so really quick, when we see the
headlines that are like menstrual cycle focus helped Chelsea win
it all, Emma Hayes leading the way by you know,
tailoring training to players of menstrual cycles.
Speaker 2 (15:56):
They were probably just good at footy.
Speaker 3 (15:58):
They were just graded.
Speaker 4 (16:00):
I mean, for sure, there's a feel good factor, you
know when it comes to you know, when it comes
to clubs or sports, which are you know, valuing these
or considering these female specific topics. Those players, those athletes
feel value, they feel sane, they've being cared for, and
you know that really comes with I don't know if
you want to say it's a placebo effect, but it
(16:21):
certainly comes with a feel good factor. And for sure,
you know there'll be some nuance there around. You know,
if one of the players maybe had a mental cycle symptom,
so some adverse symptoms, say, for example, muscle stomach cramping
or muscle pain or a headache, it could well be that,
you know, they were allowed to slightly adapt their training
(16:42):
on that day. So of course those things are going
to help. But you know, when we're talking about the physiology,
you know, if you're in a phase where there's high
issuage and do you need to train a certain way
because it affects your muscles and your ensurance capacity. No,
there isn't the evidence for that. But as they say,
if you take a more pragmatic thing and say something like, okay, well,
(17:03):
if you're in a phase where you're bleeding, we'll you know,
have some considerations around the fact that these players are bleeding.
We'll offer them X, Y and Z, will make it
easy for them to incorporate their training on these bleeding days.
You know, that just is good common sense. So it's
not a really clear picture. But if I just want
to summarize so everybody is is clear on the research evidence, No,
(17:26):
there are not phases where you win or lose. But
you know, if you are body literate, if you are
mindful of you know, either symptoms or the fact that
you bleed as part of the mental cycle, you can
certainly incorporate some of those aspects into your training. But
they are really, you know, small adjustments. So no, the
big headline grabbing things aren't aren't quite correct. But I
(17:46):
can see that certainly, you know, we've had a good
shift into considering these female things, which is certainly better
than it was ten years ago.
Speaker 1 (17:55):
Yeah, I mean, I think to your point, every woman
knows that her experience is different than other women. Some
have very heavy periods, some have a lot of cramping,
some don't want to get out of bed, some barely
feel it. So the idea that athletes would somehow uniformly
be affected by it feels like a stretch. So again,
personalized approach based on your individual response to exercising across
(18:17):
your cycle, especially if that is consistent, because again, even
among our own experiences, one month that could be terrible,
one month we could barely notice it, which really makes
it hard to make kind of sweeping decisions based on it.
I think the same seems to go for birth control,
right because whenever I hear elite athletes complaining about getting
their period during the Olympics or a major event, I
always think, well, why don't they just go on birth
(18:38):
control and you can control which part of the phase
you're in for this major track made or this championship game.
You can take your pills through the week you're supposed
to be getting it and skip ahead, Like, do you
think that that's already happening consistently and is there any
reason not to do that?
Speaker 3 (18:51):
Yeah, so it happens a lot.
Speaker 4 (18:53):
And actually, you know, when we talk to athletes about
why they use hormonal birth control, more often than not
say it's to manipulate their menstro cycle, you know, to
be able to control bleeding and so on, and actually
for contraception is often the second reason, which is a
little sort of counterintuitive.
Speaker 3 (19:11):
So, yeah, it happens a lot.
Speaker 4 (19:12):
And then I guess the second part of your question
is why why doesn't everybody do it? I guess that
maybe leans into the fact that, you know, again, we
all have different experiences of birth controls, so there's always
a concern there. If I have an athlete who comes
to me, you know, a month before the Olympic final
and says, oh, you know, I feel like, now that
the schedule is released, I might have my period when
it's the Olympic final or you know, certainly in you know,
(19:35):
during the Olympics. Quick, you know, let's get me on
the pillar, for example. Our concern is if they haven't
been on the pill before, if they're not used to it,
we don't know if they're going to have any side effects,
and potentially those side effects could be worse than any
of these sort of adversity they might you know face
because of the menstro cycle. So you know, rarely in
elite sport as one size fits all. So certainly those
(19:57):
athletes who are using birth control in order to manipulate
their cycles, or you know, they're using it, you know,
specifically around major competitions, we would always encourage them to
trial that months, you know, out before the Olympics, before
the World Championships, just to make sure that they're not
potentially swapping one set of issues for another. But yeah,
(20:17):
one size rarely fit's all exactly as you said, whether
it's birth control or whether it's the menstra cycle. And
I think you know a really good point, and you've
made it nice several times, is to remember that not
all female athletes have a menstra cycle, So yeah, we're
we're dealing with athletes with menstra cycles.
Speaker 3 (20:32):
That's one profile.
Speaker 4 (20:33):
There's probably you know, twenty thirty different hormonal profiles associated
with birth control. There are different hormonal profiles if you
have mental dysfunction, so you know, yeah, you really have
to take an individualized approach. Not everybody has the same profile,
and everybody's experience is not the same, and it's exactly
as you said, one cycle to the next cycle may
also be different, So lots of moving parts, lots of
(20:55):
nuance when it comes to this topic, and again doesn't
really lend itself, does it to those sound bites and
those headlines which really oversimplify and whitewash and assume we're
all the same.
Speaker 1 (21:05):
Which unfortunately could discourage people from studying it because they
want to be able to make those sweeping generalizations and
have some outcome that feels clean. And instead, we need
more research because it is so disparate in terms of
different experiences and outcomes for a variety of people. So
the more studies we have, the more opportunity we have
to understand how every different person might react in a
specific incidant. You know. I saw an interview with Olympic
(21:27):
volleyball player Alex Kleinman. She shared that a doctor had
told her there's a big link between birth control pills
and bone injuries.
Speaker 2 (21:34):
Is there proof to that or are.
Speaker 1 (21:35):
There any other reasons why athletes might not want to
use IUDs or pills or other hormonal treatments because of
how it might affect their performance.
Speaker 4 (21:45):
Well, that sounds like quite a big claim, an oversimplified claim.
So firstly, I would say, you know, hormonal birth control
users don't panic. It doesn't automatically increase your risk of
boney injuries. There certainly have been so studies published which
suggests that those who use progest and only contraception may
(22:07):
have a slightly increased risk. But again, you know, I
keep using this word nuance. You know there is nuance there.
It depends how long you've been using it, if you
take any breaks, what type of sport that you do.
You know, you might do a sport where you have
really great bone health anyway, you know, so your sport
lends itself to you know, good bone deposition. Whereas you know,
(22:29):
of course, if you're in a sport where you already
might have you know, lower bone mineral density or already
be at risk, then obviously that might make an additive effect.
Speaker 3 (22:39):
So I think there's lots of factors to consider.
Speaker 4 (22:41):
But again, I'd really like to avoid those sort of
headlines or bull statements around if you do this, this
will happen.
Speaker 2 (22:47):
Okay, So follow up to that.
Speaker 1 (22:48):
The doctor also told her that women need different nutrients
at each point in their cycle. Is that something we
should be thinking about what we're putting in our bodies
during different phases.
Speaker 4 (22:56):
I keep remembering that people are listening to this and
they can't see my face. This is probably a good thing. Okay,
so I made a face. No again, you know this
this really concerns me. You know, it's very similar to
the narrative around change your training in line with your
mental cycle. Faces again, the menstrual cycle, or you're or
(23:17):
you know, more broadly eure ovarian homon profile. Let's use
that as the term which incorporates all of those different
ones I mentioned. It should not be dictating your nutrition.
It might be a consideration, but it shouldn't be the
deciding factor. So again, if I was working with a
female athlete, Now full disclosure, I'm not a nutritionist, but
even you know, I'm a physiologist, but even when I'm
(23:37):
working with them, we might veer into a little bit
about nutrition, and I would always say to them, fuel
for the demands of your sport. That's the big hitter,
you know, So make sure that you're fueling, that you've
got adequate fuel for what you do. Make sure that
your fueling strategy is, you know, sufficient for recovery, all
of those things, those big pillars of performance first if,
(23:58):
of course, then let's go back to the idea of
you know, we might have an athlete who has some
adverse and mention psychosymptoms. So for example, she might have
a bit of a runnie tummy during her period.
Speaker 3 (24:09):
Yeah, it makes sense to.
Speaker 4 (24:10):
Me change your diet during that particular time point to
try and help alleviate that adversity. But when it comes
to the big you know, statement of these phases should
dictate what you're reading that's just not true based on
the current evidence.
Speaker 1 (24:25):
Yeah, and again I want to point to I read
a lot of articles and guest essays that you wrote,
and mainly what you say is you can read something
that says there's some evidence, but what it won't say
is very minimal, very small study, very you know, tenuous evidence,
not super proof, and that makes a big difference in
whether you're going to actually change behavior as a result
or whether you're going to use that to say, Okay,
(24:45):
let's keep studying it, which is great, but maybe not
making these widespread generalizations as a result. All right, I
want to talk about acls specifically. For a long time,
we've been trying to understand why women suffer ACL injuries
more we've been try trying to figure out if there's
training changes that can help, you know, prevent it. We've also, suddenly,
and at least in my world, that's been sudden, started
(25:08):
to talk about whether or not people are more likely
to tear their acls during different phases of their menstrual cycle,
whether the phase affects joint laxity or otherwise.
