Thursday, 24 December 2015

Recovery snacks: ideas to boost your recovery

Recovery snacks are very important and can make the difference between you reaping the benefits of training and not. And so, our Christmas gift you is a special one-page factsheet with lots of  recovery snack suggestions.

Did you know that failing to consume some form of food or snack within 15-20 minutes of finishing training can severely delay recovery, prevent you from adapting and benefiting from the session, and can make you more susceptible to colds and infections?

The recovery snack should contain:
1. Carbohydrates to replace muscle and liver glycogen stores and to suppress cortisol secretion - This is one time when quick release carbohydrates (ie simple sugars) are ok, and often encouraged.
2. Protein to assist with muscle repair (and after a weights session to promote muscle growth).
3. Fluids to rehydrate (and perhaps some sale or electrolytes after prolonged training in the heat).
4. Vitamins, minerals etc to support the immune system (esp Vitamins C & E, Zinc, Glutamine & Probiotics).

Lots more information, and suggestions can be found on the Recovery Foods factsheet.

Wednesday, 16 December 2015

Pre-competition nerves: can they be harnessed?

A common concern among athletes of all levels is pre-competition nerves and how to deal with them. No matter how long we've been competing for, or what level we compete at, nerves appear to hold us back.

I, like many athletes, suffer from pre-race nerves. Sometimes they completely hinder my performance, making what should have been a big performance appear more like a laboured recovery jog. Other times they are something in the background that simply makes me need the toilet a little more frequently than normal. Ok, a lot more frequently.

But the one thing that I've found that helps is embracing the nerves; recognising them for what they are, and welcoming them onboard rather than fighting them. They don't like the friendly welcome so much, and often waddle off into hiding in response.

Some otherwise talented sportspeople never fully learn to manage their pre-competition nerves, and performance anxiety can make competition day so unbearable that they quit their sport.

It doesn't have to be like this. Any good sports psychologist will be able to give you techniques to manage your nerves in a positive way.

Athletes of all levels experience pre-competition nerves, but once the gun goes the adrenaline has other outlets.

What are per-competition nerves?
Nerves manifest themselves and affect each individual in a different way. Also known as competition anxiety, pre-meet jitters (or, in the worst cases, choking), pre-competition nerves are a collection of physical and mental responses to increased adrenalin secretion. Adrenalin is required to get us up for a big performance. This 'fight or flight' hormone/neurotransmitter increases our heart rate, muscle strength, blood pressure and sugar metabolism in preparation for strenuous activity and in response to strong emotions such as fear or anger or a perceived threat. Adrenalin secretion is necessary for a good performance, but too much adrenalin or arousal (as 'getting up' for the performance is often called), can result in a number of unwanted side effects.

These unwanted symptoms include 'butterflies' in the stomach, nausea, vomiting, poor concentration, lack of spatial awareness, negative thinking/thoughts, tight muscles, sweaty palms, cotton mouth, feelings of apprehension, desire to urinate, diarrhoea, feeling of fatigue, flushed skin, forgetting details, increased respiratory rate, irritability, heart palpitations, hyperventilation, visual distortion, voice distortion, yawning and vomiting.

Many of these symptoms, particularly the ones that can be described as somatic (or related to the sympathetic nervous system e.g. increased heart rate, sweaty palms, urge to urinate), disappear once the race, game or contest starts; as soon as we have the opportunity to put the adrenaline to other uses. Their presence can be taken as a sign of physiological readiness to compete. They should have no negative effect on performance, so long as we can actually make it to the start line.

However the cognitive state anxiety symptoms - the poor concentration, feelings of apprehension, tiredness, etc. - fluctuate throughout the contest as the probability of success/failure changes. These symptoms, if not controlled, can have a harmful effect on performance. This is when our mind is feeding us negative thoughts which we start to believe.

Nerves are often at their worst when the perceived demand is not balanced by the athlete's perception of their ability to respond effectively to the 'threat'. If you want to do really well in a big competition (perceived demand), but feel inadequately prepared (ability to respond), the nervous response is potentially high. (Conversely if it is a very small competition that you can easily win, your arousal may be insufficient; this arousal malarkey is a fine balancing act).

Managing nerves
Strategies to manage and overcome nerves fall into three main categories. Firstly, relaxation techniques can reduce the level of arousal, and get you into the arousal zone in which you can perform at your best. Secondly, nerves often cause us to think negatively, or talk ourselves out of a certain situation. There are a number of strategies we can implement to redirect these negative thoughts. Finally, you need to learn to embrace the nerves.

If you suffer badly from nerves and anxiety, don't be afraid to enlist the help of a professional. Sports psychologists will be able to provide with strategies and techniques to relax, refocus and respond to nerves.

1) Relaxation Techniques
Examples of relaxation techniques that can reduce nerves, physiological arousal, anxiety and muscular tension include hypnosis, meditation, progressive relaxation and autogenic training. These techniques can be learned and practised in the training environment well in advance of important competitions. The more they are practised, the more effective they will be in competition situations. Techniques like progressive relaxation can be combined with mental imagery techniques to enhance confidence as well as relaxation. Even simple relaxation techniques such as deep breathing will reduce the somatic symptoms of pre-competition nerves.

2) Redirect Thoughts
Having things to distract your mind in the lead up to a competition can be beneficial. Constantly thinking about competition day, wondering how we're going to preform and worrying about every tiny niggle or sneeze, can lead us to over thinking things and imagining barriers to great performances that don't even exist. We also risk becoming over-aroused, or aroused too soon. If you find that you over-think things in the lead up to a competition, find ways to take your mind off it. Plan to go to the cinema with friends the night before, avoid being around other nervous people on the morning of a competition, don't get to the competition venue too early (without risking being late), find things that relax you and which you can do in the build up to a competition.

The negative thoughts that go along with pre-competition anxiety will also need to be redirected out of your mind. Process cues - words that describe the feeling or image of the perfect performance of technique and which you can say to yourself when you recognise the negative thoughts raising their heads - can be helpful. Again these should be prepared and practised in the training.

3) Embracing the Nerves
The third step to overcoming nerves is to simply face them head on. Acknowledging that you're nervous is a good first step. Recognise that nerves is a sign of physical readiness, and embrace them. Verbalise your fears or your symptoms. Over time you can identify the symptoms that you experience, and you can prepare those around you for them, particularly if you get irritable. Tell others (particularly parents, coaches, team mates) what you do and don't like them to say when you're nervous or give them cues which they can repeat when you're nervous.

A few years ago, I arrived at a team hotel the night before a World Championship event and one of the girls, who I knew reasonably well at the time, kept telling me that she had a headache. I asked her if it was nerves, and she said that she thought so. Just raising the issue seemed to lift a huge weight from her shoulders. Her mood seemed to change almost instantly. The next day she went out and had one of the best races of her life. This is just one example of how recognising or acknowledging the symptoms of nerves can help.

Dealing with pre-competition nerves - upcoming workshop
If you would like to learn more about some of these techniques and how to control pre-competition nerves, please come along to our workshop in Adamstown (Co Wexford) on Monday 4th January 2016 (1pm-3pm). Further details to follow. Email if you would like to attend.

