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Speaker 1: Welcome to Good Game with Sarah Spain, where we just

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Speaker 1: found out menopause can cause itchy ears.

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Speaker 2: Itchy ears.

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Speaker 1: Man, add that to frozen shoulder, night sweats, weight gain,

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Speaker 1: joint pain, hot flashes. Damn, let's hurry up on these

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Speaker 1: women's hormone studies and find some solutions.

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Speaker 2: I don't want to deal with any of that shit.

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Speaker 1: It's Wednesday, August thirteenth, and on today's show, we'll be

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Speaker 1: skipping the need to know and jumping straight into my

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Speaker 1: conversation with doctor Kirsty Elliott Sayle, a professor of female

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Speaker 1: endo chronology and exercise physiology and head of the Center

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Speaker 1: of Excellence for Women in Sport. We discuss the biggest

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Speaker 1: misconceptions about female physiology that need to change in sports

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Speaker 1: science and coaching, the connection between menstrual cycles and performance

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Speaker 1: and injury risk, and the push to understand why women

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Speaker 1: athletes suffer more ACL injuries. That conversation's coming up right

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Speaker 1: after this.

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Speaker 2: Joining us now.

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Speaker 1: She's a professor of female endo chronology and ex exercise

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Speaker 1: physiology at Manchester Metropolitan University and the head of the

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Speaker 1: Center of Excellence for Women in Sport based at the

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Speaker 1: Institute of Sport In addition to her research on female athletes,

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Speaker 1: the menstrual cycle, hormonal contraceptives, and menopause, her work in

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Speaker 1: recent years has also involved designing and implementing exercise interventions

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Speaker 1: during and following pregnancy for women, including athletes. She's partnered

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Speaker 1: with everybody from Angel City to arsenal UWEFA, to the

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Speaker 1: Australian Institute of Sport and more. It's doctor Kirsty Elliott Sale.

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Speaker 3: Hello, Hi Sarah, Thanks so much for having me on.

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Speaker 2: So nice to talk to you.

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Speaker 1: We spoke a couple of years ago here in Chicago

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Speaker 1: for a Gator eight Sports Science Institute event, and I

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Speaker 1: was blown away by all the things I learned that day,

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Speaker 1: and it felt particularly important to bring you back now

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Speaker 1: because finally we're having more mainstream conversations about women's physiology,

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Speaker 1: about menstrual cycles and their impact on sport. But every

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Speaker 1: once in a while someone will say something very confidently

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Speaker 1: and I'll be like, I'm pretty sure that's not what

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Speaker 1: doctor Kirsty said. Having you back to help us understand

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Speaker 1: what we know, what we don't know, what needs more research,

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Speaker 1: and of course we want folks to be interested, but

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Speaker 1: maybe not make such bold declarations If we don't have

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Speaker 1: enough science behind it yet. So can you just tell

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Speaker 1: us just generally what it is you do, what's the

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Speaker 1: scope of your work, and how did you get into

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Speaker 1: this field.

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Speaker 2: What does your kind of day to day study look like.

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Speaker 4: So I've been working in this area a long time,

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Speaker 4: so more than twenty years. I did my PhD in

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Speaker 4: this area. So I was really interested in varying hormon profiles.

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Speaker 4: So I looked at the mensia cycle pregnancy actually in

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Speaker 4: viet refertilization treatment, so you know, different hormonal profiles and

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Speaker 4: how they affect muscle strength. So that's where I started off,

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Speaker 4: sort of you know, musculo scaltal physiology, and then you

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Speaker 4: know varian hormon profiles, and and I've left.

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Speaker 3: You know, so it's really unusual.

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Speaker 4: I'm from a sports science background, and typically you know,

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Speaker 4: sports scientists might have a few studies on their CV

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Speaker 4: related to women.

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Speaker 3: I'm the opposite.

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Speaker 4: I probably, you know, have a handful if that, of

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Speaker 4: studies that I've conducted in men. So I've been in

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Speaker 4: this area a long time, and over the last twenty

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Speaker 4: or so years, I've made it my business to get

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Speaker 4: to learn all these different ovarian homeown profiles so I'd

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Speaker 4: say I have a good grasp at around fifty or

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Speaker 4: more of varian homeown profiles. So really again speaking to

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Speaker 4: that individualization that you mentioned earlier on, So, yeah, that's

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Speaker 4: what I do. I learned these different profiles and then

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Speaker 4: I basically use them to test different aspects of performance

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Speaker 4: against them. I've mostly stayed in muscular scaletal, but you know,

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Speaker 4: really gone into sort of more performance based testing as well.

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Speaker 4: So what does day to day what does that look

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Speaker 4: like for me? You mentioned at the start that I

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Speaker 4: work with lots of different sports.

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Speaker 3: I'm really lucky.

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Speaker 4: I work with sports all around the world, so individual sports,

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Speaker 4: team sports, some big organizations, some individual athletes. I work

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Speaker 4: with women who are postmenopausal, women who are in their

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Speaker 4: reproductive years, some athletes with pregnancy or returning following pregnancy.

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Speaker 4: Of course, athletes that you mentioned thinking about potential challenges

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Speaker 4: or barriers that mental cycle or moral contraceptive use might

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Speaker 4: have all the way down into adolescents. So working with

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Speaker 4: teenage girls who are first starting you know, to menstrate

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Speaker 4: to get their first period, to incorporate this into you know,

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Speaker 4: their sporting lives.

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Speaker 3: So a big remit.

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Speaker 4: A lot of the work is athletes facing so a

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Speaker 4: lot of it's education. To be honest, there is so

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Speaker 4: having conversations with athletes directly. We don't know these things necessarily,

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Speaker 4: so trying to give them some knowledge so that they

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Speaker 4: can take ownership of this aspect of their sporting careers.

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Speaker 4: Often a lot of myth busting included within that education.

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Speaker 4: So many of the things that we've mentioned today. But

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Speaker 4: then I guess really sort of working then with more

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Speaker 4: practitioners and sports organizations to do some research, so you know,

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Speaker 4: looking at the challenges or the barriers or the questions

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Speaker 4: that they have for a particular sport, you know, related

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Speaker 4: to their female athletes, and trying to interrogate those in

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Speaker 4: a robust scientific way so that we can really give

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Speaker 4: them evidence to inform their practice.

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Speaker 3: So, yeah, life is interesting.

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Speaker 4: It's a real privilege to get to work with so

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Speaker 4: many great you know, athletes and clubs and organizations. But

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Speaker 4: as I say, it's all the way from education through

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Speaker 4: to you know, research, answering questions right up to sort

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Speaker 4: of making policies.

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Speaker 1: What do you think some of the biggest misconceptions about

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Speaker 1: female physiology are that we need to change in sports

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Speaker 1: science and coaching.

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Speaker 3: That's a great question.

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Speaker 4: I think the biggest one is that the mental cycle,

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Speaker 4: for example, is the deciding factor for all aspects of

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Speaker 4: you know, women's performance in sport. That one sort of

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Speaker 4: sets my teeth on edge. It will be a contributing factor,

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Speaker 4: but it is really unlikely that it's going to be

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Speaker 4: the deciding factor. So let me give you one example

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Speaker 4: that I think has really sort of, you know, been

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Speaker 4: blown out.

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Speaker 3: Of all proportion.

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Speaker 4: So about two years ago, there were some headlines in

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Speaker 4: the in the I don't know if I should say, but.

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Speaker 3: In a very well known international newspaper, and it was how.