Speaker 2 (25:16):
So, big picture, do we have.
Speaker 1 (25:19):
A reason to believe that ACL tears are more likely
during any particular part of the cycle.
Speaker 4 (25:23):
No, So I feel like I'm on repeating now, but
you know, hopefully I'll have brainwashed everybody by the end
of this episode. So No, there's insufficient evidence to suggest
that there's an increased risk at a particular phase of.
Speaker 3 (25:37):
The menshuaw cycle.
Speaker 4 (25:38):
This one is an interesting one because actually there's two
schools of thought that we're seeing, you know, in sort
of I guess, in the popular media. So on one hand,
we're hearing from a lot of athletes that they're saying
that we're really worried about sustaining an ACL injury during
our periods. So again, just going back to that sort
of biology lesson we had at the start, that's when
(26:00):
is at its lowest, and so there's a real narrative
now amongst athletes that this is when it's going to happen.
Speaker 3 (26:06):
And they're really worried about it.
Speaker 4 (26:08):
Then in the academic or research community, research that's been
done previously has well, some of it has suggested that
there's an increased risk just before ovulation. Now back to
that biology lesson, that's when estrogen is at its highest.
So both things can't be true. So where does that
really leave us. So the anecdotal evidence it's a mixed bag.
(26:30):
I work with one particular soccer club in the UK.
They won't mind me saying this, it's in the public domain.
They had four ACL injuries in one season and I
can promise you that they were not all sustained in
the same phase as the menstrual cycle, and not all
of them.
Speaker 3 (26:46):
Were during menstruation.
Speaker 4 (26:47):
So that's the first thing when it comes to that
anecdotal evidence, that's not what we're seeing in the applied setting.
When it comes to the research evidence, as I said,
there's some evidence to suggest that it might be an
increased risk in the preovulatory phase. But for every paper
that I can show you that says that I can
find you the same amount or maybe slightly more that
said this is not true. So it's really inconclusive from
(27:09):
the research side.
Speaker 3 (27:10):
But here's what I'm going to throw out to you.
Speaker 4 (27:13):
I think it's naive to think that you know, when
it comes to something like an ACL injury, and we
know that injuries are multi factoral, that they're complex things
to understand and to study. I just really don't believe that, honestly,
on any day we're going to see a female athlete
sustain an ACL injury and the only contributing factor is
going to be her issuge in concentration. I just think
(27:34):
that is wildly oversimplified. So I think we need to
look into other areas, other aspects, And actually there's been
some really nice work in the last sort of three
to five years looking more at the gendered environment.
Speaker 3 (27:47):
Now getting a little outside of my wheelhouse.
Speaker 4 (27:49):
Here my expertise, but it really resonated with me that
if you look at the environment in which female athletes train,
and you know, even looking right back from when they
started as younger, there's a lot of disparity when you
compare that to boys and men, and so I think
that it makes sense for me to look there to
see what opportunities they have, what resources, the funding, all
(28:10):
of those things. And then I think, secondly, as you
said when you asked the question, I think we need
to look more around, you know, how are they being
trained now, what does that training look like, what are
the facilities, And certainly in the UK and other countries
in Australia as well, there's some really nice research now
starting to look at the strength and conditioning of female
athletes and how that may well, you know, help lower
(28:31):
that risk within women. But I think if we had
parity in those sort of training environments, I think, you know,
the risk or the occurrence of these injuries between men
and women would close, you know, instantly, and then it
would be worth looking into against some of those really
sort of specific contributing factors.
Speaker 1 (28:49):
Yeah, you know, I've heard something about a PEP method
that's supposedly just fifteen minutes ahead of training that can help.
I'm also part way through this book, The Stronger Sex,
and it seems like later in the book they mentioned
in the intro potentially proof that even at the very
youngest ages, when girls are twirling and boys are already
being taught to kick and throw and cut, that that
very very early time might even contribute to the way
(29:11):
that our muscles are built to withstand those movements. And
we might think it's too early, but it's actually a
part of it. So that's interesting, you know. I also,
we've been talking about individual experiences, So is it possible
that an individual athlete might have enough of a drop
in an estrogen or enough of a hormonal change during
their period that it does impact in more significant ways.
(29:31):
For instance, you know, I was listening to Megan Rapino
and Suebird on their podcast to Touch More, and Megan
said she has had three ACL tears, all three while
she was on her period. When you have anecdotal individual
evidence like that that's spread so quickly, right, and so
then everybody hears that and thinks, oh, that must be
the thing. So do we need more research into the
(29:53):
potential that that individual athlete might experience something during her
period that very greatly contributes to the likelihood or is
it possible that it's chance.
Speaker 3 (30:03):
Yeah, I think probably the latter.
Speaker 4 (30:06):
As you said, you know, there are only so many days,
and you know, of course it is going to happen
to some players, to some athletes during during their period.
Of course, it is as you say that it's random chance.
It's you know, correlation is not causation. And the thing
if it is you know, if you hear this is
particularly from you know, high profile athletes, then you know
(30:28):
it becomes you know, it just spreads, doesn't it. And
and it sort of goes like that. But as I say,
it's a bit like the research papers. For every high
profile athlete I can find you, I can that we
can find that say that happened during their period. We
can find another one who it didn't. But it's just
whether or not their stories sort of make it out
there in the same way.
Speaker 3 (30:48):
I think what is.
Speaker 4 (30:49):
Interesting though, is will it become almost like a self
fulfilling prophecy, because again, you know from the anecdotal evidence.
As we've said, now, they're you know, they're talking about it,
players and athletes.
Speaker 3 (30:59):
It's on their minds.
Speaker 4 (31:02):
And I think, you know, if you're worried about sustaining
an injury in that phase, maybe you'll be more tentative
in the tackles that you make.
Speaker 3 (31:09):
You know, you'll be distracted, you.
Speaker 4 (31:10):
Have anxiety, and it's maybe those things that will you know,
cause you to make a bad decision or cause you
just to make the movement slightly different. And maybe we
will see an increase in the occurrence of them then.
But will it be down to low estrogen.
Speaker 3 (31:25):
I think it's unlikely.
Speaker 4 (31:26):
I think it may be down to sort of some
of those wider biopsychosocial aspects. So yeah, I think we
have to be careful for sure. What I don't want
to do is come across and I'm discounting. You know,
I have absolutely believed that, you know, these injuries are occurring,
and you know, even all three in.
Speaker 3 (31:41):
The same phase.
Speaker 4 (31:43):
But personally, you know, based on my experience and what
I've read and my research in twenty something years in
this area, I don't think that that was the deal breaker,
you know, amongst this.
Speaker 1 (31:53):
Right, well, and if you actually had her in to
do a study, you would have to look at the
calendar of how often games have happened, fun menstrual weeks,
and what surface was she playing on? And you know
she differently as a result of all of that stuff. Okay,
a couple last questions for you. I actually asked my trainer,
who does the physiological side of it really well, which
(32:15):
is why I work with him, because I have lots
of injuries from sports and he works with a lot
of women, And wondered, is exercise a one size fit all?
You know, if women are not all the same structurally
and then everyone follows the same protocol, will we see
a decrease in injury? Or does it really have to
be so specific to each person? Oh?
Speaker 3 (32:33):
Can it be both?
Speaker 4 (32:36):
You know? I think for sure we still have general
principles you know of exercise prescription that will hold true
for men and for women. You know there are good
principles about specificity. You know about thresholds, all of those
things they're true, and you know there are the big
pillars around recovery and load and sleep and nutrition and
(32:57):
all of those things. So I do think, you know,
we have good principles that will fit the majority. I
think what we have to get better at doing is
considering things that affect just women. And you know, by
considering them, that doesn't necessarily mean we have to change something,
you know, it means that we've thought about them, we've
(33:19):
tested them out, and for those who are affected, we've
done something. For those who are unaffected, we've moved on by,
you know, because there are so many things.
Speaker 3 (33:27):
So of course, you know, you and I.
Speaker 4 (33:28):
Are talking about ovarying homeost today, which is my expertise,
but you know, some of the other considerations could be
around breast health, so you know, the right fitting bra,
breast biomechanics, you know, is how we're moving. Is that
causing us you know any you know, adversity or advantage
and pelvic floor health and all.
Speaker 3 (33:48):
Of those things.
Speaker 4 (33:48):
So I think it's about, you know, taking what we
know and then adjusting it if necessary. But I think
it's more it's more nuanced. Oh my god, I need
to widen my vocabulary, don't.
Speaker 1 (34:00):
I I use that word a lot too. It's a
useful one and it's so necessary these days.
Speaker 4 (34:06):
And I don't want people to get the you know,
the misconception that it's complex, because complex seems like it's
an excuse not to think about it, not to do it,
not to study it, not to talk about it. So
it's not complex, it's just a different way of thinking.