Some useful reading:

Monday, 31 August 2015

Performance Workshops

Next month we'll be running a couple of workshops at the Ferrycarrig Hotel in Co Wexford, one aimed at athletes of all levels who are looking to improve performance, and the other targeted at coaches of high performance athletes, particularly those who coach performance athletes within a mixed ability group.

Thinking like a high performance athlete: a seminar for aspiring sports people 7:30-9:30pm, Oct 15; €10/€5 (includes free entry into draw for useful resources)

This seminar will explore some of the lifestyle and sports science practices used by high performance athletes, and explore ways in which you can integrate them into your training and competition. Topics to be covered will include, but are not limited to:
  • Planning for performance – Goal setting, time management and decision making to improve performance
  • Looking after your health – An introduction to the Female Athlete Triad, eating disorders, mental health issues, burnout, anaemia, immune function and dental health
  • High performance sleep and recovery
  • Building your support network
  • Anti-doping issues – Anti-doping issues which athletes of all levels should be aware of will be outlined.
Competitive athletes aged 15 or older, of all abilities who would like to improve their performance are welcome to attend. The workshop is open to athletes from team and individual sports. Coaches and parents are also welcome to attend.

Supporting the high performance athlete: a special forum for coaches 6:30-9:30pm, Oct 19; €25

Do you coach high performance athletes as part of a mixed ability group? Are you unsure of how to support their special needs? Would you like the opportunity to meet and learn from other coaches in similar situations?

This session will provide coaches of high performance athletes with the opportunity to discuss challenges they face, to share experience and knowledge and to discuss best practice. Topics covered include:
  • An introduction to the special health concerns of the high performance athlete: mental health issues, eating disorders, the female athlete triad, anti-doping issues, burnout, injury, etc.
  • Building a support network and working within an interdisciplinary team.
  • Real life concerns: long term athlete development; athletes moving on; burnout and dropout; integrating high performance athletes into a mixed-ability group; managing packed competition schedules.
  • Lifestyle support: how the coach can help.  Will look at lifestyle balance, goal setting, time management, planning, managing transitions, decision making, dual careers, retirement and exam stress.
This session is aimed at the coaches of high performance athletes, particularly those who support high performance athletes as part of a mixed ability group. Experienced and inexperienced coaches are welcome.

We would appreciate if you reserve your place in advance via email. Payment on the night.

About the facilitators
Elizabeth Egan has more than 10 years’ experience working with high performance athletes from a range of individual and team sports. She specializes in lifestyle and personal development support for development and student-athletes, and has worked on two successful sport scholarship programmes in the UK. She has published an altitude training travel guide (Notes from Higher Grounds) and her PhD looked at the causes and consequences of menstrual dysfunction in female athletes.

Jenny Higgins is a 2014 Sport and Exercise Science graduate from University of Limerick. She has completed several research internships in the area of physical activity and diet including research in hydration, post-exercise recovery, body composition and the influence of exercise on metabolism & health. She is now pursuing a PhD looking at the interaction of diet and training on bone health in athletes.

Ciara Wilson holds a degree in PE & Biology from DCU, where she was a sports scholarship recipient, and has spent the last 2 years teaching. She is the Schools Participation Officer for the charity Cycle Against Suicide, and has an interest in a wide variety of sports. Ciara has just started a PhD at DCU.

All three have competed at a national level, have coaching experience and are passionate about supporting talented athletes in their pursuit of excellence.

Further information and news relating to these workshops will be posted here and on Facebook.

Tuesday, 4 August 2015

Transferable skills

Athletes who have been training full time their whole adult life often find it difficult to find a job once they retire. Without relevant experience in the working world, they may rely on transferable skills to give them a boost. Too often, however, we see CVs with skills listed as: ‘passion, teamwork, hardworking, works off own initiative’, or something along those lines. Show me somebody that couldn’t list those as skills!

When applying for graduate entry jobs, or roles that you don’t have specific work-based experience for, you need to think about your ‘super strengths’ or unique selling points. Think about qualities and skills that you have which will separate you from applicants and think about clear examples of where you’ve demonstrated these skills or qualities.

Useful frameworks to build examples around are ‘Challenge, Strength, Result’ or ‘Problem, Action, Result’. What problem or challenge were you faced with? What action did you take, and what was the result of your actions?

Some transferable skills that you might possess as an athlete include the following:

Self improvement
Many athletes, particularly those who have been striving for perfection for a number of years, are committed to personal development and self-improvement. Those looking for marginal gains are often self-critical (in a positive way), willing to accept feedback, aware of blind spots and dedicated to making improvements in all aspects of their performance. These skills and qualities can be useful in a variety of roles.

Problem solving and working with others to overcome a challenge
We don’t always think of the sporting field as a problem-solving environment, but think about the decisions that you and your team have to make on a regular basis in a high pressured environment. Overcoming an injury and putting together a rehabilitation plan may demonstrate problem solving skills, as may addressing defensive issues as a team, or adapting tactics following a last minute injury to a key player.  Putting forward suggestions, listening to others suggestions, devising a plan, reflecting on common goals, and following direction are just some of the important aspects of the problem solving process.

Communication skills
Being able to communicate with a variety of individuals in a variety of positions, is often something that employers look for. Think about all the people that you communicate with on a regular basis and how you communicate with them. Athletes often develop mature relationships with adults and people in authority from an early age. The coach-athlete relationship is one often reflects employer-employee relationships. The way in which athletes communicate with funders or sponsors, national governing bodies, appeals committees, and the media tends to be similar to the communication styles required in worked-based situations. Managing relationships with teammates is similar to managing relationships with colleagues. Any experience you have mentoring young athletes or less experienced teammates, coaching or officiating, or making guest speaker appearances will further demonstrate an ability to communicate with a diverse range of people. Make a map of who you communicate with on a regular basis, the roles that those people fill, and the ways in which you communicate with them.

Few athletes reach the top of their sport without demonstrating resilience and an ability to repeatedly overcome setback. Think about how appealing your ability to refocus, reassess goals and adapt your methods following setbacks, and your ability to continue to work towards your ultimate aim, no matter what life throws at you, would be to a potential employer.

Commitment to excellence
The ability to demonstrating a commitment to excellence is likely to be appreciated by many employers. Those who demonstrate a commitment to excellence in their sport are likely to commit to excellence in other aspects of their lives. Wanting to be the best you can be, taking ownership of you life in order to achieve excellence, and being able to build a support team around yourself who also want to excel are abilities which are desirable in most work settings.

These are just some examples of skills that you may have developed as an athlete which may appeal to potential employers. Think about the things that you do in your sporting life, and how the skills and qualities required to be a top athlete can be applied to the workplace. Remember to think outside of the box and to avoid vague terms such as passion, teamwork and hardworking, unless you have very specific examples which separate you from the 99% of other applicants who will also list these skills on their application form.

Thursday, 23 April 2015

Milk.... The Perfect Recovery Drink?