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Speaker 4: Female athletes might have a drops these phase of the

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Speaker 4: menstrual cycle. And I don't know about you, but drops

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Speaker 4: these doesn't really mean anything to me.

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Speaker 3: It's quite a.

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Speaker 4: Childish word, like upsie dropsy, and it's not a science

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Speaker 4: term at all. And the implication of this was the

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Speaker 4: suggestion was that for two phases of the menstu cycle

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Speaker 4: and female athletes, in particular female goalkeepers from soccer clubs,

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Speaker 4: would be unable to catch and hold and keep the ball.

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Speaker 3: And that's just outrageous.

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Speaker 4: So not only was it not backed by credible science,

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Speaker 4: it was also just a really childish way, a really

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Speaker 4: sort of patronizing sort of headline to describe, you know,

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Speaker 4: female athlete performance. So yeah, that's one of the ones

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Speaker 4: that really sort of, you know, gets me going. So yeah,

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Speaker 4: anything to do with the menstrual cycle dictating your success

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Speaker 4: or your ability to train or compete, that's that's a

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Speaker 4: really big misconception that we really need to put to bed.

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Speaker 2: Let's talk about that a little more.

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Speaker 1: And I want to start with some stuff that might

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Speaker 1: feel obvious, but I have to say, the more I

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Speaker 1: dig into my own body, the more I realize I

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Speaker 1: don't know shit about it, and we haven't learned a

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Speaker 1: lot about it. I remember I was watching a show

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Speaker 1: here in Chicago, a real estate woman who like flips houses,

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Speaker 1: and she said on camera, you know, I'm going through

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Speaker 1: the process of freezing my eggs in case I want

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Speaker 1: to have kids later because I'm getting older, so I'm.

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Speaker 2: Making fewer and fewer every year. And I was like,

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Speaker 2: that's not right.

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Speaker 1: Not only do you not know that going through the process,

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Speaker 1: but none of your producers, nobody in the editing room,

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Speaker 1: not a single person knows that we're born with all

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Speaker 1: of our eggs and we lose them it's not a

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Speaker 1: matter of not producing anymore, it's a matter of not

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Speaker 1: having as many left. And it was kind of shocking

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Speaker 1: but also in some ways not surprising how little we

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Speaker 1: know about this stuff. So take us through the menstrual

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Speaker 1: cycle and performance. What are the three phase is what's

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Speaker 1: happening to us and in us during.

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Speaker 4: Each Okay, but firstly, let me say, you're so right.

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Speaker 4: There's so much misinformation out there or we just don't know.

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Speaker 4: And I think it's been assumed that because you're a girl,

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Speaker 4: because you're a woman, you will know these things. But

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Speaker 4: it's like everything else, we need to be taught these

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Speaker 4: and I don't know what it's like in the US there,

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Speaker 4: but in the UK we don't get a lot of

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Speaker 4: education on this, either at school or even at university,

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Speaker 4: you say, when you're doing a sports science degree. So

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Speaker 4: let me try and sort of be brief and make

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Speaker 4: it digestible so that everybody can understand. So we know

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Speaker 4: that the mental cycle is the body's way of preparing

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Speaker 4: for pregnancy, and so what happens is that the two

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Speaker 4: ovarian hormones esogen progesterone change across the cycle. So phase

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Speaker 4: one is when you're ment tuating, so when you're bleeding,

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Speaker 4: and that's when estrogen or progesterone are low. So that's

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Speaker 4: phase one. Then estrogen starts to rise. Sarah's probably laughing.

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Speaker 3: I know this is a notable thing.

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Speaker 4: So I'm starting to a diagram in the in the air,

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Speaker 4: but it doesn't help. Okay, So after phase one, when

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Speaker 4: esogen progesterone low, esogen starts to rise and it peaks

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Speaker 4: almost around the halfway point of the cycle. And this

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Speaker 4: peak in estrogen occurs just before ovulation happens. Now, progesterone

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Speaker 4: stays low at that point, so we're moving into the

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Speaker 4: second phase with a peak in estrogen. Pogesterone is low,

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Speaker 4: so it's a significantly different hormonal environment. Then when ovulation occurs,

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Speaker 4: estrogen drops again and it sort of has a secondary peak.

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Speaker 4: It's not as big as the first one, but this

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Speaker 4: time around, when it's having that secondary peak, we have

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Speaker 4: a peak in progesterone. So this is really the first

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Speaker 4: time pogesterone is rising. It's increasing it at its highest concentration,

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Speaker 4: and that's the sort of third really sort of significantly

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Speaker 4: different phase of the menstra cycle. Then both of those

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Speaker 4: homones start to drop again and it's when they drop

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Speaker 4: and they become low that then the woman the athlete

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Speaker 4: gets her period again. So really this sort of menstrual cycle,

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Speaker 4: it sort of represents fluctuations in these two hormones over time,

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Speaker 4: last roughly around twenty one to thirty five days, so

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Speaker 4: there's quite a big window variability there. So you know,

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Speaker 4: when different women are talking, you might hear one say, yeah,

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Speaker 4: I get my period every twenty six days, and another

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Speaker 4: woman might say I get mine every thirty one days.

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Speaker 4: So yeah, that's sort of I think it in a nutshell.

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Speaker 4: If hopefully that was simplistic enough.

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Speaker 1: Yeah, Well, before we get into the athletes side of it, two,

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Speaker 1: just more basic questions. If all those hormonal changes are happening,

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Speaker 1: should we be intentional about when we schedule doctor's appointments,

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Speaker 1: if they're going to take blood or if they're going

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Speaker 1: to look at levels of things. Are there times in

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Speaker 1: our cycle where we're more likely to test for things

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Speaker 1: that might look problematic or be indicators of something that

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Speaker 1: are actually just natural during that phase?

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Speaker 2: Yeah?

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Speaker 3: Absolutely.

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Speaker 4: I mean, you know, if you have a blood sample

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Speaker 4: take and during the mental cycle, it really is a snapshot.

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Speaker 4: It's like taking a photograph. You don't know what's happening

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Speaker 4: five minutes before or five minutes after, So yeah, it

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Speaker 4: should absolutely be intentional. If you're interested in a particular

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Speaker 4: outcome or aspect of health that's linked to low hormones,

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Speaker 4: of course, target that in phase one when you've.

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Speaker 3: Got your period.

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Speaker 4: But equally, if you're interested in ovulation, whether you're not

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Speaker 4: you're releasing an egg, then of course then it would

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Speaker 4: be timely to target that blood sample when we expect

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Speaker 4: that peak and estrogen. So absolutely it's really important. If

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Speaker 4: we take a blood sample on Monday, it really wouldn't

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Speaker 4: represent what was happening on Friday.

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Speaker 2: And does that change it all or matter at all

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Speaker 2: if you're on birth.

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Speaker 4: Control, Yeah, so absolutely so if you're using hormonal birth control,

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Speaker 4: so any type of birth control that changes your homone concentrations,

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Speaker 4: then yet you have an entirely different profile. And I

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Speaker 4: guess that's another really big misconception. I hear women and

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Speaker 4: athletes talking about their cycle when, for example, they're taking

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Speaker 4: the contraceptive pill, they don't have that cycle, they don't

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Speaker 4: have that menstrul cycle.

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Speaker 3: And that makes sense.

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Speaker 4: Because birth control is there to prevent pregnancy, so it's

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Speaker 4: there to prevent ovulation, because if you don't release the egg,

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Speaker 4: then of course you can't get pre So, yeah, there

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Speaker 4: are lots of different profiles and that relate to issues

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Speaker 4: and progesterone depending on which type of hormonal birth control

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Speaker 4: you're on. So again, if you are trying to get

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Speaker 4: an indication of what your homonne profile is and you're

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Speaker 4: on birth control, then again you have to be targeted.