It's about upskilling, getting this body literacy, whether it's for
yourself as the athlete, as the exercise, or whether you're
the practitioner, the.
Speaker 3 (34:26):
Trainer, the coach.
Speaker 4 (34:28):
Once we have this knowledge, we can start to test
these things out. And as I say, more often than not,
when we start to do these things with female athletes,
the majority are not significantly affected. So that's great news,
by the way, because I think if you were to
go on to social media right now, you would think
that we would have to change our whole lives based
on this one thing, and that's just not true. It's
(34:48):
got a little bit overinflated. It's the pendulum swing, right.
We've gone from you know, the dark ages where we never.
Speaker 3 (34:54):
Spoke about it. It was a taboo hate that word
as well, by the way.
Speaker 4 (34:58):
And now it's almost like, you know, we've gone to
the other end of the ex you know, the extremes.
The pendulum has swung all the way over and now
it seems to be you know, the go to the everything.
So I'd like for us to course correct, come back
into the middle. Let's get more knowledge and awareness. Let's
really test these things out, and let's remember that if
you're not affected, that's great news.
Speaker 3 (35:17):
Move on. There's so many other things to consider.
Speaker 4 (35:20):
And if you are affected, again, that's not bad news.
There are lots of interventions out there. If you have symptoms,
there are either pharmaceutical avenues to explore, or there are.
Speaker 3 (35:31):
Changes in diet or recovery that we can do.
Speaker 4 (35:33):
If you have heavy mental bleeding, there are therapies and
treatments for that, or we can change the environment so that,
you know, mental psycho products are more accessible.
Speaker 3 (35:42):
There are solutions to.
Speaker 4 (35:43):
The challenges the female athletes face, but I think it's
about being mindful of them, testing them out and then
looking for interventions. I hate when people say, you know, oh,
we have to constantly adjust training on these things. No,
let's be proactive instead of reactive. Let's learn about them,
let's test them, Let's get interventions, and that way women
and girls can train and compete as.
Speaker 3 (36:04):
They want to on any day of the mental cycle.
That's the goal, right, Yeah, I.
Speaker 1 (36:09):
Think part of the reach is that people want answers,
especially as there's more investment, more money, more care about
these athletes to lose so many top particularly football players
soccer players, to acl We want to be able to
have this easy answer of oh, now that we understand it,
we can fix it immediately. But is it modifiable through
training versus just being biological in terms of women getting
(36:30):
their acls torn more commonly, or is it still a
matter of, like you said, really comprehensive study of all
the factors that might be contributing.
Speaker 3 (36:38):
Yeah.
Speaker 4 (36:39):
I think the investment, you know, whilst really welcome into
the research, you know side of things, I think there's
only so much we can do. So firstly, good quality research.
You know that we have confidence in the finding. It's slow,
it takes time. We also need the athletes to be involved. So,
you know, when we hear the elite female athletes calling
(36:59):
for more research, by definition that requires them to.
Speaker 3 (37:03):
Take part in research. But they're busy people who've got
huge demands. So it becomes a little bit of a vicious.
Speaker 4 (37:08):
Circle that they want answers, but the researchers need the
athletes to take part to get those answers. So you
know that availability is difficult, So firstly, research is slow. Secondly,
you know it needs the athletes to be involved in
that can be difficult. And then I guess thirdly, you know,
research is about taking a small sample from the population
and then trying to generalize those findings.
Speaker 3 (37:28):
I'm not entirely sure when it.
Speaker 4 (37:30):
Comes to something like ovarian homown profiles that will ever
have a universal blueprint For all the reasons that we've
been talking about, Sarah, it's so individual. Those profiles are
so variable. You know, my peak of estrogen in this
cycle might be lower or higher. You know, it's still
a peak, but it could be lower higher in the
next cycle. So with all that variability, will research ever
give us a blueprint? So I think that's difficult. So
(37:52):
going back to your question, I think that investment, yes, please,
let's have some for research.
Speaker 3 (37:57):
Don't want to talk myself out of the job.
Speaker 4 (37:58):
It is important with those caveats, but maybe the investment
needs to go into that sort of wider you know,
women's sports funding it making sure they have adequate salaries
so that when they go home, they're not going home.
Speaker 3 (38:10):
To do a second job.
Speaker 4 (38:11):
You know that they can go home and recover that
they have, you know, enough money to fuel themselves. Well,
you know that they're on good pit surfaces, all of
those things. So the investment is super welcome, but it
needs to do a lot of things.
Speaker 2 (38:24):
Okay, no, we're running out of time.
Speaker 1 (38:25):
But now you maybe think of another question that I
feel like as an endochronologist, even though it might not
be your focus, you might be able to answer, which is,
do women have the same fluctuating levels of testosterone in
their bodies or does that stay steady?
Speaker 2 (38:38):
Oh?
Speaker 4 (38:38):
So, yes, testosterone does fluctuate, but not to the same extent,
so the magnitude and the frequency of those fluctuations is
not as much, so particularly in something like the MENSTU cycle.
Bioavailable testosterone and now I'm sorry, I feel like I'm
going into full nerd and science jeogonal but biovailable testostere
(39:00):
Your own isn't fluctuating to anywhere near the same extent
as something like bioavailable each to dial. So yes, it
does change, but not so much in a meaningful way
that we're really concerned about how that's affecting things like
muscle strength and muscle capacity and function.
Speaker 2 (39:14):
Yeah, that's a topic for another time.
Speaker 1 (39:15):
I've just started thinking about that because of the ways
that sometimes testosterone and these like artificial caps on what
testosterone levels women can or can't have might impact their
ability to compete. And I wondered if testosterone fluctuated the
same way, kind of in the same vein, but slightly different.
I wanted to ask this too. You know, sometimes when
we talk about why it's so important to research cisgender
(39:36):
women's bodies and understand how their physiology is different than
that of cisgender men, those conversations sometimes can be weaponized
by those who oppose transgender inclusion in sports, even when
there's also very little research out there about transgender athletes
and their specific individual experiences. So I wonder how you
see the balance of sort of understanding that cisgender women
and sisgender men are physiologically different from each other, while
(39:58):
also not drawing huge conclusions about transgender competitors.
Speaker 4 (40:03):
Yeah, so now I'm really getting out of my area
of expertise, and I work with some colleagues who've, you know,
really got some expertise and experience with with transathletes.
Speaker 3 (40:13):
So I wish they were sat here with me.
Speaker 4 (40:15):
What I will say is Yeah, I don't think that
we As we talk about some sex differences between cisgender
men and cisgender women, I don't think they should be
necessarily or at all actually extrapolated into the trans athlete space.
I think that's doing transathletes a disservice. I personally feel
that as a researcher who's been researching cisgender women or
(40:36):
varying hormones for the last twenty five years, that does
not give me the expertise or the knowledge or the
right to speak to trans physiology. So I haven't really
answered your question there, but I agree with you that
I think we should be cautious. You know, my area
is specifically focused on this, and it cannot be used
to speak about something you know that may well be
again more nuanced or different.
Speaker 1 (40:58):
Yeah, that makes sense. It's always hard on this show
because it's a show about women's sports. We want to
talk about women, but obviously that category is broad, and
so sometimes it might feel like we're leaving out non
binary or trans women or otherwise, and it can be
complicated to talk about these topics. But this was so fascinating.
I could keep you here so much longer. Just keep
(41:19):
peppering you with questions that I probably should have learned
and sex at or at least at some other point
over the course of my forty plus years on this earth,
and yet I haven't thank you so much.
Speaker 2 (41:28):
This was so fantastic.
Speaker 4 (41:29):
You're very welcome. Thank you for the really great, insightful questions.
I hope that the listeners find them useful.
Speaker 1 (41:37):
Thanks so much to doctor Elliott Sale for joining us.
We got to take another break when we come back.
Some stats that help put the WNBA's injury issues in perspective.
Speaker 5 (41:46):
That's next, Welcome back slices.
Speaker 1 (41:56):
We always love that you're listening, but we want you
to get in the game every day too, So here's
our good game play of the day. Follow doctor Elliot
Sayle on social media. We'll link to her profile in
our show notes. And we're always interested in reading more
about this topic. So if you read a great scientific
study or hear of a great story about this, send
it our way. You can hit us up on email
Good game at wondermedianetwork dot com or leave us a
(42:18):
voicemail at eight seven two two four fifty seventy and
don't forget to subscribe, rate and review slices. It's so
easy watch the upsetting amount of injuries this WNBA season,
rating out a review As of August eleventh, per a
tracker by the Next Tubes and reporter Lucas Siehoffer, with
(42:39):
four weeks to play, there have already been one hundred
and eighty seven injuries this WNBA season, twelve more than
there were the entirety of the twenty twenty three campaign,
and on pace to eclipse the two hundred three injuries
suffered last season. A total of seven hundred and sixty
four games have been lost this season between all injured players.
Speaker 2 (42:58):
Now, why is this happening?