Athletes of all abilities are looking for marginal gains, for the added extras that will improve their performance. When exploring marginal gains, diet is one of the first areas to look at. And athletes who are spending lots of time training, travelling and competing need to ensure they have a diet that is meeting their nutritional demands. They often turn to supplements as a quick fix to filling any nutritional gaps. Trying to fill these gaps with a natural source will not only be a cheaper approach, but may also be a healthier one, and some natural foods may also provide nutritional benefits beyond those intended.

Milk is one of these foods and may well be a suitable alternative to many sports drinks on the market. In terms of recovery products, there is none better than milk!

What is milk made up of?

Milk is a nutrient dense food containing lactose, proteins, fats, minerals, vitamins and water. Lactose, the major carbohydrate present, is essentially only found in milk. Milk contains a number of specific proteins, but the most common is casein, which compared to other proteins is very digestible in the intestine. Like eggs, milk also provides all nine essential amino acids. Calcium and phosphorous are the major minerals found in milk, and there are relatively small amounts of most other minerals required by the body, including zinc, magnesium, iron and copper. In addition, compared to other beverages, milk contains relatively large quantities of the electrolytes sodium, chloride and potassium. Milk contains varying quantities of many vitamins, including the fat soluble vitamins A, D, E, and K, found primarily in the milk fat.

Milk and performance

Due to issues relating to ease of consumption, the speed of release and the palatability of milk, it is less popular as a sports drink immediately before and during exercise and commercial sports drinks often become the preferred choice. But it's as a recovery drink that milk really comes into its own, and elite athletes often consume bottles of flavoured milk or milkshakes immediately after training or competition.

Post Recovery Nutrition

Many athletes will be familiar with the ‘golden window’, the period 30-60 mins immediately following exercise, during which nutrition can aid recovery. Refuelling correctly during this period is vital to those who may be training or competing more than once a day.

Recovery includes a number of processes, and milk can play a role in all of these:

1. Refuelling the muscle and liver glycogen stores (carbohydrate):
Athletes should aim for around 1g carbohydrate per kg of body weight to help refuel after exercise. Around 600ml of milk will provide 50g of carbohydrate, approximately the same amount as around 500-700ml of a sports drink (depending on the brand).

2. Replacing the fluids and electrolytes lost in sweat:
Athletes should aim to replace around 150% of their sweat lost during the 4-6 hours after training or competition. They should also replace the electrolytes lost in sweat, to ensure that fluids taken on board aren't just excreted in the urine. As well as being 87% water, milk is also a source of sodium, potassium and magnesium, all important electrolytes. Some but not all sports drinks contain electrolytes.

3. Manufacturing new muscle protein, red blood cells and other cellular components as part of the repair and adaptation process:
Early intake after exercise (within the first hour) of essential amino acids from good quality protein foods helps to promote protein rebuilding. Though research into the optimal type (e.g. casein versus whey), timing and amount of protein needed to maximise the desired adaptation from the training stimulus continues, most agree that both resistance and endurance athletes will benefit from consuming 15-25g of high quality protein in the first hour after exercise. Adding a source of carbohydrate to this post exercise snack will further enhance the training adaptation by reducing the degree of muscle protein breakdown. Around 300ml of milk contains 10g of naturally occurring protein and amino acids.

4. Allowing the immune system to handle the damage:
Ensuring adequate carbohydrate stores before exercise and consuming carbohydrate during and/or after a prolonged or high intensity workout has been shown to reduce the disturbance to immune system markers. The carbohydrate reduces the stress hormone to exercise, thus minimising its effect on the immune system, as well as also supplying glucose to fuel the activity of many of the immune system white cells. Milk provides a good source of protein and carbohydrates as well as a number of key vitamins and minerals to enhance the immune system and support overall health.

Milk can play a role in all the key recovery processes, is a naturally occurring product, supplies a number of key nutrients, and is cheaper than many sports drinks and recovery supplements. It could well be the best sports drink available!

Tuesday, 24 March 2015

Why is depression so common in sport?

PDF version of this piece to download

Think of your sporting hero. Chances are you're thinking of somebody that you see as a real winner. Somebody with seemingly superhuman qualities. Somebody who can overcome the most challenging of obstacles. Somebody who personifies physical and mental strength. Somebody who is invincible.

Mental illness is probably not something that you associate with your sporting heroes.  Yet, a surprising number of world class athletes suffer from depression, anxiety, addiction, eating disorders and other mental illnesses. On an almost weekly basis we hear of another high level athlete suffering from depression, and many more continue to suffer in silence.  Kelly Holmes has admitted to self-harm during an illustrious career which saw her become a double Olympic Champion. Ian Thorpe, a five-time Olympic swimming champion, was admitted to rehab for depression in 2014. Boxers Ricky Hatton, Frank Bruno and Mike Tyson, jockeys Frankie Dettori and Mark Enright, and footballers Paul Gascoigne, Neil Lennon, Stan Collymore and Clarke Carlisle are among the many well-known sports stars to have admitted to periods of depression. In a previous blog post we have looked at the life, and death, of Robert Enke, the former German goalkeeper who took his own life in 2009. Just last week, Olympic medallist and former badminton player Gail Emms became the latest sportsperson to speak about suffering depression after retirement.

So why are athletes, people that we see as invincible superhumans, so susceptible to mental illness? Do the perceived superhuman qualities in themselves play a part?

Kelly Holmes, one of the many high profile sports start to have suffered from depression during her career
By Russell Garner derivative work: MachoCarioca (Kelly_Holmes_at_Athens_2004.jpg) [CC BY-SA 2.0], via Wikimedia Commons

Mental illness in cricket

England cricketer Marcus Trescothick returned home from the 2006-07 Ashes in Australia due to a 'recurrence of a stress-related illness'.  Despite several attempts, Trescothick never returned to play for England, and announced his retirement from the international game in 2008, seemingly unable to cope with the stress of touring.  In his autobiography, Coming Back to Me, released later that year, Trescothick revealed that he had suffered from anxiety attacks since he was 10.

Cricketers appear to be at particularly at risk.  As is well known, mental health issues are higher in men than in women, and so, in a male dominated sport, it's no coincidence that depression is common. But it would appear that there's more to it than that.  Writing in the wake of the Trescothick case, Geoffrey Boycott blames the congested international test calendar, and states that 'the burden of playing non-stop cricket is taking its toll'.  This may be a slightly simplistic view.  An online article by Antionette Muller (2013), looked at why cricketers, more than other sports people, are at risk.  She concluded that the long periods of time spent away from home, the pressure of top-level, high-profile sport, and the game itself were contributing factors.

Cricketers can spend as much as half the year on tour, and a disproportionate amount of that time, particularly during test matches, is spent waiting to bat, or to bowl.  Skill is important, but luck also plays a major factor, and after waiting for hours to have their chance in the spotlight, a highly-skilled batter can often be left reflecting on why they are walking off the field without even hitting a ball. Knowing that their public perception and perhaps their place on the team are dependent on their latest performance, it's little wonder that cricketers are at risk of developing a distorted perception of their own self worth.  And the long periods of inactivity in hotel rooms and media analysis which follows provides the perfect conditions for such distorted perceptions to fester, distort further and ingrain themselves in the individual's psyche.