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Speaker 4: So for example, you might get a blood sample taken

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Speaker 4: on one of the days that you're taking your pill

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Speaker 4: versus it could be different. Of course, it will be

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Speaker 4: different if you're on a pill free day or acebo

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Speaker 4: pill day.

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Speaker 2: Yeah.

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Speaker 1: Okay, now I have one complete random question. This is

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Speaker 1: going back to my college days because there were no

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Speaker 1: answers at the time, and maybe you have them now.

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Speaker 1: I was in a human bonding class and it talked

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Speaker 1: about pheromones and the sort of unspoken chemical connection that

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Speaker 1: we have to people that we might be physically attracted to,

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Speaker 1: and that oftentimes our attraction is a reflection of having

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Speaker 1: different bodily makeups that would best allow for our children

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Speaker 1: to survive. We're attracted to people who have a different

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Speaker 1: set of things that they would bring to the genetic

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Speaker 1: makeup of our child and most likely produced a child

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Speaker 1: that would go on to survive, you know, birth in

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Speaker 1: the world and everything else. But that when women were

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Speaker 1: on birth control, their reactions to the pheromones in sweaty

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Speaker 1: T shirts and things that they smelled were the opposite

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Speaker 1: of what they were when they weren't. So I'm wondering

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Speaker 1: if every woman out there who has a bad picker

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Speaker 1: and is making bad choices is making those choices because

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Speaker 1: of birth control. And if we're looking for our quote

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Speaker 1: unquote soulmate or someone that we're forever going to be

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Speaker 1: attracted to, do we have to go looking for them

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Speaker 1: when we're not on birth control.

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Speaker 2: I love that question.

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Speaker 3: I have never been asked that question before.

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Speaker 4: Quite honestly, I don't think anybody has the answer to

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Speaker 4: that question.

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Speaker 3: I'm unaware of research in this area. But I'm going

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Speaker 3: to go for a big fat no on that one.

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Speaker 2: Okay, so we might be all right. I go out

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Speaker 2: a courtin on the pith.

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Speaker 1: Absolutely good news for my husband. It's been it's been

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Speaker 1: sixteen years together, but I could finally rest Jesus.

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Speaker 2: We got to take a quick break.

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Speaker 1: When we come back more with doctor Kirsty Elliott sale,

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Speaker 1: don't move a muscle. Let's get back to the phases

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Speaker 1: that you were talking about, because one of the things

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Speaker 1: that has gotten attention is this idea that could you

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Speaker 1: potentially change your training for elite athletes based on the

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Speaker 1: time of their cycle. First, I don't know how you

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Speaker 1: do that for a team, do you first have to

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Speaker 1: try to sync them all up, or even for individual athletes.

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Speaker 1: Is there any science yet that tells us we should

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Speaker 1: be adjusting training based on the time of a cycle.

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Speaker 4: Brilliant question. So let's go for the science first. No,

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Speaker 4: there isn't a significant body of credible evidence that would

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Speaker 4: suggest that we need to change our training in order

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Speaker 4: to sink with different phases of the menstrual cycle. Now,

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Speaker 4: of course, somebody listening to this is going to say,

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Speaker 4: but I saw a paper, I read a paper, I've

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Speaker 4: seen on social media this evidence. Yep, there's evidence out there,

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Speaker 4: for sure, But there's I guess the nuance to research evidence.

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Speaker 4: Not all research evidence is created equally, so we have

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Speaker 4: high quality evidence, and of course that means we have

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Speaker 4: low quality evidence. So right now, the evidence that exists,

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Speaker 4: it's small.

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Speaker 3: In its quantity, so we're not overwhelmed.

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Speaker 4: You know, we don't see this sort of big consensus.

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Speaker 4: You know, so lots of different labs, lots of different

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Speaker 4: independent as scientists showing the same things. So firstly there's

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Speaker 4: little of it, and then secondly it tends to be

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Speaker 4: sort of lower moderate quality, meaning that we don't have

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Speaker 4: the scientific community don't have confidence in those findings.

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Speaker 3: So right now we're saying there's not enough credible evidence

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Speaker 3: to suggest that you need to.

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Speaker 1: Do this well, so really quick, when we see the

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Speaker 1: headlines that are like menstrual cycle focus helped Chelsea win

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Speaker 1: it all, Emma Hayes leading the way by you know,

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Speaker 1: tailoring training to players of menstrual cycles.

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Speaker 2: They were probably just good at footy.

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Speaker 3: They were just graded.

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Speaker 4: I mean, for sure, there's a feel good factor, you

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Speaker 4: know when it comes to you know, when it comes

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Speaker 4: to clubs or sports, which are you know, valuing these

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Speaker 4: or considering these female specific topics. Those players, those athletes

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Speaker 4: feel value, they feel sane, they've being cared for, and

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Speaker 4: you know that really comes with I don't know if

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Speaker 4: you want to say it's a placebo effect, but it

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Speaker 4: certainly comes with a feel good factor. And for sure,

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Speaker 4: you know there'll be some nuance there around. You know,

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Speaker 4: if one of the players maybe had a mental cycle symptom,

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Speaker 4: so some adverse symptoms, say, for example, muscle stomach cramping

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Speaker 4: or muscle pain or a headache, it could well be that,

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Speaker 4: you know, they were allowed to slightly adapt their training

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Speaker 4: on that day. So of course those things are going

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Speaker 4: to help. But you know, when we're talking about the physiology,

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Speaker 4: you know, if you're in a phase where there's high

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Speaker 4: issuage and do you need to train a certain way

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Speaker 4: because it affects your muscles and your ensurance capacity. No,

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Speaker 4: there isn't the evidence for that. But as they say,

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Speaker 4: if you take a more pragmatic thing and say something like, okay, well,

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Speaker 4: if you're in a phase where you're bleeding, we'll you know,

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Speaker 4: have some considerations around the fact that these players are bleeding.

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Speaker 4: We'll offer them X, Y and Z, will make it

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Speaker 4: easy for them to incorporate their training on these bleeding days.

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Speaker 4: You know, that just is good common sense. So it's

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Speaker 4: not a really clear picture. But if I just want

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Speaker 4: to summarize so everybody is is clear on the research evidence, No,

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Speaker 4: there are not phases where you win or lose. But

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Speaker 4: you know, if you are body literate, if you are

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Speaker 4: mindful of you know, either symptoms or the fact that

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Speaker 4: you bleed as part of the mental cycle, you can

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Speaker 4: certainly incorporate some of those aspects into your training. But

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Speaker 4: they are really, you know, small adjustments. So no, the

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Speaker 4: big headline grabbing things aren't aren't quite correct. But I

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Speaker 4: can see that certainly, you know, we've had a good

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Speaker 4: shift into considering these female things, which is certainly better

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Speaker 4: than it was ten years ago.

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Speaker 1: Yeah, I mean, I think to your point, every woman

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Speaker 1: knows that her experience is different than other women. Some

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Speaker 1: have very heavy periods, some have a lot of cramping,

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Speaker 1: some don't want to get out of bed, some barely

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Speaker 1: feel it. So the idea that athletes would somehow uniformly

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Speaker 1: be affected by it feels like a stretch. So again,

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Speaker 1: personalized approach based on your individual response to exercising across

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Speaker 1: your cycle, especially if that is consistent, because again, even

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Speaker 1: among our own experiences, one month that could be terrible,

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Speaker 1: one month we could barely notice it, which really makes

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Speaker 1: it hard to make kind of sweeping decisions based on it.