Speaker 1 (42:59):
Well, more games, less rest, and more players to potentially
get injured. Frankly, with thirteen teams now in the league,
however you slice it, slices, this sucks. It's never fun
to start working on our episodes and realize we have
to announce that another player has gone down. But one
thing that does give me some solace folks like doctor
(43:19):
Elliott Sayle, who are working tirelessly to help us find
some answers and make the game safer for every athlete
who suits up. Now it's your turn, y'all, rate and review.
Thanks for listening, See you tomorrow. Good Game, Doctor, Kirsty,
Good Game, athletes who still kick ass during their period you,
anyone who underestimates period pain.
Speaker 2 (43:39):
Those craps can be killers sometimes.
Speaker 1 (43:45):
Good Game with Sarah Spain is an iHeart women's sports
production in partnership with Deep Blue Sports and Entertainment. You
can find us on the iHeartRadio app, Apple Podcasts, or
wherever you get your podcasts. Production by Wonder Media Network,
our producers are Alex and Misha Jones.
Speaker 2 (44:01):
Our executive producers are Christina Everett.
Speaker 5 (44:03):
Jesse Katz, Jenny Kaplan and Emily Rutder.
Speaker 1 (44:07):
Our editors are Emily Rutter, Britney Martinez, Grace Lynch, and
Gianna Palmer.
Speaker 2 (44:11):
Our associate producer is Lucy Jones.
Speaker 1 (44:14):
Production assistance from Avery Loftus and I'm Your Host Sarah
Spain
Welcome to Good Game with Sarah Spain, where we just
found out menopause can cause itchy ears.
Speaker 2 (00:06):
Itchy ears.
Speaker 1 (00:08):
Man, add that to frozen shoulder, night sweats, weight gain,
joint pain, hot flashes. Damn, let's hurry up on these
women's hormone studies and find some solutions.
Speaker 2 (00:17):
I don't want to deal with any of that shit.
Speaker 1 (00:20):
It's Wednesday, August thirteenth, and on today's show, we'll be
skipping the need to know and jumping straight into my
conversation with doctor Kirsty Elliott Sayle, a professor of female
endo chronology and exercise physiology and head of the Center
of Excellence for Women in Sport. We discuss the biggest
misconceptions about female physiology that need to change in sports
science and coaching, the connection between menstrual cycles and performance
(00:41):
and injury risk, and the push to understand why women
athletes suffer more ACL injuries. That conversation's coming up right
after this.
Speaker 2 (00:56):
Joining us now.
Speaker 1 (00:57):
She's a professor of female endo chronology and ex exercise
physiology at Manchester Metropolitan University and the head of the
Center of Excellence for Women in Sport based at the
Institute of Sport In addition to her research on female athletes,
the menstrual cycle, hormonal contraceptives, and menopause, her work in
recent years has also involved designing and implementing exercise interventions
during and following pregnancy for women, including athletes. She's partnered
(01:20):
with everybody from Angel City to arsenal UWEFA, to the
Australian Institute of Sport and more. It's doctor Kirsty Elliott Sale.
Speaker 3 (01:27):
Hello, Hi Sarah, Thanks so much for having me on.
Speaker 2 (01:30):
So nice to talk to you.
Speaker 1 (01:32):
We spoke a couple of years ago here in Chicago
for a Gator eight Sports Science Institute event, and I
was blown away by all the things I learned that day,
and it felt particularly important to bring you back now
because finally we're having more mainstream conversations about women's physiology,
about menstrual cycles and their impact on sport. But every
(01:53):
once in a while someone will say something very confidently
and I'll be like, I'm pretty sure that's not what
doctor Kirsty said. Having you back to help us understand
what we know, what we don't know, what needs more research,
and of course we want folks to be interested, but
maybe not make such bold declarations If we don't have
enough science behind it yet. So can you just tell
(02:13):
us just generally what it is you do, what's the
scope of your work, and how did you get into
this field.
Speaker 2 (02:19):
What does your kind of day to day study look like.
Speaker 4 (02:21):
So I've been working in this area a long time,
so more than twenty years. I did my PhD in
this area. So I was really interested in varying hormon profiles.
So I looked at the mensia cycle pregnancy actually in
viet refertilization treatment, so you know, different hormonal profiles and
how they affect muscle strength. So that's where I started off,
(02:42):
sort of you know, musculo scaltal physiology, and then you
know varian hormon profiles, and and I've left.
Speaker 3 (02:49):
You know, so it's really unusual.
Speaker 4 (02:51):
I'm from a sports science background, and typically you know,
sports scientists might have a few studies on their CV
related to women.
Speaker 3 (02:58):
I'm the opposite.
Speaker 4 (02:59):
I probably, you know, have a handful if that, of
studies that I've conducted in men. So I've been in
this area a long time, and over the last twenty
or so years, I've made it my business to get
to learn all these different ovarian homeown profiles so I'd
say I have a good grasp at around fifty or
more of varian homeown profiles. So really again speaking to
(03:19):
that individualization that you mentioned earlier on, So, yeah, that's
what I do. I learned these different profiles and then
I basically use them to test different aspects of performance
against them. I've mostly stayed in muscular scaletal, but you know,
really gone into sort of more performance based testing as well.
So what does day to day what does that look
(03:41):
like for me? You mentioned at the start that I
work with lots of different sports.
Speaker 3 (03:45):
I'm really lucky.
Speaker 4 (03:46):
I work with sports all around the world, so individual sports,
team sports, some big organizations, some individual athletes. I work
with women who are postmenopausal, women who are in their
reproductive years, some athletes with pregnancy or returning following pregnancy.
Of course, athletes that you mentioned thinking about potential challenges
(04:07):
or barriers that mental cycle or moral contraceptive use might
have all the way down into adolescents. So working with
teenage girls who are first starting you know, to menstrate
to get their first period, to incorporate this into you know,
their sporting lives.
Speaker 3 (04:22):
So a big remit.
Speaker 4 (04:25):
A lot of the work is athletes facing so a
lot of it's education. To be honest, there is so
having conversations with athletes directly. We don't know these things necessarily,
so trying to give them some knowledge so that they
can take ownership of this aspect of their sporting careers.
Often a lot of myth busting included within that education.
So many of the things that we've mentioned today. But
(04:47):
then I guess really sort of working then with more
practitioners and sports organizations to do some research, so you know,
looking at the challenges or the barriers or the questions
that they have for a particular sport, you know, related
to their female athletes, and trying to interrogate those in
a robust scientific way so that we can really give
(05:09):
them evidence to inform their practice.
Speaker 3 (05:12):
So, yeah, life is interesting.
Speaker 4 (05:14):
It's a real privilege to get to work with so
many great you know, athletes and clubs and organizations. But
as I say, it's all the way from education through
to you know, research, answering questions right up to sort
of making policies.
Speaker 1 (05:27):
What do you think some of the biggest misconceptions about
female physiology are that we need to change in sports
science and coaching.
Speaker 3 (05:33):
That's a great question.
Speaker 4 (05:36):
I think the biggest one is that the mental cycle,
for example, is the deciding factor for all aspects of
you know, women's performance in sport. That one sort of
sets my teeth on edge. It will be a contributing factor,
but it is really unlikely that it's going to be
the deciding factor. So let me give you one example
(05:57):
that I think has really sort of, you know, been
blown out.
Speaker 3 (06:00):
Of all proportion.
Speaker 4 (06:01):
So about two years ago, there were some headlines in
the in the I don't know if I should say, but.
Speaker 3 (06:06):
In a very well known international newspaper, and it was how.
Speaker 4 (06:12):
Female athletes might have a drops these phase of the
menstrual cycle. And I don't know about you, but drops
these doesn't really mean anything to me.
Speaker 3 (06:21):
It's quite a.
Speaker 4 (06:21):
Childish word, like upsie dropsy, and it's not a science
term at all. And the implication of this was the
suggestion was that for two phases of the menstu cycle
and female athletes, in particular female goalkeepers from soccer clubs,
would be unable to catch and hold and keep the ball.
Speaker 3 (06:39):
And that's just outrageous.
Speaker 4 (06:41):
So not only was it not backed by credible science,
it was also just a really childish way, a really
sort of patronizing sort of headline to describe, you know,
female athlete performance. So yeah, that's one of the ones
that really sort of, you know, gets me going. So yeah,
anything to do with the menstrual cycle dictating your success
or your ability to train or compete, that's that's a
(07:03):
really big misconception that we really need to put to bed.
Speaker 2 (07:07):
Let's talk about that a little more.
Speaker 1 (07:08):
And I want to start with some stuff that might
feel obvious, but I have to say, the more I
dig into my own body, the more I realize I
don't know shit about it, and we haven't learned a
lot about it. I remember I was watching a show
here in Chicago, a real estate woman who like flips houses,
and she said on camera, you know, I'm going through
the process of freezing my eggs in case I want
(07:30):
to have kids later because I'm getting older, so I'm.
Speaker 2 (07:32):
Making fewer and fewer every year. And I was like,
that's not right.