A batter's performance can last anything from a single ball, to a prolonged innings stretching over the course of two days, with a completely unpredictable outcome to each ball bowled in their direction. In few other sports is the duration of the performance so unpredictable. In many sports, the better you perform, the shorter the race or match.  In cricket, the complete opposite is true.

In cricket, more so than in other sports, there is a lot of time to contemplate failure, but not an awful lot of time to celebrate success.

In his book Silence of the heart: cricket suicides (2001), David Frith poses a further, important question:
'... does cricket more than any other game, actually attract the susceptible by virtue of its wicked, teasing uncertainties, its long-drawn-out routine, its compulsive, all-consuming commitment? Or conversely, by its sometimes cruel and frustrating pattern, does it gradually transform unwary cricket-loving boys into brooding, insecure and ultimately self-destructive men when the best days are past?'
This is one of the points that former New Zealand cricketer Iain O'Brien touches on in the excellent video which follows. O'Brien also speaks about his own depression and the social anxiety that he experienced as a player. He felt at home on the park, but it was in the dressing room that O'Brien was least comfortable, and he spend much of his career trying to fit in with the other personalities on the team.

Cricket governing bodies are starting to recognise the mental health issues within their sport, and steps are being taken to help prevent depression.  More needs to be done, but recognising the problem and being willing to implement change are important first steps.

The stresses and strains of cricket appear to contribute to the high rates of depression and anxiety among it's players
Photo credit: Matthew Bowden, via Wikimedia Commons

Mental illness in football

Football, too, appears to have an above average incidence of mental illness. Research carried out by the international footballers association, FIFAPro, reported that just over a quarter of 149 current players and 39% of 104 former footballers experienced anxiety and/or depression (Gouttebarge, 2015).  While there may have been a response bias (the response rate was 29%), these are pretty stark results. Recent life events and low social support were among the factors significantly associated with mental health problems in this study.

In reports associated with this study (Telegraph Sport and agencies, 2014), former New Zealand captain Chris Jackson, linked his disappointment at not making it into European football with his depression and substance abuse. Jackson says:
'I had and still have a lot of anxiety regarding performance. The pressure bottled up for years particularly when I captained different teams and had to be the face of the team when going through tough times.'
The wellbeing section of the Professional Footballer's Association website deals predominantly with depression and mental wellbeing.  It has four important subsections, each looking at a section of the footballer's life and the predominant associated feeling or emotion: Change & Anxiety, Contracts & Stress, Performance & Panic and Retirement & Anger.  This grouping highlights the main risk areas for players.  It also recognises the role of emotions in mental illness.

In a male dominated environment, machoism and a pressure to confirm no doubt play a part, and there would be, at least until recently, a stigma associated with mental health, which, no doubt would prevent players from seeking help. Players are typically involved in football-focused surroundings from a very early age and few top players earn qualifications outside of their sport. This increases the likelihood of identity and retirement related issues discussed later.  Players at the top level, more so than in other sports, live out their lives is the media spotlight.  Constantly moving clubs can also have an effect.

Football is a sport where your worth as a players is dependent on how much you earn, or how much you are sold for. Consequently, time lost through injury, a lack of form, or a run of bad luck can adversely affect your perceived value as a player, and if internalised, your self worth.
'I'd just suffered a severe knee injury and had convinced myself that without football people would see me for what I really was, which was nothing. I sat on a bench in that park, washed the pills down with a can of beer, and waited for it to happen.' (Carlisle, 2013)
These are the words of Clarke Carlisle, speaking about his suicide attempt aged just 21, in a BBC website piece promoting his 2013 BBC Three documentary Football's Suicide Secret.  Carlisle was found in time and had his stomach pumped, though depression and alcoholism dogged his career and he made further attempts to take his life.  While Carlisle will always suffer from the illness, he is now actively involved in increasing awareness of the disease and ensuring that others in his position are supported.

In an interview following the launch of the Mental Health Charter for Sport and Recreation last week (Liew, 2015), Carlisle pointed to another important factor within football that may explain high mental illness rates - the unnatural social environment in which footballers often find themselves:
'I was in the sport for 17 years, and I could count on two hands the number of genuine life friends I've made. That's just a by-product of the industry. You're there for a month, a year, if you're lucky three years. In training there are five centre-halves, and I'm fighting against at least three of them to get in the side. Then you're sold the next day, and all of that team are now opponents. It's a very complex dynamic, and it's incredibly hard to make genuine life friends in that situation.' (Liew, 2015)
High disposable incomes can lead to gambling and substance abuse, and may in turn may lead to depression.  Not having interests or work outside of football may increase the likelihood of psychosocial problems such as these, particularly when a player is injured or not getting game time.

Mental illness in other sports

Rugby league is among the other sports which recently recognised that it has a mental health problem.  Many of the factors associated with depression in football may also play a part here. Constant pressure to perform and media spotlight, along with issues surrounding injury and lack of form, are likely to play a large part.

Boxing, particularly at a professional level, also seems to have a major problem.  In addition to Hatton, Bruno and Tyson - who all have had mental health issues - there have been a number of suicides in the sport.  Jonny Tapia, a five times world champion, and Lewis Pinto, a promising young super middleweight fighter, both ended their own lives in May 2012.  Irish 2008 Olympic bronze medallist Darren Sutherland's death in 2009, not long after turning professional, is presumed to have been by suicide.  He too had suffered from depression.

Along with all the aforementioned issues, repeated brain injury, making weight, inconsistent income, a long time between fights and the bravado and intense rivalries surrounding fights, could all contribute to the high rate of suicide and depression in boxing. Another important factor is the extreme self believe that goes alongside fighting. This focus on the positives, and complete dismissal of vulnerabilities, weaknesses and fears, and its effect on mental health will be discussed in more detail later, but is probably most evident in a sport where the aim of your opponent is to literally knock you out.

Highlighting these sports and some of the factors within them may help us gain a better understanding of mental illnesses, the unique pressures that sportspeople face, and what can be done to prevent depression.  But it should not detract from the fact that no sport is immune to depression and mental illness.  Gaelic footballers and hurlers, who do not have the money, lack of distraction and changing team issues evident in football, are also at risk.

Identity and purpose

Depression is highly associated with identity issues, low self-esteem, and a low sense of self-worth. While it is unknown whether low self-esteem and low self-worth cause depression, or are as a result of it, there is considerable evidence to suggest that identity issues in athletes can lead to depression.

Athletic identity, the degree to which an individual feels that his or her identity is built around his or her role as an athlete, is a major factor in determining the degree of depression felt by an injured athlete.  Athletic identity is also a major cause of post retirement depression in sportspeople. When the thing that a person feels defines them and gives them purpose is taken away, their self-esteem and purpose diminishes.

Temperament and personality traits

Various personality traits common in successful athletes have been associated with mental illness, though much more research is required to ascertain whether susceptible personalities are attracted to sport, or sport 'creates' susceptible personality characteristics. As was suggested in relation to cricket, individuals with certain traits may be attracted to certain activities, and these traits may predispose them to depression and anxiety. A form of natural selection may exist, meaning that the most successful athletes are those who are most susceptible to depression.