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Speaker 1: I think the same seems to go for birth control,

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Speaker 1: right because whenever I hear elite athletes complaining about getting

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Speaker 1: their period during the Olympics or a major event, I

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Speaker 1: always think, well, why don't they just go on birth

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Speaker 1: control and you can control which part of the phase

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Speaker 1: you're in for this major track made or this championship game.

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Speaker 1: You can take your pills through the week you're supposed

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Speaker 1: to be getting it and skip ahead, Like, do you

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Speaker 1: think that that's already happening consistently and is there any

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Speaker 1: reason not to do that?

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Speaker 3: Yeah, so it happens a lot.

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Speaker 4: And actually, you know, when we talk to athletes about

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Speaker 4: why they use hormonal birth control, more often than not

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Speaker 4: say it's to manipulate their menstro cycle, you know, to

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Speaker 4: be able to control bleeding and so on, and actually

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Speaker 4: for contraception is often the second reason, which is a

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Speaker 4: little sort of counterintuitive.

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Speaker 3: So, yeah, it happens a lot.

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Speaker 4: And then I guess the second part of your question

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Speaker 4: is why why doesn't everybody do it? I guess that

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Speaker 4: maybe leans into the fact that, you know, again, we

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Speaker 4: all have different experiences of birth controls, so there's always

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Speaker 4: a concern there. If I have an athlete who comes

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Speaker 4: to me, you know, a month before the Olympic final

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Speaker 4: and says, oh, you know, I feel like, now that

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Speaker 4: the schedule is released, I might have my period when

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Speaker 4: it's the Olympic final or you know, certainly in you know,

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Speaker 4: during the Olympics. Quick, you know, let's get me on

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Speaker 4: the pillar, for example. Our concern is if they haven't

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Speaker 4: been on the pill before, if they're not used to it,

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Speaker 4: we don't know if they're going to have any side effects,

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Speaker 4: and potentially those side effects could be worse than any

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Speaker 4: of these sort of adversity they might you know face

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Speaker 4: because of the menstro cycle. So you know, rarely in

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Speaker 4: elite sport as one size fits all. So certainly those

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Speaker 4: athletes who are using birth control in order to manipulate

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Speaker 4: their cycles, or you know, they're using it, you know,

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Speaker 4: specifically around major competitions, we would always encourage them to

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Speaker 4: trial that months, you know, out before the Olympics, before

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Speaker 4: the World Championships, just to make sure that they're not

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Speaker 4: potentially swapping one set of issues for another. But yeah,

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Speaker 4: one size rarely fit's all exactly as you said, whether

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Speaker 4: it's birth control or whether it's the menstra cycle. And

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Speaker 4: I think you know a really good point, and you've

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Speaker 4: made it nice several times, is to remember that not

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Speaker 4: all female athletes have a menstra cycle, So yeah, we're

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Speaker 4: we're dealing with athletes with menstra cycles.

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Speaker 3: That's one profile.

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Speaker 4: There's probably you know, twenty thirty different hormonal profiles associated

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Speaker 4: with birth control. There are different hormonal profiles if you

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Speaker 4: have mental dysfunction, so you know, yeah, you really have

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Speaker 4: to take an individualized approach. Not everybody has the same profile,

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Speaker 4: and everybody's experience is not the same, and it's exactly

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Speaker 4: as you said, one cycle to the next cycle may

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Speaker 4: also be different, So lots of moving parts, lots of

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Speaker 4: nuance when it comes to this topic, and again doesn't

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Speaker 4: really lend itself, does it to those sound bites and

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Speaker 4: those headlines which really oversimplify and whitewash and assume we're

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Speaker 4: all the same.

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Speaker 1: Which unfortunately could discourage people from studying it because they

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Speaker 1: want to be able to make those sweeping generalizations and

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Speaker 1: have some outcome that feels clean. And instead, we need

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Speaker 1: more research because it is so disparate in terms of

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Speaker 1: different experiences and outcomes for a variety of people. So

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Speaker 1: the more studies we have, the more opportunity we have

438
00:21:21,920 --> 00:21:24,720
Speaker 1: to understand how every different person might react in a

439
00:21:24,760 --> 00:21:27,080
Speaker 1: specific incidant. You know. I saw an interview with Olympic

440
00:21:27,119 --> 00:21:30,040
Speaker 1: volleyball player Alex Kleinman. She shared that a doctor had

441
00:21:30,080 --> 00:21:32,320
Speaker 1: told her there's a big link between birth control pills

442
00:21:32,320 --> 00:21:33,520
Speaker 1: and bone injuries.

443
00:21:34,200 --> 00:21:35,840
Speaker 2: Is there proof to that or are.

444
00:21:35,720 --> 00:21:38,680
Speaker 1: There any other reasons why athletes might not want to

445
00:21:38,800 --> 00:21:42,840
Speaker 1: use IUDs or pills or other hormonal treatments because of

446
00:21:42,880 --> 00:21:44,879
Speaker 1: how it might affect their performance.

447
00:21:45,119 --> 00:21:49,359
Speaker 4: Well, that sounds like quite a big claim, an oversimplified claim.

448
00:21:49,840 --> 00:21:53,280
Speaker 4: So firstly, I would say, you know, hormonal birth control

449
00:21:53,359 --> 00:21:57,040
Speaker 4: users don't panic. It doesn't automatically increase your risk of

450
00:21:57,080 --> 00:22:01,600
Speaker 4: boney injuries. There certainly have been so studies published which

451
00:22:02,440 --> 00:22:07,840
Speaker 4: suggests that those who use progest and only contraception may

452
00:22:07,880 --> 00:22:11,600
Speaker 4: have a slightly increased risk. But again, you know, I

453
00:22:11,680 --> 00:22:14,960
Speaker 4: keep using this word nuance. You know there is nuance there.

454
00:22:15,000 --> 00:22:17,000
Speaker 4: It depends how long you've been using it, if you

455
00:22:17,040 --> 00:22:19,560
Speaker 4: take any breaks, what type of sport that you do.

456
00:22:19,640 --> 00:22:21,720
Speaker 4: You know, you might do a sport where you have

457
00:22:21,840 --> 00:22:24,760
Speaker 4: really great bone health anyway, you know, so your sport

458
00:22:24,880 --> 00:22:29,119
Speaker 4: lends itself to you know, good bone deposition. Whereas you know,

459
00:22:29,160 --> 00:22:31,200
Speaker 4: of course, if you're in a sport where you already

460
00:22:31,280 --> 00:22:35,320
Speaker 4: might have you know, lower bone mineral density or already

461
00:22:35,359 --> 00:22:38,919
Speaker 4: be at risk, then obviously that might make an additive effect.

462
00:22:39,000 --> 00:22:41,240
Speaker 3: So I think there's lots of factors to consider.

463
00:22:41,320 --> 00:22:43,200
Speaker 4: But again, I'd really like to avoid those sort of

464
00:22:43,280 --> 00:22:46,160
Speaker 4: headlines or bull statements around if you do this, this

465
00:22:46,200 --> 00:22:46,840
Speaker 4: will happen.

466
00:22:47,200 --> 00:22:48,439
Speaker 2: Okay, So follow up to that.

467
00:22:48,520 --> 00:22:51,280
Speaker 1: The doctor also told her that women need different nutrients

468
00:22:51,280 --> 00:22:53,240
Speaker 1: at each point in their cycle. Is that something we

469
00:22:53,240 --> 00:22:55,320
Speaker 1: should be thinking about what we're putting in our bodies

470
00:22:55,520 --> 00:22:58,040
Speaker 1: during different phases.