Speaker 1 (07:36):
Not only do you not know that going through the process,
but none of your producers, nobody in the editing room,
not a single person knows that we're born with all
of our eggs and we lose them it's not a
matter of not producing anymore, it's a matter of not
having as many left. And it was kind of shocking
but also in some ways not surprising how little we
know about this stuff. So take us through the menstrual
(07:58):
cycle and performance. What are the three phase is what's
happening to us and in us during.
Speaker 4 (08:02):
Each Okay, but firstly, let me say, you're so right.
There's so much misinformation out there or we just don't know.
And I think it's been assumed that because you're a girl,
because you're a woman, you will know these things. But
it's like everything else, we need to be taught these
and I don't know what it's like in the US there,
but in the UK we don't get a lot of
education on this, either at school or even at university,
(08:23):
you say, when you're doing a sports science degree. So
let me try and sort of be brief and make
it digestible so that everybody can understand. So we know
that the mental cycle is the body's way of preparing
for pregnancy, and so what happens is that the two
ovarian hormones esogen progesterone change across the cycle. So phase
(08:45):
one is when you're ment tuating, so when you're bleeding,
and that's when estrogen or progesterone are low. So that's
phase one. Then estrogen starts to rise. Sarah's probably laughing.
Speaker 3 (08:56):
I know this is a notable thing.
Speaker 4 (08:58):
So I'm starting to a diagram in the in the air,
but it doesn't help. Okay, So after phase one, when
esogen progesterone low, esogen starts to rise and it peaks
almost around the halfway point of the cycle. And this
peak in estrogen occurs just before ovulation happens. Now, progesterone
stays low at that point, so we're moving into the
second phase with a peak in estrogen. Pogesterone is low,
(09:21):
so it's a significantly different hormonal environment. Then when ovulation occurs,
estrogen drops again and it sort of has a secondary peak.
It's not as big as the first one, but this
time around, when it's having that secondary peak, we have
a peak in progesterone. So this is really the first
time pogesterone is rising. It's increasing it at its highest concentration,
(09:41):
and that's the sort of third really sort of significantly
different phase of the menstra cycle. Then both of those
homones start to drop again and it's when they drop
and they become low that then the woman the athlete
gets her period again. So really this sort of menstrual cycle,
it sort of represents fluctuations in these two hormones over time,
last roughly around twenty one to thirty five days, so
(10:03):
there's quite a big window variability there. So you know,
when different women are talking, you might hear one say, yeah,
I get my period every twenty six days, and another
woman might say I get mine every thirty one days.
So yeah, that's sort of I think it in a nutshell.
If hopefully that was simplistic enough.
Speaker 1 (10:18):
Yeah, Well, before we get into the athletes side of it, two,
just more basic questions. If all those hormonal changes are happening,
should we be intentional about when we schedule doctor's appointments,
if they're going to take blood or if they're going
to look at levels of things. Are there times in
our cycle where we're more likely to test for things
that might look problematic or be indicators of something that
(10:41):
are actually just natural during that phase?
Speaker 2 (10:43):
Yeah?
Speaker 3 (10:43):
Absolutely.
Speaker 4 (10:44):
I mean, you know, if you have a blood sample
take and during the mental cycle, it really is a snapshot.
It's like taking a photograph. You don't know what's happening
five minutes before or five minutes after, So yeah, it
should absolutely be intentional. If you're interested in a particular
outcome or aspect of health that's linked to low hormones,
of course, target that in phase one when you've.
Speaker 3 (11:05):
Got your period.
Speaker 4 (11:06):
But equally, if you're interested in ovulation, whether you're not
you're releasing an egg, then of course then it would
be timely to target that blood sample when we expect
that peak and estrogen. So absolutely it's really important. If
we take a blood sample on Monday, it really wouldn't
represent what was happening on Friday.
Speaker 2 (11:25):
And does that change it all or matter at all
if you're on birth.
Speaker 4 (11:28):
Control, Yeah, so absolutely so if you're using hormonal birth control,
so any type of birth control that changes your homone concentrations,
then yet you have an entirely different profile. And I
guess that's another really big misconception. I hear women and
athletes talking about their cycle when, for example, they're taking
the contraceptive pill, they don't have that cycle, they don't
(11:50):
have that menstrul cycle.
Speaker 3 (11:51):
And that makes sense.
Speaker 4 (11:52):
Because birth control is there to prevent pregnancy, so it's
there to prevent ovulation, because if you don't release the egg,
then of course you can't get pre So, yeah, there
are lots of different profiles and that relate to issues
and progesterone depending on which type of hormonal birth control
you're on. So again, if you are trying to get
an indication of what your homonne profile is and you're
(12:13):
on birth control, then again you have to be targeted.
So for example, you might get a blood sample taken
on one of the days that you're taking your pill
versus it could be different. Of course, it will be
different if you're on a pill free day or acebo
pill day.
Speaker 2 (12:27):
Yeah.
Speaker 1 (12:29):
Okay, now I have one complete random question. This is
going back to my college days because there were no
answers at the time, and maybe you have them now.
I was in a human bonding class and it talked
about pheromones and the sort of unspoken chemical connection that
we have to people that we might be physically attracted to,
and that oftentimes our attraction is a reflection of having
(12:50):
different bodily makeups that would best allow for our children
to survive. We're attracted to people who have a different
set of things that they would bring to the genetic
makeup of our child and most likely produced a child
that would go on to survive, you know, birth in
the world and everything else. But that when women were
on birth control, their reactions to the pheromones in sweaty
(13:14):
T shirts and things that they smelled were the opposite
of what they were when they weren't. So I'm wondering
if every woman out there who has a bad picker
and is making bad choices is making those choices because
of birth control. And if we're looking for our quote
unquote soulmate or someone that we're forever going to be
attracted to, do we have to go looking for them
when we're not on birth control.
Speaker 2 (13:33):
I love that question.
Speaker 3 (13:34):
I have never been asked that question before.
Speaker 4 (13:37):
Quite honestly, I don't think anybody has the answer to
that question.
Speaker 3 (13:41):
I'm unaware of research in this area. But I'm going
to go for a big fat no on that one.
Speaker 2 (13:47):
Okay, so we might be all right. I go out
a courtin on the pith.
Speaker 1 (13:52):
Absolutely good news for my husband. It's been it's been
sixteen years together, but I could finally rest Jesus.
Speaker 2 (14:01):
We got to take a quick break.
Speaker 1 (14:02):
When we come back more with doctor Kirsty Elliott sale,
don't move a muscle. Let's get back to the phases
that you were talking about, because one of the things
that has gotten attention is this idea that could you
(14:22):
potentially change your training for elite athletes based on the
time of their cycle. First, I don't know how you
do that for a team, do you first have to
try to sync them all up, or even for individual athletes.
Is there any science yet that tells us we should
be adjusting training based on the time of a cycle.
Speaker 4 (14:41):
Brilliant question. So let's go for the science first. No,
there isn't a significant body of credible evidence that would
suggest that we need to change our training in order
to sink with different phases of the menstrual cycle. Now,
of course, somebody listening to this is going to say,
but I saw a paper, I read a paper, I've
seen on social media this evidence. Yep, there's evidence out there,
(15:04):
for sure, But there's I guess the nuance to research evidence.
Not all research evidence is created equally, so we have
high quality evidence, and of course that means we have
low quality evidence. So right now, the evidence that exists,
it's small.
Speaker 3 (15:20):
In its quantity, so we're not overwhelmed.
Speaker 4 (15:22):
You know, we don't see this sort of big consensus.
You know, so lots of different labs, lots of different
independent as scientists showing the same things. So firstly there's
little of it, and then secondly it tends to be
sort of lower moderate quality, meaning that we don't have
the scientific community don't have confidence in those findings.
Speaker 3 (15:40):
So right now we're saying there's not enough credible evidence
to suggest that you need to.
Speaker 1 (15:45):
Do this well, so really quick, when we see the
headlines that are like menstrual cycle focus helped Chelsea win
it all, Emma Hayes leading the way by you know,
tailoring training to players of menstrual cycles.
Speaker 2 (15:56):
They were probably just good at footy.
Speaker 3 (15:58):
They were just graded.
Speaker 4 (16:00):
I mean, for sure, there's a feel good factor, you
know when it comes to you know, when it comes
to clubs or sports, which are you know, valuing these
or considering these female specific topics. Those players, those athletes
feel value, they feel sane, they've being cared for, and
you know that really comes with I don't know if
you want to say it's a placebo effect, but it
(16:21):
certainly comes with a feel good factor. And for sure,
you know there'll be some nuance there around. You know,
if one of the players maybe had a mental cycle symptom,
so some adverse symptoms, say, for example, muscle stomach cramping
or muscle pain or a headache, it could well be that,
you know, they were allowed to slightly adapt their training
(16:42):
on that day. So of course those things are going
to help. But you know, when we're talking about the physiology,
you know, if you're in a phase where there's high
issuage and do you need to train a certain way
because it affects your muscles and your ensurance capacity. No,
there isn't the evidence for that. But as they say,
if you take a more pragmatic thing and say something like, okay, well,
(17:03):
if you're in a phase where you're bleeding, we'll you know,
have some considerations around the fact that these players are bleeding.