Perfectionism has been associated with various forms of maladjustment, particularly in sports (Hewitt, 1990). Flett and Hewitt (2005) have identified and described what they call the perfectionism paradox - the way in which certain sports require athletes to achieve perfect performance outcomes, though being 'cognitively preoccupied with the attainment of perfection often undermines performance and fosters a sense of dissatisfaction with performance'. In addition to maladjustment, this obsession with perfectionism can actually hinder sporting performance.

Research by the Black Dog Institute indicates that those with certain temperament and personality styles are at a greater risk of developing depression. Among the susceptible personality and temperament styles are self-focused and perfectionistic personalities, both of which may be high among sports people.

Obsessive compulsive disorder (OCD) is just one of the mental disorders for which former footballer Paul Gascoigne has received treatment. He has also suffered from bipolar disorder, alcoholism and eating disorders. Obsessive-compulsive disorder (OCD) is highly linked with depression, and some aspects of high performance sport may contribute to the development of OCD  (Aldhous, 2009). Those susceptible to OCD may, of course, be attracted to certain skilled sports sports to begin with, and there is little, if any evidence to link OCD in such cases with depression.


Examples of sportspeople who have struggled with the 'loss' that comes with retirement are plentiful. Indeed, research by the Professional Players Federation, published in 2013, found that 16% of 1200 ex-footballers, rugby union and rugby league players, jockeys and cricketers surveyed experienced depression or feelings of despair in the 12 months post retirement.

In 2014, Rubgy League star and former Great Britain player Sean Long admitted to attempting suicide, having struggled to cope since being forced to give up the game, due to injury, in 2011.
'I didn't finish playing on my terms really. It was the injuries...I didn't know at the time but I've had depression and suffered from anxiety over two-and-a-half years.'
Those who are forced to retire because of injury or deselection generally have greater difficulty in adjusting to life after sport than those who retire on their own terms.  Forced retirement is often followed by a period of grieving, as the individual attempts to come to terms with their loss.

But even those who retire on their own terms can struggle, as athletes lose their perceived purpose in life, the structure and routine which they have lived around for so many years and, for some, their livelihood. Others simply miss the endorphin kick that comes with exercise. Endorphins are, of course, a natural antidepressant.

Athletic identity, the degree to which an individual feels that his or her identity is built around his or her role as an athlete, is also a major factor in determining the degree of depression felt by an athlete post retirement. Planning for retirement is an important determinant for successfully transitioning from the life of an athlete to the life of an ex-athlete, and finding meaning and purpose in the world outside of sport is crucial.

Gail Emms recently spoke about suffering from depression after retiring, and stated that it was only when she had her first child that she found a new meaning to her life. Hers is just one of thousands of stories

Retirement and the associated problems will be dealt with in more detail in a forthcoming post.

Post Olympic blues

The aftermath of an Olympic Games, FIFA World Cup, or other major sporting can be a major breathing ground for depression and addiction. Post Olympic Depression Syndrome (or Post Olympic Stress Disorder, as it is sometimes known) is a well-known phenomenon, and not just something that is experienced by the fans! Even (or more accurately, especially) athletes that have been successful suffer from the condition. Only a small proportion of the world's population will ever win an Olympic gold medal, and no medal comes with an instruction manual on how to deal to the emotions that go along with it.

After a major sporting event as big as the Olympics, athletes struggle to adjust to normal life and find their place in the world.  For many athletes, the completion of a Games coincides with retirement or an unplanned for future, with some having put off retirement decisions until after the Olympics. Identity and retirement issues have been dealt with earlier, so only get a passing mention here.

Other causes of Post Olympic Depression Syndrome relate to coming down from a massive high, dealing with becoming famous, a sudden lack of routine, achievement of extrinsic goals or dealing with failure on the world's greatest stage, and simply readjusting to life in the real world.

An overwhealming majority (77%) of surveyed South African participants at the 2000 Olympic Games  reported subjective feelings of post-Olympic depression (Portgieter, 2001). Of these, 27% reported 'extreme' depression after the Games.

The Olympics provide a platform for successful athletes, particularly in minority sports, to gain media attention. Athletes previously unknown to the outside world find themselves in a strange and unfamiliar place; one which some may find particularly stressful. While some gain the recognition that they have craved for so long, many struggle to come to terms with their new found fame and the social and media demands that go along with success.

Bradley Wiggins is just one of the numerous athletes to have suffered depression and addiction after the Olympics. In his 2008 autobiography Wiggins revealed how, having little else to do with his time, he found himself waiting outside his local pub at 11am each day, for a period of 8 or 9 months following the 2004 Olympic Games. 'I wasn't just drinking for England during this period, I wasn't quite at the races mentally either. For a while my life threatened to spiral out of control.' He had won 3 medals, including his first gold in Athens.

For Wiggins, it was not the fame, but the lack of fame, which was most difficult to deal with. He expected things to change after the Olympics. He thought that sponsorship and endorsements would come flooding in and things to be a little easier financially. They didn't. In a 2008 interview (McRae, 2008), Wiggins says:
"You end up trying to give the perception you've got a bit of money. 'Yeah, it's great, lots of offers rolling in ...' The reality was quite different. I woke up every Monday morning and we were still overdrawn and I'd think, 'God, I don't feel like riding my bike again.' There was a bitterness that nothing had changed after all the hard work but it went deeper than that. I'm not saying I was clinically depressed but there were definite bouts of depression - and lots of drinking."
Those who are extrinsically driven and motivated purely by winning are more likely to suffer from post Olympic depression than those who are motivated by the process.

Those who were successful and achieved their goals may suffer from something known as post achievement depression, similar to the feeling many get following the completion of a PhD thesis or other project in which they have been engrossed for a prolonged period of time.  Post-Olympic blues and post achievement depression are similar in some ways to post-natal depression, post wedding blues, and other emotional come-downs following a 'high'.


The link between injury and depression can operate on at least three different levels, namely the emotional stress and boredom as a direct result of the injury and subsequent loss of training, the link between any prolonged or chronic pain and depression, and depression as a result of opioid painkillers.

Injury, a constant worry and major interruption to the attainment of their goals, and indeed their livelihood, plays a major role in lives of many athletes.  In most athletes, depression is a short-term response to an injury, and is seen as a normal emotional response to severe injury. In extreme cases, recurrent injury can constitute stress, one of the factors which can lead to major depressive episodes. Boredom, if training is not possible, can also exacerbate the depressed mood.

Athletic identity, the degree to which an individual feels that his or her identity is built around his or her role as an athlete, is a major factor in determining the degree of depression felt by an injured athlete. Like retirement, athletes who see injury as a threat to their core identity are more likely to experience depressed mood during an injury. While this response is depression the emotion, rather than depression the illness, it's likely that prolonged, repeated and severe injury could result in long-term depression.

Though not all injuries involve pain, it is important to note that chronic pain can often go hand in hand with depression.  Both physical and emotional pain are registered in the same part of the brain, which essentially treats depression in the same way as physical pain. Physical pain therefore often causes depression, and depression can worsen the physical pain.  Some antidepressants can actually help relieve the physical as well as the mental pain

Opioid painkillers, often prescribed for chronic pain, have been linked with depression (Scherrer et al., 2014), anxiety, hallucinations and suicidal tendencies.  Their abuse to enhance performance is dealt with the doping section below.