471
00:22:56,800 --> 00:23:01,119
Speaker 4: I keep remembering that people are listening to this and

472
00:23:01,160 --> 00:23:03,800
Speaker 4: they can't see my face. This is probably a good thing. Okay,

473
00:23:03,880 --> 00:23:08,359
Speaker 4: so I made a face. No again, you know this

474
00:23:08,359 --> 00:23:11,119
Speaker 4: this really concerns me. You know, it's very similar to

475
00:23:11,160 --> 00:23:13,600
Speaker 4: the narrative around change your training in line with your

476
00:23:13,640 --> 00:23:17,080
Speaker 4: mental cycle. Faces again, the menstrual cycle, or you're or

477
00:23:17,320 --> 00:23:20,240
Speaker 4: you know, more broadly eure ovarian homon profile. Let's use

478
00:23:20,280 --> 00:23:22,560
Speaker 4: that as the term which incorporates all of those different

479
00:23:22,600 --> 00:23:25,879
Speaker 4: ones I mentioned. It should not be dictating your nutrition.

480
00:23:26,160 --> 00:23:28,439
Speaker 4: It might be a consideration, but it shouldn't be the

481
00:23:28,480 --> 00:23:31,199
Speaker 4: deciding factor. So again, if I was working with a

482
00:23:31,240 --> 00:23:34,879
Speaker 4: female athlete, Now full disclosure, I'm not a nutritionist, but

483
00:23:35,000 --> 00:23:37,480
Speaker 4: even you know, I'm a physiologist, but even when I'm

484
00:23:37,520 --> 00:23:39,520
Speaker 4: working with them, we might veer into a little bit

485
00:23:39,560 --> 00:23:42,280
Speaker 4: about nutrition, and I would always say to them, fuel

486
00:23:42,320 --> 00:23:44,920
Speaker 4: for the demands of your sport. That's the big hitter,

487
00:23:45,240 --> 00:23:47,160
Speaker 4: you know, So make sure that you're fueling, that you've

488
00:23:47,160 --> 00:23:50,479
Speaker 4: got adequate fuel for what you do. Make sure that

489
00:23:50,520 --> 00:23:54,520
Speaker 4: your fueling strategy is, you know, sufficient for recovery, all

490
00:23:54,560 --> 00:23:58,240
Speaker 4: of those things, those big pillars of performance first if,

491
00:23:58,240 --> 00:24:00,640
Speaker 4: of course, then let's go back to the idea of

492
00:24:00,800 --> 00:24:02,679
Speaker 4: you know, we might have an athlete who has some

493
00:24:03,160 --> 00:24:07,160
Speaker 4: adverse and mention psychosymptoms. So for example, she might have

494
00:24:07,280 --> 00:24:09,440
Speaker 4: a bit of a runnie tummy during her period.

495
00:24:09,800 --> 00:24:10,880
Speaker 3: Yeah, it makes sense to.

496
00:24:10,840 --> 00:24:14,119
Speaker 4: Me change your diet during that particular time point to

497
00:24:14,200 --> 00:24:17,720
Speaker 4: try and help alleviate that adversity. But when it comes

498
00:24:17,720 --> 00:24:20,440
Speaker 4: to the big you know, statement of these phases should

499
00:24:20,480 --> 00:24:23,919
Speaker 4: dictate what you're reading that's just not true based on

500
00:24:23,960 --> 00:24:24,800
Speaker 4: the current evidence.

501
00:24:25,520 --> 00:24:26,920
Speaker 1: Yeah, and again I want to point to I read

502
00:24:26,920 --> 00:24:29,960
Speaker 1: a lot of articles and guest essays that you wrote,

503
00:24:30,040 --> 00:24:32,200
Speaker 1: and mainly what you say is you can read something

504
00:24:32,200 --> 00:24:34,680
Speaker 1: that says there's some evidence, but what it won't say

505
00:24:34,760 --> 00:24:39,960
Speaker 1: is very minimal, very small study, very you know, tenuous evidence,

506
00:24:40,040 --> 00:24:42,520
Speaker 1: not super proof, and that makes a big difference in

507
00:24:42,560 --> 00:24:44,480
Speaker 1: whether you're going to actually change behavior as a result

508
00:24:44,600 --> 00:24:45,920
Speaker 1: or whether you're going to use that to say, Okay,

509
00:24:45,960 --> 00:24:48,600
Speaker 1: let's keep studying it, which is great, but maybe not

510
00:24:48,720 --> 00:24:52,199
Speaker 1: making these widespread generalizations as a result. All right, I

511
00:24:52,240 --> 00:24:55,680
Speaker 1: want to talk about acls specifically. For a long time,

512
00:24:55,760 --> 00:24:59,040
Speaker 1: we've been trying to understand why women suffer ACL injuries

513
00:24:59,080 --> 00:25:00,960
Speaker 1: more we've been try trying to figure out if there's

514
00:25:01,040 --> 00:25:05,320
Speaker 1: training changes that can help, you know, prevent it. We've also, suddenly,

515
00:25:05,560 --> 00:25:08,080
Speaker 1: and at least in my world, that's been sudden, started

516
00:25:08,119 --> 00:25:10,320
Speaker 1: to talk about whether or not people are more likely

517
00:25:10,359 --> 00:25:13,600
Speaker 1: to tear their acls during different phases of their menstrual cycle,

518
00:25:13,600 --> 00:25:16,600
Speaker 1: whether the phase affects joint laxity or otherwise.

519
00:25:16,720 --> 00:25:19,080
Speaker 2: So, big picture, do we have.

520
00:25:19,040 --> 00:25:21,320
Speaker 1: A reason to believe that ACL tears are more likely

521
00:25:21,400 --> 00:25:23,040
Speaker 1: during any particular part of the cycle.

522
00:25:23,320 --> 00:25:26,600
Speaker 4: No, So I feel like I'm on repeating now, but

523
00:25:26,760 --> 00:25:29,959
Speaker 4: you know, hopefully I'll have brainwashed everybody by the end

524
00:25:30,000 --> 00:25:34,760
Speaker 4: of this episode. So No, there's insufficient evidence to suggest

525
00:25:34,840 --> 00:25:37,119
Speaker 4: that there's an increased risk at a particular phase of.

526
00:25:37,119 --> 00:25:37,959
Speaker 3: The menshuaw cycle.

527
00:25:38,680 --> 00:25:41,560
Speaker 4: This one is an interesting one because actually there's two

528
00:25:41,560 --> 00:25:44,200
Speaker 4: schools of thought that we're seeing, you know, in sort

529
00:25:44,200 --> 00:25:48,000
Speaker 4: of I guess, in the popular media. So on one hand,

530
00:25:48,119 --> 00:25:50,960
Speaker 4: we're hearing from a lot of athletes that they're saying

531
00:25:51,040 --> 00:25:54,720
Speaker 4: that we're really worried about sustaining an ACL injury during

532
00:25:54,720 --> 00:25:57,400
Speaker 4: our periods. So again, just going back to that sort

533
00:25:57,440 --> 00:25:59,800
Speaker 4: of biology lesson we had at the start, that's when

534
00:26:00,600 --> 00:26:03,640
Speaker 4: is at its lowest, and so there's a real narrative

535
00:26:03,680 --> 00:26:06,720
Speaker 4: now amongst athletes that this is when it's going to happen.

536
00:26:06,520 --> 00:26:08,120
Speaker 3: And they're really worried about it.