We'll offer them X, Y and Z, will make it
easy for them to incorporate their training on these bleeding days.
You know, that just is good common sense. So it's
not a really clear picture. But if I just want
to summarize so everybody is is clear on the research evidence, No,
(17:26):
there are not phases where you win or lose. But
you know, if you are body literate, if you are
mindful of you know, either symptoms or the fact that
you bleed as part of the mental cycle, you can
certainly incorporate some of those aspects into your training. But
they are really, you know, small adjustments. So no, the
big headline grabbing things aren't aren't quite correct. But I
(17:46):
can see that certainly, you know, we've had a good
shift into considering these female things, which is certainly better
than it was ten years ago.
Speaker 1 (17:55):
Yeah, I mean, I think to your point, every woman
knows that her experience is different than other women. Some
have very heavy periods, some have a lot of cramping,
some don't want to get out of bed, some barely
feel it. So the idea that athletes would somehow uniformly
be affected by it feels like a stretch. So again,
personalized approach based on your individual response to exercising across
(18:17):
your cycle, especially if that is consistent, because again, even
among our own experiences, one month that could be terrible,
one month we could barely notice it, which really makes
it hard to make kind of sweeping decisions based on it.
I think the same seems to go for birth control,
right because whenever I hear elite athletes complaining about getting
their period during the Olympics or a major event, I
always think, well, why don't they just go on birth
(18:38):
control and you can control which part of the phase
you're in for this major track made or this championship game.
You can take your pills through the week you're supposed
to be getting it and skip ahead, Like, do you
think that that's already happening consistently and is there any
reason not to do that?
Speaker 3 (18:51):
Yeah, so it happens a lot.
Speaker 4 (18:53):
And actually, you know, when we talk to athletes about
why they use hormonal birth control, more often than not
say it's to manipulate their menstro cycle, you know, to
be able to control bleeding and so on, and actually
for contraception is often the second reason, which is a
little sort of counterintuitive.
Speaker 3 (19:11):
So, yeah, it happens a lot.
Speaker 4 (19:12):
And then I guess the second part of your question
is why why doesn't everybody do it? I guess that
maybe leans into the fact that, you know, again, we
all have different experiences of birth controls, so there's always
a concern there. If I have an athlete who comes
to me, you know, a month before the Olympic final
and says, oh, you know, I feel like, now that
the schedule is released, I might have my period when
it's the Olympic final or you know, certainly in you know,
(19:35):
during the Olympics. Quick, you know, let's get me on
the pillar, for example. Our concern is if they haven't
been on the pill before, if they're not used to it,
we don't know if they're going to have any side effects,
and potentially those side effects could be worse than any
of these sort of adversity they might you know face
because of the menstro cycle. So you know, rarely in
elite sport as one size fits all. So certainly those
(19:57):
athletes who are using birth control in order to manipulate
their cycles, or you know, they're using it, you know,
specifically around major competitions, we would always encourage them to
trial that months, you know, out before the Olympics, before
the World Championships, just to make sure that they're not
potentially swapping one set of issues for another. But yeah,
(20:17):
one size rarely fit's all exactly as you said, whether
it's birth control or whether it's the menstra cycle. And
I think you know a really good point, and you've
made it nice several times, is to remember that not
all female athletes have a menstra cycle, So yeah, we're
we're dealing with athletes with menstra cycles.
Speaker 3 (20:32):
That's one profile.
Speaker 4 (20:33):
There's probably you know, twenty thirty different hormonal profiles associated
with birth control. There are different hormonal profiles if you
have mental dysfunction, so you know, yeah, you really have
to take an individualized approach. Not everybody has the same profile,
and everybody's experience is not the same, and it's exactly
as you said, one cycle to the next cycle may
also be different, So lots of moving parts, lots of
(20:55):
nuance when it comes to this topic, and again doesn't
really lend itself, does it to those sound bites and
those headlines which really oversimplify and whitewash and assume we're
all the same.
Speaker 1 (21:05):
Which unfortunately could discourage people from studying it because they
want to be able to make those sweeping generalizations and
have some outcome that feels clean. And instead, we need
more research because it is so disparate in terms of
different experiences and outcomes for a variety of people. So
the more studies we have, the more opportunity we have
to understand how every different person might react in a
specific incidant. You know. I saw an interview with Olympic
(21:27):
volleyball player Alex Kleinman. She shared that a doctor had
told her there's a big link between birth control pills
and bone injuries.
Speaker 2 (21:34):
Is there proof to that or are.
Speaker 1 (21:35):
There any other reasons why athletes might not want to
use IUDs or pills or other hormonal treatments because of
how it might affect their performance.
Speaker 4 (21:45):
Well, that sounds like quite a big claim, an oversimplified claim.
So firstly, I would say, you know, hormonal birth control
users don't panic. It doesn't automatically increase your risk of
boney injuries. There certainly have been so studies published which
suggests that those who use progest and only contraception may
(22:07):
have a slightly increased risk. But again, you know, I
keep using this word nuance. You know there is nuance there.
It depends how long you've been using it, if you
take any breaks, what type of sport that you do.
You know, you might do a sport where you have
really great bone health anyway, you know, so your sport
lends itself to you know, good bone deposition. Whereas you know,
(22:29):
of course, if you're in a sport where you already
might have you know, lower bone mineral density or already
be at risk, then obviously that might make an additive effect.
Speaker 3 (22:39):
So I think there's lots of factors to consider.
Speaker 4 (22:41):
But again, I'd really like to avoid those sort of
headlines or bull statements around if you do this, this
will happen.
Speaker 2 (22:47):
Okay, So follow up to that.
Speaker 1 (22:48):
The doctor also told her that women need different nutrients
at each point in their cycle. Is that something we
should be thinking about what we're putting in our bodies
during different phases.
Speaker 4 (22:56):
I keep remembering that people are listening to this and
they can't see my face. This is probably a good thing. Okay,
so I made a face. No again, you know this
this really concerns me. You know, it's very similar to
the narrative around change your training in line with your
mental cycle. Faces again, the menstrual cycle, or you're or
(23:17):
you know, more broadly eure ovarian homon profile. Let's use
that as the term which incorporates all of those different
ones I mentioned. It should not be dictating your nutrition.
It might be a consideration, but it shouldn't be the
deciding factor. So again, if I was working with a
female athlete, Now full disclosure, I'm not a nutritionist, but
even you know, I'm a physiologist, but even when I'm
(23:37):
working with them, we might veer into a little bit
about nutrition, and I would always say to them, fuel
for the demands of your sport. That's the big hitter,
you know, So make sure that you're fueling, that you've
got adequate fuel for what you do. Make sure that
your fueling strategy is, you know, sufficient for recovery, all
of those things, those big pillars of performance first if,
(23:58):
of course, then let's go back to the idea of
you know, we might have an athlete who has some
adverse and mention psychosymptoms. So for example, she might have
a bit of a runnie tummy during her period.
Speaker 3 (24:09):
Yeah, it makes sense to.
Speaker 4 (24:10):
Me change your diet during that particular time point to
try and help alleviate that adversity. But when it comes
to the big you know, statement of these phases should
dictate what you're reading that's just not true based on
the current evidence.
Speaker 1 (24:25):
Yeah, and again I want to point to I read
a lot of articles and guest essays that you wrote,
and mainly what you say is you can read something
that says there's some evidence, but what it won't say
is very minimal, very small study, very you know, tenuous evidence,
not super proof, and that makes a big difference in
whether you're going to actually change behavior as a result
or whether you're going to use that to say, Okay,
(24:45):
let's keep studying it, which is great, but maybe not
making these widespread generalizations as a result. All right, I
want to talk about acls specifically. For a long time,
we've been trying to understand why women suffer ACL injuries
more we've been try trying to figure out if there's
training changes that can help, you know, prevent it. We've also, suddenly,
and at least in my world, that's been sudden, started
(25:08):
to talk about whether or not people are more likely
to tear their acls during different phases of their menstrual cycle,
whether the phase affects joint laxity or otherwise.
Speaker 2 (25:16):
So, big picture, do we have.
Speaker 1 (25:19):
A reason to believe that ACL tears are more likely
during any particular part of the cycle.
Speaker 4 (25:23):
No, So I feel like I'm on repeating now, but
you know, hopefully I'll have brainwashed everybody by the end
of this episode. So No, there's insufficient evidence to suggest
that there's an increased risk at a particular phase of.
Speaker 3 (25:37):
The menshuaw cycle.
Speaker 4 (25:38):
This one is an interesting one because actually there's two
schools of thought that we're seeing, you know, in sort
of I guess, in the popular media. So on one hand,
we're hearing from a lot of athletes that they're saying
that we're really worried about sustaining an ACL injury during
our periods. So again, just going back to that sort
of biology lesson we had at the start, that's when
(26:00):
is at its lowest, and so there's a real narrative
now amongst athletes that this is when it's going to happen.
Speaker 3 (26:06):
And they're really worried about it.
Speaker 4 (26:08):
Then in the academic or research community, research that's been
done previously has well, some of it has suggested that
there's an increased risk just before ovulation. Now back to
that biology lesson, that's when estrogen is at its highest.