While it may be unethical and practically impossible to prove a link between doping in sport and depression, there is at least a theoretical and anecdotal basis for such an association.  Some drugs, including steroids, have been associated with mental disorders, and may result in depression in those who abuse them.

The use and discontinuation of anabolic steroids in particular have been associated with depression (Pope & Katz, 1994) and other mood disturbances and mental disorders such as paranoia, mania, hypomania, steroid dependence and schizophrenia.  Cortiosteroids, a group of steroids often prescribed for injury and other medical conditions and abused by cyclists and other athletes to enhance performance, have also been linked with mood disturbances and depression in a large proportion of users (Patten, 2000).

EPO, the performance enhancing drug of choice for endurance performancers overstepping the doping rules, appears to actually treat depression. However, anecdotal accounts report that cyclists associate depression with the use and discontinuation of EPO.  Amphetamines, beta blockers and cannabinoids, drugs abused to varying degrees in various sports, may also lead to depression.

Opioids, a group of drugs with both pain killing (analgesic) and narcotic properties that includes codeine and Tramadol, among others, appear to be abused in cycling (Benson, 2013), and are taken by riders simply to get them through a race.  This group of substances, though not currently on the WADA banned list, are highly addictive, and can cause a number of nasty side effects, including anxiety, depression, suicidal thoughts and hallucinations. Withdrawal can also cause serious side effects, including insomnia, depression and anxiety.

In her excellent article outlining the high incidence of depression in cycling, Suze Clemitson (2014) proposes that there is a possible link between the prevalence of doping and the seemingly high incidence of mental health issues and suicides in the sport. In the article Clemitson quotes cyclist and whistleblower Jesus Manzona, who says:
'The drugs lead you to other addictions. The anti-depressants almost automatically accompany other doping treatments. I took up to eight pills of prozac a day when I was racing...Prozac cuts the appetite, keeps you in another world, a world where you're not afraid of what you're doing.  You're no longer afraid to inject yourself with all the crap. It takes you to a world where you don't ask any more questions, especially you don't ask your doctor questions either or your sporting director. Then there are periods where you must stop doping you feel like superman. Then one day all of the sudden it stops and you become dramatically depressed.'
When you put it like that...!

A cycle of shame and guilt, a constant fear of being caught, a redirection of one's moral compass as a result of choosing to dope, and dealing with the sense of loss if caught, are just some of the other factors which may result in depression.

While there are many possible causes behind the high rates of depression, suicide and unexplained deaths in cycling, the sport we most associate with doping, there is at least a theoretical link between doping and mental illness.

Concussion and other medical issues

We often think of depression as a purely psychological issue.  But physiological factors may contribute to depression and anxiety. Overtraining, iron-deficiency anaemia and thyroid problems - which can be common in athletes - and a number of other underlying medical conditions may also contribute to a depressed mood or result in similar symptoms.

Among the many symptoms of iron-deficiency anaemia are depression and anxiety, which may result in OCD-type obsessions and compulsions, as well as many of the symptoms of depression itself, including insomnia, irritability and poor appetite. While these depressive symptoms appear to be reversed with treatment, they may lead to full blown depression in those who are already at risk.

Many of the signs and symptoms of overtraining syndrome and depression overlap, making it difficult to establish if overtraining and burnout can cause depression, if depressed mood is simply a reversible symptom of overtraining, or if overtraining syndrome is, in fact, a form of depression experienced by athletes. In addition to sharing many physical and emotional signs and symptoms, biochemical responses, including immune, endocrine, and neourtransmitter patterns, are remarkable similar in the two conditions. The cycle of poor performance and inadequate recovery which result in overtraining could, in theory, independently also lead to depression.

A history of recurrent concussion and head trauma appears to be linked with an increased likelihood of being diagnosed with clinical depression in retired America Football players (Guskiewicz, 2007). Other sportspeople who experience recurrent concussions may also be at risk.

Performance psychology and a focus on winning

Sports psychology is all about winning at all costs, ignoring all weaknesses and negative thoughts, and 'believing' that you can do it.  An unrealistic mental environment in which you believe that you are better than anybody else is often created. There is no room for weakness or vulnerability on the playing field.

While this may be the optimum approach from a performance perspective, it is far removed from everything that psychiatry has thought us. Failing to acknowledge and work through our tiny everyday concerns, worries and weaknesses can lead to major psychological issues in the long term, and in an environment where the focus is always placed on the positive, unbreakable and invincible can remove the opportunity for sportspeople to learn everyday coping skills.

This is not to say that some sports psychologists don't take a holistic approach, or that they fail to deal with everyday concerns and worries, but more that performance psychology in its purest sense can fail to take into account such issues.


Stress, or a series of stressful events, can trigger depression and anxiety. Performance in itself, particularly under constant media scrutiny, can be seen as a form of stress. While good and bad days are an accepted part of the life of a development athlete, there is little room for an off day for those in the media spotlight. This pressure to perform week in, week out for the duration of an ever extending season can place a lot of stress on a sportsperson, and the fear of a bad performance, while not likely to be the sole cause of depression, may contribute to depression in those that are particularly susceptible.

Defeats, disappointments and failures are accepted steps along the path to the top. Individuals often learn more from their mistakes than they do their successes, and shouldn't be afraid to take risks and to make mistakes along the way. Issues may arise when athletes are suddenly shot into the media spotlight and suddenly feel that they can no longer make mistakes, are not used to having their performance analysed in such a public way, or go through a particularly bad dip in performance.

Trying to maintain a place on a team, making up for previous misfortune or underperformance, or simply trying to reward somebody's belief in you can be additional sources of stress.

Other factors associated with professional sport

Professional sport does much to disempower participants. Those who participate in a very structured and protected environment from a young age (e.g. footballers who join a club academy) rarely have to make major decisions for themselves, and don't go through the same life learning as their peers. The life skills that a typical 18 year old is learning is far removed from those of an 18 year old academy player, and while the typical 18 year old can set out on their voyage of discovery in a pretty anonymous fashion, the professional sportsperson is growing up in the media spotlight. Modern sports support structures often try to make life easy for the sportsperson and reduce the 'stress' in their lives. In doing so, they often reduce the opportunities for athletes to grow and learn, and to deal with manageable amounts of stress.

Professional sportspeople often spend large amounts of time away from home.  Cricketers, for example, often spend months at a time on tour, away from family, and lack certainty and routine. While life on the road may be an ideal life for some, it is not for everyone, and can be particularly difficult for those with young children. Despite being around their team mates, many can feel isolated and lonely. Spending large amounts of time in the presence of those who may be fighting for your place on the team can also be difficult.

Being a fulltime athlete has many advantages. But it also has downsides. Large amounts of downtime can result in boredom, overanalysis of performance and results, or a reduction in self worth, all of which may contribute to the development of depression. Boredom or having time on their hands, together with access to large amounts of cash, may, in turn, lead to problem drinking and substance abuse.

The sports supporter

We always talk about the sports participant, but is there a risk for sports supporters? Participants are, at least most of the time, in control of their own destiny. Once they get out on the pitch or track, they are doing what they can to win, but the supporter can do nothing to control their destiny. They have no arena in which to dissipate the pressure. If superstition is an issue for the player, then what potential does it have to upset the onlooker?