537
00:26:08,800 --> 00:26:13,360
Speaker 4: Then in the academic or research community, research that's been

538
00:26:13,359 --> 00:26:16,639
Speaker 4: done previously has well, some of it has suggested that

539
00:26:16,680 --> 00:26:19,960
Speaker 4: there's an increased risk just before ovulation. Now back to

540
00:26:19,960 --> 00:26:23,120
Speaker 4: that biology lesson, that's when estrogen is at its highest.

541
00:26:23,560 --> 00:26:26,480
Speaker 4: So both things can't be true. So where does that

542
00:26:26,560 --> 00:26:30,119
Speaker 4: really leave us. So the anecdotal evidence it's a mixed bag.

543
00:26:30,640 --> 00:26:33,200
Speaker 4: I work with one particular soccer club in the UK.

544
00:26:33,920 --> 00:26:36,159
Speaker 4: They won't mind me saying this, it's in the public domain.

545
00:26:36,280 --> 00:26:40,359
Speaker 4: They had four ACL injuries in one season and I

546
00:26:40,400 --> 00:26:42,840
Speaker 4: can promise you that they were not all sustained in

547
00:26:42,880 --> 00:26:45,679
Speaker 4: the same phase as the menstrual cycle, and not all

548
00:26:45,760 --> 00:26:46,200
Speaker 4: of them.

549
00:26:46,080 --> 00:26:47,160
Speaker 3: Were during menstruation.

550
00:26:47,760 --> 00:26:49,240
Speaker 4: So that's the first thing when it comes to that

551
00:26:49,280 --> 00:26:52,600
Speaker 4: anecdotal evidence, that's not what we're seeing in the applied setting.

552
00:26:53,119 --> 00:26:55,200
Speaker 4: When it comes to the research evidence, as I said,

553
00:26:55,240 --> 00:26:57,800
Speaker 4: there's some evidence to suggest that it might be an

554
00:26:57,840 --> 00:27:01,199
Speaker 4: increased risk in the preovulatory phase. But for every paper

555
00:27:01,240 --> 00:27:03,520
Speaker 4: that I can show you that says that I can

556
00:27:03,560 --> 00:27:05,720
Speaker 4: find you the same amount or maybe slightly more that

557
00:27:05,800 --> 00:27:09,320
Speaker 4: said this is not true. So it's really inconclusive from

558
00:27:09,320 --> 00:27:10,360
Speaker 4: the research side.

559
00:27:10,760 --> 00:27:12,760
Speaker 3: But here's what I'm going to throw out to you.

560
00:27:13,320 --> 00:27:15,880
Speaker 4: I think it's naive to think that you know, when

561
00:27:15,880 --> 00:27:18,840
Speaker 4: it comes to something like an ACL injury, and we

562
00:27:18,920 --> 00:27:22,040
Speaker 4: know that injuries are multi factoral, that they're complex things

563
00:27:22,040 --> 00:27:25,840
Speaker 4: to understand and to study. I just really don't believe that, honestly,

564
00:27:25,880 --> 00:27:28,600
Speaker 4: on any day we're going to see a female athlete

565
00:27:28,600 --> 00:27:31,600
Speaker 4: sustain an ACL injury and the only contributing factor is

566
00:27:31,640 --> 00:27:34,360
Speaker 4: going to be her issuge in concentration. I just think

567
00:27:34,440 --> 00:27:38,600
Speaker 4: that is wildly oversimplified. So I think we need to

568
00:27:38,640 --> 00:27:41,600
Speaker 4: look into other areas, other aspects, And actually there's been

569
00:27:41,640 --> 00:27:43,640
Speaker 4: some really nice work in the last sort of three

570
00:27:43,720 --> 00:27:47,040
Speaker 4: to five years looking more at the gendered environment.

571
00:27:47,040 --> 00:27:49,800
Speaker 3: Now getting a little outside of my wheelhouse.

572
00:27:49,280 --> 00:27:52,359
Speaker 4: Here my expertise, but it really resonated with me that

573
00:27:52,440 --> 00:27:56,600
Speaker 4: if you look at the environment in which female athletes train,

574
00:27:56,760 --> 00:27:59,159
Speaker 4: and you know, even looking right back from when they

575
00:27:59,200 --> 00:28:02,240
Speaker 4: started as younger, there's a lot of disparity when you

576
00:28:02,280 --> 00:28:04,800
Speaker 4: compare that to boys and men, and so I think

577
00:28:04,840 --> 00:28:07,520
Speaker 4: that it makes sense for me to look there to

578
00:28:07,520 --> 00:28:10,840
Speaker 4: see what opportunities they have, what resources, the funding, all

579
00:28:10,880 --> 00:28:13,399
Speaker 4: of those things. And then I think, secondly, as you

580
00:28:13,440 --> 00:28:15,320
Speaker 4: said when you asked the question, I think we need

581
00:28:15,359 --> 00:28:17,480
Speaker 4: to look more around, you know, how are they being

582
00:28:17,520 --> 00:28:20,040
Speaker 4: trained now, what does that training look like, what are

583
00:28:20,080 --> 00:28:23,480
Speaker 4: the facilities, And certainly in the UK and other countries

584
00:28:23,480 --> 00:28:26,040
Speaker 4: in Australia as well, there's some really nice research now

585
00:28:26,080 --> 00:28:28,359
Speaker 4: starting to look at the strength and conditioning of female

586
00:28:28,400 --> 00:28:31,679
Speaker 4: athletes and how that may well, you know, help lower

587
00:28:31,760 --> 00:28:34,280
Speaker 4: that risk within women. But I think if we had

588
00:28:34,400 --> 00:28:37,720
Speaker 4: parity in those sort of training environments, I think, you know,

589
00:28:37,800 --> 00:28:41,080
Speaker 4: the risk or the occurrence of these injuries between men

590
00:28:41,120 --> 00:28:44,720
Speaker 4: and women would close, you know, instantly, and then it

591
00:28:44,760 --> 00:28:47,000
Speaker 4: would be worth looking into against some of those really

592
00:28:47,040 --> 00:28:49,200
Speaker 4: sort of specific contributing factors.

593
00:28:49,680 --> 00:28:52,440
Speaker 1: Yeah, you know, I've heard something about a PEP method

594
00:28:52,440 --> 00:28:55,120
Speaker 1: that's supposedly just fifteen minutes ahead of training that can help.

595
00:28:55,160 --> 00:28:57,800
Speaker 1: I'm also part way through this book, The Stronger Sex,

596
00:28:57,840 --> 00:29:00,320
Speaker 1: and it seems like later in the book they mentioned

597
00:29:00,360 --> 00:29:02,680
Speaker 1: in the intro potentially proof that even at the very

598
00:29:02,720 --> 00:29:05,960
Speaker 1: youngest ages, when girls are twirling and boys are already

599
00:29:06,000 --> 00:29:09,360
Speaker 1: being taught to kick and throw and cut, that that

600
00:29:09,560 --> 00:29:11,840
Speaker 1: very very early time might even contribute to the way

601
00:29:11,880 --> 00:29:14,480
Speaker 1: that our muscles are built to withstand those movements. And

602
00:29:14,520 --> 00:29:16,240
Speaker 1: we might think it's too early, but it's actually a

603
00:29:16,280 --> 00:29:18,840
Speaker 1: part of it. So that's interesting, you know. I also,

604
00:29:18,880 --> 00:29:23,160
Speaker 1: we've been talking about individual experiences, So is it possible

605
00:29:23,200 --> 00:29:26,760
Speaker 1: that an individual athlete might have enough of a drop

606
00:29:26,800 --> 00:29:29,200
Speaker 1: in an estrogen or enough of a hormonal change during

607
00:29:29,200 --> 00:29:31,960
Speaker 1: their period that it does impact in more significant ways.