So both things can't be true. So where does that
really leave us. So the anecdotal evidence it's a mixed bag.
(26:30):
I work with one particular soccer club in the UK.
They won't mind me saying this, it's in the public domain.
They had four ACL injuries in one season and I
can promise you that they were not all sustained in
the same phase as the menstrual cycle, and not all
of them.
Speaker 3 (26:46):
Were during menstruation.
Speaker 4 (26:47):
So that's the first thing when it comes to that
anecdotal evidence, that's not what we're seeing in the applied setting.
When it comes to the research evidence, as I said,
there's some evidence to suggest that it might be an
increased risk in the preovulatory phase. But for every paper
that I can show you that says that I can
find you the same amount or maybe slightly more that
said this is not true. So it's really inconclusive from
(27:09):
the research side.
Speaker 3 (27:10):
But here's what I'm going to throw out to you.
Speaker 4 (27:13):
I think it's naive to think that you know, when
it comes to something like an ACL injury, and we
know that injuries are multi factoral, that they're complex things
to understand and to study. I just really don't believe that, honestly,
on any day we're going to see a female athlete
sustain an ACL injury and the only contributing factor is
going to be her issuge in concentration. I just think
(27:34):
that is wildly oversimplified. So I think we need to
look into other areas, other aspects, And actually there's been
some really nice work in the last sort of three
to five years looking more at the gendered environment.
Speaker 3 (27:47):
Now getting a little outside of my wheelhouse.
Speaker 4 (27:49):
Here my expertise, but it really resonated with me that
if you look at the environment in which female athletes train,
and you know, even looking right back from when they
started as younger, there's a lot of disparity when you
compare that to boys and men, and so I think
that it makes sense for me to look there to
see what opportunities they have, what resources, the funding, all
(28:10):
of those things. And then I think, secondly, as you
said when you asked the question, I think we need
to look more around, you know, how are they being
trained now, what does that training look like, what are
the facilities, And certainly in the UK and other countries
in Australia as well, there's some really nice research now
starting to look at the strength and conditioning of female
athletes and how that may well, you know, help lower
(28:31):
that risk within women. But I think if we had
parity in those sort of training environments, I think, you know,
the risk or the occurrence of these injuries between men
and women would close, you know, instantly, and then it
would be worth looking into against some of those really
sort of specific contributing factors.
Speaker 1 (28:49):
Yeah, you know, I've heard something about a PEP method
that's supposedly just fifteen minutes ahead of training that can help.
I'm also part way through this book, The Stronger Sex,
and it seems like later in the book they mentioned
in the intro potentially proof that even at the very
youngest ages, when girls are twirling and boys are already
being taught to kick and throw and cut, that that
very very early time might even contribute to the way
(29:11):
that our muscles are built to withstand those movements. And
we might think it's too early, but it's actually a
part of it. So that's interesting, you know. I also,
we've been talking about individual experiences, So is it possible
that an individual athlete might have enough of a drop
in an estrogen or enough of a hormonal change during
their period that it does impact in more significant ways.
(29:31):
For instance, you know, I was listening to Megan Rapino
and Suebird on their podcast to Touch More, and Megan
said she has had three ACL tears, all three while
she was on her period. When you have anecdotal individual
evidence like that that's spread so quickly, right, and so
then everybody hears that and thinks, oh, that must be
the thing. So do we need more research into the
(29:53):
potential that that individual athlete might experience something during her
period that very greatly contributes to the likelihood or is
it possible that it's chance.
Speaker 3 (30:03):
Yeah, I think probably the latter.
Speaker 4 (30:06):
As you said, you know, there are only so many days,
and you know, of course it is going to happen
to some players, to some athletes during during their period.
Of course, it is as you say that it's random chance.
It's you know, correlation is not causation. And the thing
if it is you know, if you hear this is
particularly from you know, high profile athletes, then you know
(30:28):
it becomes you know, it just spreads, doesn't it. And
and it sort of goes like that. But as I say,
it's a bit like the research papers. For every high
profile athlete I can find you, I can that we
can find that say that happened during their period. We
can find another one who it didn't. But it's just
whether or not their stories sort of make it out
there in the same way.
Speaker 3 (30:48):
I think what is.
Speaker 4 (30:49):
Interesting though, is will it become almost like a self
fulfilling prophecy, because again, you know from the anecdotal evidence.
As we've said, now, they're you know, they're talking about it,
players and athletes.
Speaker 3 (30:59):
It's on their minds.
Speaker 4 (31:02):
And I think, you know, if you're worried about sustaining
an injury in that phase, maybe you'll be more tentative
in the tackles that you make.
Speaker 3 (31:09):
You know, you'll be distracted, you.
Speaker 4 (31:10):
Have anxiety, and it's maybe those things that will you know,
cause you to make a bad decision or cause you
just to make the movement slightly different. And maybe we
will see an increase in the occurrence of them then.
But will it be down to low estrogen.
Speaker 3 (31:25):
I think it's unlikely.
Speaker 4 (31:26):
I think it may be down to sort of some
of those wider biopsychosocial aspects. So yeah, I think we
have to be careful for sure. What I don't want
to do is come across and I'm discounting. You know,
I have absolutely believed that, you know, these injuries are occurring,
and you know, even all three in.
Speaker 3 (31:41):
The same phase.
Speaker 4 (31:43):
But personally, you know, based on my experience and what
I've read and my research in twenty something years in
this area, I don't think that that was the deal breaker,
you know, amongst this.
Speaker 1 (31:53):
Right, well, and if you actually had her in to
do a study, you would have to look at the
calendar of how often games have happened, fun menstrual weeks,
and what surface was she playing on? And you know
she differently as a result of all of that stuff. Okay,
a couple last questions for you. I actually asked my trainer,
who does the physiological side of it really well, which
(32:15):
is why I work with him, because I have lots
of injuries from sports and he works with a lot
of women, And wondered, is exercise a one size fit all?
You know, if women are not all the same structurally
and then everyone follows the same protocol, will we see
a decrease in injury? Or does it really have to
be so specific to each person? Oh?
Speaker 3 (32:33):
Can it be both?
Speaker 4 (32:36):
You know? I think for sure we still have general
principles you know of exercise prescription that will hold true
for men and for women. You know there are good
principles about specificity. You know about thresholds, all of those
things they're true, and you know there are the big
pillars around recovery and load and sleep and nutrition and
(32:57):
all of those things. So I do think, you know,
we have good principles that will fit the majority. I
think what we have to get better at doing is
considering things that affect just women. And you know, by
considering them, that doesn't necessarily mean we have to change something,
you know, it means that we've thought about them, we've
(33:19):
tested them out, and for those who are affected, we've
done something. For those who are unaffected, we've moved on by,
you know, because there are so many things.
Speaker 3 (33:27):
So of course, you know, you and I.
Speaker 4 (33:28):
Are talking about ovarying homeost today, which is my expertise,
but you know, some of the other considerations could be
around breast health, so you know, the right fitting bra,
breast biomechanics, you know, is how we're moving. Is that
causing us you know any you know, adversity or advantage
and pelvic floor health and all.
Speaker 3 (33:48):
Of those things.
Speaker 4 (33:48):
So I think it's about, you know, taking what we
know and then adjusting it if necessary. But I think
it's more it's more nuanced. Oh my god, I need
to widen my vocabulary, don't.
Speaker 1 (34:00):
I I use that word a lot too. It's a
useful one and it's so necessary these days.
Speaker 4 (34:06):
And I don't want people to get the you know,
the misconception that it's complex, because complex seems like it's
an excuse not to think about it, not to do it,
not to study it, not to talk about it. So
it's not complex, it's just a different way of thinking.
It's about upskilling, getting this body literacy, whether it's for
yourself as the athlete, as the exercise, or whether you're
the practitioner, the.
Speaker 3 (34:26):
Trainer, the coach.
Speaker 4 (34:28):
Once we have this knowledge, we can start to test
these things out. And as I say, more often than not,
when we start to do these things with female athletes,
the majority are not significantly affected. So that's great news,
by the way, because I think if you were to
go on to social media right now, you would think
that we would have to change our whole lives based
on this one thing, and that's just not true. It's
(34:48):
got a little bit overinflated. It's the pendulum swing, right.
We've gone from you know, the dark ages where we never.
Speaker 3 (34:54):
Spoke about it. It was a taboo hate that word
as well, by the way.
Speaker 4 (34:58):
And now it's almost like, you know, we've gone to
the other end of the ex you know, the extremes.
The pendulum has swung all the way over and now
it seems to be you know, the go to the everything.
So I'd like for us to course correct, come back
into the middle. Let's get more knowledge and awareness. Let's
really test these things out, and let's remember that if
you're not affected, that's great news.
Speaker 3 (35:17):
Move on. There's so many other things to consider.
Speaker 4 (35:20):
And if you are affected, again, that's not bad news.
There are lots of interventions out there. If you have symptoms,
there are either pharmaceutical avenues to explore, or there are.
Speaker 3 (35:31):
Changes in diet or recovery that we can do.
