Performance-Related Injuries and Exercise Orientation of National Collegiate Athletic Association Division I, II, and III Female Collegiate Cross Country Runners

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A serious commitment to sport and exercise may predispose female athletes to the development of eating disorders. The energy restriction and accompanying menstrual disorders that are often associated with eating disorders may increase female athletes' injury risks. The purpose of this study was to assess NCAA Division I, II, and III female collegiate cross country athletes' weekly exercise time, rates of injury, menstrual dysfunction, and subclinical eating disorder risks. A paper-pencil survey was completed by athletes (mean age = 19.64 years) from NCAA Division I (n = 82), Division II (n = 103) and Division III (n = 115) colleges across the United States. Division I athletes spent significantly more weekly exercise time (M = 687.97 minutes) than Division II (M = 512.38 minutes, p = .0007) or Division III (M = 501.32 minutes, p = .0003) athletes. When examining rates of menstrual dysfunction, 23 percent reported amenorrhea or oligomenorrhea. Over 60 percent (64.3%) of the athletes reported a performance-related injury, with the knee being the most commonly injured site. 24 percent (23.7%) of the athletes reported having stress fractures. Scores for subclinical eating disorders for Division I athletes were significantly higher (M = 87.11) than Division III athletes (M = 82.94, p = .0042). Division I female athletes may be at an increased risk of developing subclinical eating disorders compared to those competing in Division II or III. Because early identification of those with subclinical eating disorders prevents the progression to eating disorders, further study is warranted.


As rates of obesity continue to increase in the Western world, so do occurrences of unhealthy dieting, weight preoccupation, and eating disorders (Cash & Henry, 1995). Although one might justifiably praise the many health benefits of exercise to prevent obesity and other health problems, it has been found that a serious commitment to sport or exercise may contribute to the predisposition and progression of eating disorders (Davis, Kennedy, Ravelski, & Dionne, 1994). For example, female athletes are at a greater risk of developing eating disorders than nonathletes of similar age (Beals & Manore, 1994). National Collegiate Athletic Association (NCAA) studies have shown, at least 40 percent of member institutions reported at least one case of anorexia or bulimia (NCAA, 1998a).

Multiple factors contribute to the increased risk of disordered eating among female athletes (Yeager, Agostini, Nattiv, & Drinkwater, 1993). Women who are successful in sport may have personality characteristics that increase their risk of developing eating disorders (NCAA, 1998b). Lowering caloric consumption to maintain an "ideal" weight or to enhance performance may also exacerbate the problem (Thrash & Anderson, 2000). A reduction in food intake and extreme training can lead to menstrual dysfunction (Henriksson, Schnell, & Hirschberg, 2000; Putukian, 1994), a disorder that is particularly prevalent among females who participate in sports where a "thin build" improves performance (Warren & Shantha, 2000). In fact, amenorrhea is a frequent symptom of eating disorders in women (Yeager et al., 1993). Athletic amenorrhea, the absence of three to six menstrual cycles, decreases bone mineral density, which compromises present and future bone health (Drinkwater, 1990).

Beals (2000) has proposed that female athletes with eating and body-weight problems who fail to meet all of the criteria for anorexia nervosa and bulimia nervosa may have subclinical eating disorders. The energy restriction associated with this disorder may increase the risk of injury due to deprivation of the fuel needed by the body for energy, tissue repair and building, and micronutrient requirements (Beals & Manore, 1999). Reduced bone-mineral density and premature osteoporosis could lead to injuries, such as stress fractures (Beals & Manore, 1999). …


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