608
00:29:31,960 --> 00:29:34,680
Speaker 1: For instance, you know, I was listening to Megan Rapino

609
00:29:34,760 --> 00:29:37,320
Speaker 1: and Suebird on their podcast to Touch More, and Megan

610
00:29:37,360 --> 00:29:40,400
Speaker 1: said she has had three ACL tears, all three while

611
00:29:40,440 --> 00:29:44,160
Speaker 1: she was on her period. When you have anecdotal individual

612
00:29:44,200 --> 00:29:47,760
Speaker 1: evidence like that that's spread so quickly, right, and so

613
00:29:48,000 --> 00:29:50,080
Speaker 1: then everybody hears that and thinks, oh, that must be

614
00:29:50,560 --> 00:29:53,280
Speaker 1: the thing. So do we need more research into the

615
00:29:53,320 --> 00:29:57,000
Speaker 1: potential that that individual athlete might experience something during her

616
00:29:57,040 --> 00:30:01,400
Speaker 1: period that very greatly contributes to the likelihood or is

617
00:30:01,440 --> 00:30:03,240
Speaker 1: it possible that it's chance.

618
00:30:03,840 --> 00:30:05,920
Speaker 3: Yeah, I think probably the latter.

619
00:30:06,040 --> 00:30:09,360
Speaker 4: As you said, you know, there are only so many days,

620
00:30:09,360 --> 00:30:12,160
Speaker 4: and you know, of course it is going to happen

621
00:30:12,480 --> 00:30:15,360
Speaker 4: to some players, to some athletes during during their period.

622
00:30:15,400 --> 00:30:19,000
Speaker 4: Of course, it is as you say that it's random chance.

623
00:30:19,120 --> 00:30:22,600
Speaker 4: It's you know, correlation is not causation. And the thing

624
00:30:22,600 --> 00:30:25,360
Speaker 4: if it is you know, if you hear this is

625
00:30:25,400 --> 00:30:28,040
Speaker 4: particularly from you know, high profile athletes, then you know

626
00:30:28,440 --> 00:30:32,320
Speaker 4: it becomes you know, it just spreads, doesn't it. And

627
00:30:32,520 --> 00:30:34,840
Speaker 4: and it sort of goes like that. But as I say,

628
00:30:34,960 --> 00:30:37,360
Speaker 4: it's a bit like the research papers. For every high

629
00:30:37,440 --> 00:30:39,600
Speaker 4: profile athlete I can find you, I can that we

630
00:30:39,640 --> 00:30:41,720
Speaker 4: can find that say that happened during their period. We

631
00:30:41,760 --> 00:30:44,560
Speaker 4: can find another one who it didn't. But it's just

632
00:30:44,560 --> 00:30:46,840
Speaker 4: whether or not their stories sort of make it out

633
00:30:46,880 --> 00:30:48,080
Speaker 4: there in the same way.

634
00:30:48,560 --> 00:30:49,280
Speaker 3: I think what is.

635
00:30:49,240 --> 00:30:52,040
Speaker 4: Interesting though, is will it become almost like a self

636
00:30:52,080 --> 00:30:55,680
Speaker 4: fulfilling prophecy, because again, you know from the anecdotal evidence.

637
00:30:55,720 --> 00:30:58,560
Speaker 4: As we've said, now, they're you know, they're talking about it,

638
00:30:58,600 --> 00:30:59,520
Speaker 4: players and athletes.

639
00:30:59,760 --> 00:31:01,400
Speaker 3: It's on their minds.

640
00:31:02,280 --> 00:31:04,800
Speaker 4: And I think, you know, if you're worried about sustaining

641
00:31:04,800 --> 00:31:07,880
Speaker 4: an injury in that phase, maybe you'll be more tentative

642
00:31:08,160 --> 00:31:09,400
Speaker 4: in the tackles that you make.

643
00:31:09,520 --> 00:31:10,840
Speaker 3: You know, you'll be distracted, you.

644
00:31:10,800 --> 00:31:14,400
Speaker 4: Have anxiety, and it's maybe those things that will you know,

645
00:31:14,640 --> 00:31:16,760
Speaker 4: cause you to make a bad decision or cause you

646
00:31:16,840 --> 00:31:19,800
Speaker 4: just to make the movement slightly different. And maybe we

647
00:31:19,880 --> 00:31:22,240
Speaker 4: will see an increase in the occurrence of them then.

648
00:31:22,360 --> 00:31:25,040
Speaker 4: But will it be down to low estrogen.

649
00:31:25,560 --> 00:31:26,520
Speaker 3: I think it's unlikely.

650
00:31:26,560 --> 00:31:27,960
Speaker 4: I think it may be down to sort of some

651
00:31:28,040 --> 00:31:32,320
Speaker 4: of those wider biopsychosocial aspects. So yeah, I think we

652
00:31:32,400 --> 00:31:34,480
Speaker 4: have to be careful for sure. What I don't want

653
00:31:34,520 --> 00:31:36,560
Speaker 4: to do is come across and I'm discounting. You know,

654
00:31:36,640 --> 00:31:40,200
Speaker 4: I have absolutely believed that, you know, these injuries are occurring,

655
00:31:40,280 --> 00:31:41,920
Speaker 4: and you know, even all three in.

656
00:31:41,880 --> 00:31:42,600
Speaker 3: The same phase.

657
00:31:43,000 --> 00:31:46,640
Speaker 4: But personally, you know, based on my experience and what

658
00:31:46,680 --> 00:31:49,440
Speaker 4: I've read and my research in twenty something years in

659
00:31:49,440 --> 00:31:52,320
Speaker 4: this area, I don't think that that was the deal breaker,

660
00:31:52,680 --> 00:31:53,480
Speaker 4: you know, amongst this.

661
00:31:53,760 --> 00:31:56,360
Speaker 1: Right, well, and if you actually had her in to

662
00:31:56,480 --> 00:31:57,920
Speaker 1: do a study, you would have to look at the

663
00:31:57,960 --> 00:32:01,800
Speaker 1: calendar of how often games have happened, fun menstrual weeks,

664
00:32:01,840 --> 00:32:04,920
Speaker 1: and what surface was she playing on? And you know

665
00:32:05,240 --> 00:32:09,680
Speaker 1: she differently as a result of all of that stuff. Okay,

666
00:32:09,680 --> 00:32:13,200
Speaker 1: a couple last questions for you. I actually asked my trainer,

667
00:32:13,240 --> 00:32:15,520
Speaker 1: who does the physiological side of it really well, which

668
00:32:15,560 --> 00:32:17,040
Speaker 1: is why I work with him, because I have lots

669
00:32:17,080 --> 00:32:19,200
Speaker 1: of injuries from sports and he works with a lot

670
00:32:19,200 --> 00:32:22,240
Speaker 1: of women, And wondered, is exercise a one size fit all?

671
00:32:22,720 --> 00:32:25,240
Speaker 1: You know, if women are not all the same structurally

672
00:32:25,600 --> 00:32:27,720
Speaker 1: and then everyone follows the same protocol, will we see

673
00:32:27,720 --> 00:32:29,880
Speaker 1: a decrease in injury? Or does it really have to

674
00:32:29,920 --> 00:32:33,600
Speaker 1: be so specific to each person? Oh?

675
00:32:33,920 --> 00:32:34,720
Speaker 3: Can it be both?