Speaker 4 (35:33):
If you have heavy mental bleeding, there are therapies and
treatments for that, or we can change the environment so that,
you know, mental psycho products are more accessible.
Speaker 3 (35:42):
There are solutions to.
Speaker 4 (35:43):
The challenges the female athletes face, but I think it's
about being mindful of them, testing them out and then
looking for interventions. I hate when people say, you know, oh,
we have to constantly adjust training on these things. No,
let's be proactive instead of reactive. Let's learn about them,
let's test them, Let's get interventions, and that way women
and girls can train and compete as.
Speaker 3 (36:04):
They want to on any day of the mental cycle.
That's the goal, right, Yeah, I.
Speaker 1 (36:09):
Think part of the reach is that people want answers,
especially as there's more investment, more money, more care about
these athletes to lose so many top particularly football players
soccer players, to acl We want to be able to
have this easy answer of oh, now that we understand it,
we can fix it immediately. But is it modifiable through
training versus just being biological in terms of women getting
(36:30):
their acls torn more commonly, or is it still a
matter of, like you said, really comprehensive study of all
the factors that might be contributing.
Speaker 3 (36:38):
Yeah.
Speaker 4 (36:39):
I think the investment, you know, whilst really welcome into
the research, you know side of things, I think there's
only so much we can do. So firstly, good quality research.
You know that we have confidence in the finding. It's slow,
it takes time. We also need the athletes to be involved. So,
you know, when we hear the elite female athletes calling
(36:59):
for more research, by definition that requires them to.
Speaker 3 (37:03):
Take part in research. But they're busy people who've got
huge demands. So it becomes a little bit of a vicious.
Speaker 4 (37:08):
Circle that they want answers, but the researchers need the
athletes to take part to get those answers. So you
know that availability is difficult, So firstly, research is slow. Secondly,
you know it needs the athletes to be involved in
that can be difficult. And then I guess thirdly, you know,
research is about taking a small sample from the population
and then trying to generalize those findings.
Speaker 3 (37:28):
I'm not entirely sure when it.
Speaker 4 (37:30):
Comes to something like ovarian homown profiles that will ever
have a universal blueprint For all the reasons that we've
been talking about, Sarah, it's so individual. Those profiles are
so variable. You know, my peak of estrogen in this
cycle might be lower or higher. You know, it's still
a peak, but it could be lower higher in the
next cycle. So with all that variability, will research ever
give us a blueprint? So I think that's difficult. So
(37:52):
going back to your question, I think that investment, yes, please,
let's have some for research.
Speaker 3 (37:57):
Don't want to talk myself out of the job.
Speaker 4 (37:58):
It is important with those caveats, but maybe the investment
needs to go into that sort of wider you know,
women's sports funding it making sure they have adequate salaries
so that when they go home, they're not going home.
Speaker 3 (38:10):
To do a second job.
Speaker 4 (38:11):
You know that they can go home and recover that
they have, you know, enough money to fuel themselves. Well,
you know that they're on good pit surfaces, all of
those things. So the investment is super welcome, but it
needs to do a lot of things.
Speaker 2 (38:24):
Okay, no, we're running out of time.
Speaker 1 (38:25):
But now you maybe think of another question that I
feel like as an endochronologist, even though it might not
be your focus, you might be able to answer, which is,
do women have the same fluctuating levels of testosterone in
their bodies or does that stay steady?
Speaker 2 (38:38):
Oh?
Speaker 4 (38:38):
So, yes, testosterone does fluctuate, but not to the same extent,
so the magnitude and the frequency of those fluctuations is
not as much, so particularly in something like the MENSTU cycle.
Bioavailable testosterone and now I'm sorry, I feel like I'm
going into full nerd and science jeogonal but biovailable testostere
(39:00):
Your own isn't fluctuating to anywhere near the same extent
as something like bioavailable each to dial. So yes, it
does change, but not so much in a meaningful way
that we're really concerned about how that's affecting things like
muscle strength and muscle capacity and function.
Speaker 2 (39:14):
Yeah, that's a topic for another time.
Speaker 1 (39:15):
I've just started thinking about that because of the ways
that sometimes testosterone and these like artificial caps on what
testosterone levels women can or can't have might impact their
ability to compete. And I wondered if testosterone fluctuated the
same way, kind of in the same vein, but slightly different.
I wanted to ask this too. You know, sometimes when
we talk about why it's so important to research cisgender
(39:36):
women's bodies and understand how their physiology is different than
that of cisgender men, those conversations sometimes can be weaponized
by those who oppose transgender inclusion in sports, even when
there's also very little research out there about transgender athletes
and their specific individual experiences. So I wonder how you
see the balance of sort of understanding that cisgender women
and sisgender men are physiologically different from each other, while
(39:58):
also not drawing huge conclusions about transgender competitors.
Speaker 4 (40:03):
Yeah, so now I'm really getting out of my area
of expertise, and I work with some colleagues who've, you know,
really got some expertise and experience with with transathletes.
Speaker 3 (40:13):
So I wish they were sat here with me.
Speaker 4 (40:15):
What I will say is Yeah, I don't think that
we As we talk about some sex differences between cisgender
men and cisgender women, I don't think they should be
necessarily or at all actually extrapolated into the trans athlete space.
I think that's doing transathletes a disservice. I personally feel
that as a researcher who's been researching cisgender women or
(40:36):
varying hormones for the last twenty five years, that does
not give me the expertise or the knowledge or the
right to speak to trans physiology. So I haven't really
answered your question there, but I agree with you that
I think we should be cautious. You know, my area
is specifically focused on this, and it cannot be used
to speak about something you know that may well be
again more nuanced or different.
Speaker 1 (40:58):
Yeah, that makes sense. It's always hard on this show
because it's a show about women's sports. We want to
talk about women, but obviously that category is broad, and
so sometimes it might feel like we're leaving out non
binary or trans women or otherwise, and it can be
complicated to talk about these topics. But this was so fascinating.
I could keep you here so much longer. Just keep
(41:19):
peppering you with questions that I probably should have learned
and sex at or at least at some other point
over the course of my forty plus years on this earth,
and yet I haven't thank you so much.
Speaker 2 (41:28):
This was so fantastic.
Speaker 4 (41:29):
You're very welcome. Thank you for the really great, insightful questions.
I hope that the listeners find them useful.
Speaker 1 (41:37):
Thanks so much to doctor Elliott Sale for joining us.
We got to take another break when we come back.
Some stats that help put the WNBA's injury issues in perspective.
Speaker 5 (41:46):
That's next, Welcome back slices.
Speaker 1 (41:56):
We always love that you're listening, but we want you
to get in the game every day too, So here's
our good game play of the day. Follow doctor Elliot
Sayle on social media. We'll link to her profile in
our show notes. And we're always interested in reading more
about this topic. So if you read a great scientific
study or hear of a great story about this, send
it our way. You can hit us up on email
Good game at wondermedianetwork dot com or leave us a
(42:18):
voicemail at eight seven two two four fifty seventy and
don't forget to subscribe, rate and review slices. It's so
easy watch the upsetting amount of injuries this WNBA season,
rating out a review As of August eleventh, per a
tracker by the Next Tubes and reporter Lucas Siehoffer, with
(42:39):
four weeks to play, there have already been one hundred
and eighty seven injuries this WNBA season, twelve more than
there were the entirety of the twenty twenty three campaign,
and on pace to eclipse the two hundred three injuries
suffered last season. A total of seven hundred and sixty
four games have been lost this season between all injured players.
Speaker 2 (42:58):
Now, why is this happening?
Speaker 1 (42:59):
Well, more games, less rest, and more players to potentially
get injured. Frankly, with thirteen teams now in the league,
however you slice it, slices, this sucks. It's never fun
to start working on our episodes and realize we have
to announce that another player has gone down. But one
thing that does give me some solace folks like doctor
(43:19):
Elliott Sayle, who are working tirelessly to help us find
some answers and make the game safer for every athlete
who suits up. Now it's your turn, y'all, rate and review.
Thanks for listening, See you tomorrow. Good Game, Doctor, Kirsty,
Good Game, athletes who still kick ass during their period you,
anyone who underestimates period pain.
Speaker 2 (43:39):
Those craps can be killers sometimes.
Speaker 1 (43:45):
Good Game with Sarah Spain is an iHeart women's sports
production in partnership with Deep Blue Sports and Entertainment. You
can find us on the iHeartRadio app, Apple Podcasts, or
wherever you get your podcasts. Production by Wonder Media Network,
our producers are Alex and Misha Jones.
Speaker 2 (44:01):
Our executive producers are Christina Everett.
Speaker 5 (44:03):
Jesse Katz, Jenny Kaplan and Emily Rutder.
Speaker 1 (44:07):
Our editors are Emily Rutter, Britney Martinez, Grace Lynch, and
Gianna Palmer.
Speaker 2 (44:11):
Our associate producer is Lucy Jones.
Speaker 1 (44:14):
Production assistance from Avery Loftus and I'm Your Host Sarah
Spain
Host
Sarah Spain
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