And then there's the off season! Where does the sports fan get their kicks from during the off season? Or do they, like the player, benefit from taking time away from the sport, recuperating from the season's exertions, bringing some sense of balance to their lives, and preparing for the inevitable highs and lows of the season ahead?

It appears that experiencing the blues after a sports related defeat is a common experience among sports fans. Sometimes, after watching their team losing an important game fans can go through a form of grieving. Indeed, some radio phone-in shows after weekend football fixtures sound more like counselling sessions than they do sports programmes. Prolonged post-mortems in modern sport can add to the grief felt by fans, and extend the depressed feelings beyond their natural life (Woods, 2014).

On the flip side, some research suggests that those who have a close affiliation with a sports team have fewer bouts of depression and alienation than those uninterested in sport (Branscombe & Wann, 1991).

And of course, spectators as well as participants can experience post-Olympic blues.

The final paradox

Exercise is a known cure for depression and other forms of mental illness. It is often a prescribed treatment for such illnesses. Chemicals known as endorphins, a form of natural anti-depressant, are released during exercise. Regular exercise can help relieve stress, and provide an opportunity to unwind after a difficult or stressful day. Sports participation can also give individuals a sense of routine and a purpose in life. It can increase self-esteem and feelings of self-worth. And most of all, it can empower.

This seems to contradict everything that has gone before. I guess, like everything in life, a sense of balance is needed. Sport has the power to enrich the lives of those who participate in it, but it also has the power to destroy them. Knowing the risks, spotting the warning signs and recognising that individual growth is more important than winning at all costs, are good first steps in the fight against mental illness in sport.


There are lots of unknowns, and much more research is needed in the area. The question, however, is not whether or not sportspeople are more susceptible to mental illness that the general population. Many top level professional sports are dominated by males in their twenties and early thirties – the group in which mental illness and suicide are at their highest – and so, a high level of mental illness should not be unexpected. Depression, in many cases, is preventable, and the real questions that we should ask is why sport - something that should empower, increase self-esteem, promote self-worth, and allow talented individuals achieve their goals - can, in certain circumstances, take all that away? Why, when exercise is often prescribed as a treatment for depression, does it lead to depression in some, and what can be done to ensure that sports can have positive outcomes for participants at all levels? And finally, and most importantly, are there still barriers stopping those suffering mental illness from seeking help?

No one factor leads to depression, and the information discussed here include hypothetical aspects of sport that may lead to mental illness. We hope that this article will help raise awareness of some of the issues faced by high performance sportspeople, and lead to more open discussion on the topic. Please share your thoughts by commenting below.

Useful reading



Saturday, 14 February 2015

The Menstrual Cycle and Performance

As a result of comments by tennis player Heather Watson, there has been some debate in the sports media recently as to whether or not periods affect performance.  As someone who suffered from period pain, and seemingly unexplained awful performances at 'the time of the month' in my younger days, I have no doubt but that they do. The research, however, may suggest otherwise, as I found when researching for my undergraduate project some 14 years ago.

Recent mainstream articles have indicated that there has been very little research in the area. Technically, that is not true.  The research, however, like much other research, may not be relevant in the high performance environment, and does not take into consideration the huge variation in menstrual symptoms between individuals.

The Menstrual Cycle and Hormone Fluctuations

The monthly cycles of ovum maturation, ovulation, endometrium thickening and menstrual flow are controlled by the interactions and fluctuations of a number of hormones. The ovarian hormones (oestrogen and progesterone); gonadrotropin-releasing hormone, secreted from the hypothalamus; the pituitary gonadrophic hormones (follicle stimulating hormone and luteinising hormone); and peptides (inhibin) all play an important role in the human menstrual cycle. The complicated interaction between these hormones involves both negative and positive feedback loops, and results in two main phases, each approximately two weeks in duration: the follicular phase (the time between the beginning of menses and ovulation), and the luteal phase (between ovulation and menses).

Menstrual hormones and physiological parameters

It is well know that the two main reproductive hormones - oestrogen and progesterone - affect muscle strength and bone health.  The steep decline in muscle strength (Greeves et al, 1999, Phillips et al, 1993a, Skelton et al, 1999) and bone mineral density that occurs during and after menopause reflects the sharp reduction in oestrogen and progesterone that occurs at this time. This has led investigators to question whether the much smaller fluctuations in oestrogen and progesterone that occur during the menstrual cycle have any effect on muscle strength performance or any other physiological parameter.

The results from subsequent studies - and there have been quite a few - are far from conclusive. Previous research has found increased muscle strength (Jacobson et al, 1998, Phillips et al, 1993b, Phillips et al, 1996) and increased heat tolerance (Tenaglia et al, 1999) during the follicular phase of the menstrual cycle. High progesterone levels characteristic of the luteal phase of the menstrual cycle are associated with decreased muscle coordination and increased susceptibility to injury (Moller-Nielse & Hammer, 1989), increased body temperature (Tenaglia et al, 1999), and reduced lactate production (Hall Jurkowski, 1981).  But not all research has found such variations.  Indeed a study of 80 females at the 1964 Tokyo Olympic Games indicated that gold medals were won during all phases of the menstrual cycle (Zaharieva, 1965).

Problems with the research

The current research may not be given the whole picture.  The factors which determine performance at the highest level are numerous and complex, and isolated studies on small groups of untrained females are unlikely to tell us much about what happens in an individual, highly trained athlete competing in an Olympic final.  The issues include the following:
  1. Few studies used trained individuals
  2. There are large individual variations in menstrual and premenstural symptoms between individuals.  Not only do some females suffer a lot more than others, but the timing of adverse symptoms may vary between individuals.  Scientific studies, by their very nature look at group average responses, but each athlete is an individual, and research based on average response is of little use in the performance environment.
  3. Determining the exact phase of the menstural cycle is difficult without measuring hormone levels.  There may be large variations in progesterone levels from one day to the next during the luteal phase of the cycle, so standardising testing points is notoriously difficult.
  4. In order to be scientifically sound, most studies take objective measures of muscle strength (or other variable), taking away the psychological element of performance.  In the real sporting world, psychological factors such as motivation will play a role.
  5. Because there is little scientific evidence to support menstrual cycle detriments to performance, there has been little research into what athletes who do suffer can do.

Menstrual pain and performance

The indirect effect of menstrual pain, and premenstrual symptoms such as fatigue, upste stomach, bloating, constipation, diarrhoea and headaches, are far more likely to be detrimental to performance that the direct effects of oestrogen or progesterone on muscle strength, carbohydrate metabolism or ventilation.

Dysmenorrhoea - very severe pain which precedes and/or accompanies menstruation and which interferes with daily activity - is experienced by some women.  While there is nothing to suggest that dysmenorrhoea is greater among athletes, it is obvious that this level of pain would affect performance.

The risk of anaemia

Anaemia is one of the greatest contributors to unexplained poor performance in female athletes. Those with regular heavy periods may be at particular risk or anaemia.  While all female athletes should have their haemoglobin and ferritin levels monitored, those with high monthly blood loss should be particularly cautious.

Menstrual Dysfunction

For all too many athletes, the problem is not menstrual pain, premenstrual symptoms, or cyclical variations in performance, but rather the complete absence of menstruation at all. Some studies have suggested that menstrual dysfunction may be as high as 50% in some endurance athletes (Wakat et al., 1982). While the absence of monthly pain and discomfort may not be top of an athlete's list of worries, inadequate levels of reproductive hormones can have much more far reaching consequences than any potential variation in performance over the cycle. Prolonged absence of menstruation (known as amenorrhoea) can have detrimental, irreversible and life-long effects on bone health, cardiovascular health, and even diabetes risk.  Infertility is also a potential problem, though in many cases this is reversible. While osteoporosis in later life may not be of immediate concern to a high performance athlete looking for Olympic glory, the associated increased stress fracture risk is, and time lost through injury will have a much greater effect on performance than any cyclical change in oestrogen or progesterone.  The consequences of amenorrhoea are compounded by its causes, with inadequate energy intake and low body fat percentages major contributors to the premature ageing of bone often seen in athletes.  The phenomenon, known as The Female Athlete Triad, has been covered in a separate post.

Regulating the cycle

In addition to using it as a form of birth control, athletes may use the contraceptive pill, which contains of low doses of oestrogen and progestins (substances which mimic the actions of progesterone), to control menstrual dysfunction, reduce menstrual discomfort and PMS symptoms, and to ensure that important competitions do not coincide with menses.  The pill can also be used to replace absent hormones in those with amenorrhoea.

Some studies have compared muscle strength, bone health, injury risk and various other physiological parameters between individuals using the pill and those with natural periods.  While the results are largely inconclusive, there doesn't appear to be any major differences in physiological parameters between the two groups.

It should be noted that oral contraceptives have changed considerably over the years, and not all research is relevant in the modern context.  Some research showing differences between oral contraceptive users and those not taking the pill may no longer be valid.

Regular natural cycles are preferable from a bone health perspective, but some level of hormones is better than none, and the pill, or other form of hormone replacement, may be prescribed for those with amenorrhoea.  The underlying causes of amenorrhoea should, however, also be addressed. Progesterone only pills or contraceptive injections may have sever detrimental effects on bone health. Depot medrozyprogesterone acetate (DMPA), an injectable, progesterone-only contraceptive, which may offer relief to those with sever menstrual symptoms, are associated with significantly reduced bone mineral density.

There are some things to be aware of if using the oral contraceptive pill.  Oral contraceptive use has been associated with significantly reduced serum levels of B Vitamins.

The aforementioned recent media coverage of the topic (Lewis, 2015) indicated that short-term interventions to delay menses is not the solution.  British 800m athlete Jessica Judd was given norethisterone, a hormonal tablet, to prevent her period - which was due on the day of the 800m heats at the 2013 World Championship - interfering with her performance, despite other female athletes knowing that this wasn't a solution.  Judd underperformed,

The final question

Should top athletes, often portrayed as invincible heroines, capable of overcoming even the most painful of hurdles and setbacks, be blaming something as common as a period for a sub-par performance?  Dam right they should.  And what's more, with the seemingly high rates of menstrual dysfunction in athletes, and the severe consequences of prolonged amenorrhoea, we should be celebrating the very fact that elite athletes are menstruating at all.


  • Athletes who experience very heavy periods should be particularly aware of the risk of anaemia. They should be aware of the signs and symptoms of low iron levels, have their ferritin and haemoglobin levels checked regularly, and act accordingly.
  • Though there is little scientific evidence to suggest that performance is affected by the menstrual cycle, considerable anecdotal evidence suggests that some athletes experience dips in performance in and around menses. Athletes with severe dysmenorrhoea may look to regulate their cycle so that menses doesn't coincide with an important event. This should be planned well in advance, and short-term measures should be avoided.
  • Progesterone-only contraceptives may increase bone turnover and/or reduce bone mineral density, placing an athlete at increased risk of stress fractures. Where possible, such contraceptives should be avoided.
  • The menstrual cycle, and other female issues, can be a major factor in an athlete's life. Coaches should be open to discussion of menstruation with their athletes, and aware of potential female health issues.

References and useful reading

  • Lewis, A. Curse or myth - do periods affect performance? BBC Sport Website, 22/1/15, retrieved 13/2/15
  • Paula Radcliffe: Sport has not learned about periods BBC Sport Website, 22/1/15, retrieved 14/2/15
  • Wakat, D, Sweeney, K, Rogol, A (1982) Reproductive system function in women cross-country runners. Medicine and Science in Sports and Exercise, 14, 263-269. Abstract
  • Zaharieva, E (1965) Survey of sports-women at the Tokyo Olympics. Journal of Sports Medicine and Physical Fitness, 5, 215.
  • Greeves, J, Cable, N, Rielly, T, Kingston, C (1999) Changes in muscle strength in women following the menopause: a longitudinal assessment of the efficacy of hormone replacement therapy. Clinical Science, 97, 79-84. Full text
  • Phillips, S, Gopinathan, J, Meehan, K, Bruce, S, Woledge, R  (1993a) Muscle strength changes during the menstual cycle in human adductor pollicis. Journal of physiology, 473: 125. 
  • Skelton, D, Phillips, S, Bruce C, Naylor, C, Woledge, R (1999) Hormone replacement therapy increases isometric muscle strength of adductor pollicis in postmenopausal women. Clinical Science, 96: 357-364. Full text.
  • Jacobson, B, Lentz, W, Kulling, F (1998) Strength and performance perceptions differences between four phases of the menstrual cycle. Medicine and Science in Sports and Exercise, 30: S208. 
  • Phillips, S, Rook, K, Siddle, N, Bruce, S, Woledge, R (1993b) Muscle weakness in women occurs at an earlier age than in men, but strength is preserved by hormone replacement therapy. Clinical Science, 84: 95-98. 
  • Phillips, S, Sanderson, A, Birch, K, Bruce S, Woledge, R (1996) Changes in maximal voluntary force of human adductor pollicis muscle during the menstural cycle.  Journal of Physiology, 496: 551-557.
  • Tenaglia, S, McLellan, T, Klentrou, P (1999) Influences of menstrual cycle and oral contraceptive on tolerance to uncompensable heat stress.  European Journal of Applied Physiology, 80: 76-83.
  • Moller-Nielse, I, Hammer, M (1989) Women's soccer injuries in relation to the menstrual cycle phase and oral contraceptive use. Medicine and Science in Sports and exercise, 21: 126-129.
  • Hall Jurkowski, J, Jones, N, Toews, C, Sutton, J (1981) Effects of menstrual cycle on blood lactate, O2 delivery, and performance during exercise.  Journal of Applied Phyiology. 51: 1493-1499.
  • Frankovich, R, Lebrun, C (2000) Menstrual cycle, contraception, and performance. The Athletic Woman, 19, 251-271. Full text
  • Bennell, K, White, S, Crossley, K (1999) The oral contraceptive pill: a revolution for sportswomen? British Journal of Sports Medicine, 33, 231-238. Full text