676
00:32:36,200 --> 00:32:39,920
Speaker 4: You know? I think for sure we still have general

677
00:32:39,960 --> 00:32:44,040
Speaker 4: principles you know of exercise prescription that will hold true

678
00:32:44,040 --> 00:32:46,000
Speaker 4: for men and for women. You know there are good

679
00:32:46,040 --> 00:32:50,240
Speaker 4: principles about specificity. You know about thresholds, all of those

680
00:32:50,280 --> 00:32:52,520
Speaker 4: things they're true, and you know there are the big

681
00:32:52,560 --> 00:32:57,080
Speaker 4: pillars around recovery and load and sleep and nutrition and

682
00:32:57,160 --> 00:32:59,480
Speaker 4: all of those things. So I do think, you know,

683
00:32:59,520 --> 00:33:03,640
Speaker 4: we have good principles that will fit the majority. I

684
00:33:03,680 --> 00:33:05,800
Speaker 4: think what we have to get better at doing is

685
00:33:06,360 --> 00:33:12,520
Speaker 4: considering things that affect just women. And you know, by

686
00:33:12,600 --> 00:33:15,920
Speaker 4: considering them, that doesn't necessarily mean we have to change something,

687
00:33:16,320 --> 00:33:19,160
Speaker 4: you know, it means that we've thought about them, we've

688
00:33:19,280 --> 00:33:22,240
Speaker 4: tested them out, and for those who are affected, we've

689
00:33:22,240 --> 00:33:25,280
Speaker 4: done something. For those who are unaffected, we've moved on by,

690
00:33:25,600 --> 00:33:27,120
Speaker 4: you know, because there are so many things.

691
00:33:27,360 --> 00:33:28,600
Speaker 3: So of course, you know, you and I.

692
00:33:28,560 --> 00:33:31,640
Speaker 4: Are talking about ovarying homeost today, which is my expertise,

693
00:33:31,720 --> 00:33:33,880
Speaker 4: but you know, some of the other considerations could be

694
00:33:33,960 --> 00:33:36,959
Speaker 4: around breast health, so you know, the right fitting bra,

695
00:33:37,560 --> 00:33:41,440
Speaker 4: breast biomechanics, you know, is how we're moving. Is that

696
00:33:41,560 --> 00:33:46,080
Speaker 4: causing us you know any you know, adversity or advantage

697
00:33:46,480 --> 00:33:48,280
Speaker 4: and pelvic floor health and all.

698
00:33:48,200 --> 00:33:48,720
Speaker 3: Of those things.

699
00:33:48,760 --> 00:33:51,360
Speaker 4: So I think it's about, you know, taking what we

700
00:33:51,480 --> 00:33:55,760
Speaker 4: know and then adjusting it if necessary. But I think

701
00:33:55,880 --> 00:33:59,520
Speaker 4: it's more it's more nuanced. Oh my god, I need

702
00:33:59,520 --> 00:34:01,080
Speaker 4: to widen my vocabulary, don't.

703
00:34:00,840 --> 00:34:03,800
Speaker 1: I I use that word a lot too. It's a

704
00:34:03,880 --> 00:34:05,959
Speaker 1: useful one and it's so necessary these days.

705
00:34:06,240 --> 00:34:08,200
Speaker 4: And I don't want people to get the you know,

706
00:34:08,280 --> 00:34:11,680
Speaker 4: the misconception that it's complex, because complex seems like it's

707
00:34:11,719 --> 00:34:14,040
Speaker 4: an excuse not to think about it, not to do it,

708
00:34:14,120 --> 00:34:16,319
Speaker 4: not to study it, not to talk about it. So

709
00:34:16,360 --> 00:34:19,760
Speaker 4: it's not complex, it's just a different way of thinking.

710
00:34:19,840 --> 00:34:22,759
Speaker 4: It's about upskilling, getting this body literacy, whether it's for

711
00:34:22,800 --> 00:34:25,719
Speaker 4: yourself as the athlete, as the exercise, or whether you're

712
00:34:25,760 --> 00:34:26,600
Speaker 4: the practitioner, the.

713
00:34:26,680 --> 00:34:27,600
Speaker 3: Trainer, the coach.

714
00:34:28,360 --> 00:34:30,560
Speaker 4: Once we have this knowledge, we can start to test

715
00:34:30,640 --> 00:34:33,360
Speaker 4: these things out. And as I say, more often than not,

716
00:34:33,520 --> 00:34:35,960
Speaker 4: when we start to do these things with female athletes,

717
00:34:36,160 --> 00:34:39,879
Speaker 4: the majority are not significantly affected. So that's great news,

718
00:34:39,880 --> 00:34:41,759
Speaker 4: by the way, because I think if you were to

719
00:34:41,800 --> 00:34:43,920
Speaker 4: go on to social media right now, you would think

720
00:34:43,920 --> 00:34:46,120
Speaker 4: that we would have to change our whole lives based

721
00:34:46,120 --> 00:34:48,840
Speaker 4: on this one thing, and that's just not true. It's

722
00:34:48,880 --> 00:34:51,799
Speaker 4: got a little bit overinflated. It's the pendulum swing, right.

723
00:34:52,040 --> 00:34:54,440
Speaker 4: We've gone from you know, the dark ages where we never.

724
00:34:54,320 --> 00:34:56,879
Speaker 3: Spoke about it. It was a taboo hate that word

725
00:34:56,920 --> 00:34:57,840
Speaker 3: as well, by the way.

726
00:34:58,000 --> 00:34:59,920
Speaker 4: And now it's almost like, you know, we've gone to

727
00:35:00,080 --> 00:35:02,360
Speaker 4: the other end of the ex you know, the extremes.

728
00:35:02,440 --> 00:35:04,799
Speaker 4: The pendulum has swung all the way over and now

729
00:35:04,840 --> 00:35:07,560
Speaker 4: it seems to be you know, the go to the everything.

730
00:35:07,920 --> 00:35:10,000
Speaker 4: So I'd like for us to course correct, come back

731
00:35:10,000 --> 00:35:13,200
Speaker 4: into the middle. Let's get more knowledge and awareness. Let's

732
00:35:13,239 --> 00:35:15,560
Speaker 4: really test these things out, and let's remember that if

733
00:35:15,560 --> 00:35:17,680
Speaker 4: you're not affected, that's great news.

734
00:35:17,760 --> 00:35:19,960
Speaker 3: Move on. There's so many other things to consider.

735
00:35:20,239 --> 00:35:23,040
Speaker 4: And if you are affected, again, that's not bad news.

736
00:35:23,080 --> 00:35:26,239
Speaker 4: There are lots of interventions out there. If you have symptoms,

737
00:35:26,440 --> 00:35:30,880
Speaker 4: there are either pharmaceutical avenues to explore, or there are.

738
00:35:31,000 --> 00:35:33,359
Speaker 3: Changes in diet or recovery that we can do.

739
00:35:33,719 --> 00:35:36,520
Speaker 4: If you have heavy mental bleeding, there are therapies and

740
00:35:36,520 --> 00:35:39,600
Speaker 4: treatments for that, or we can change the environment so that,

741
00:35:39,640 --> 00:35:41,799
Speaker 4: you know, mental psycho products are more accessible.

742
00:35:42,200 --> 00:35:43,640
Speaker 3: There are solutions to.

743
00:35:43,640 --> 00:35:46,359
Speaker 4: The challenges the female athletes face, but I think it's

744
00:35:46,400 --> 00:35:48,839
Speaker 4: about being mindful of them, testing them out and then

745
00:35:48,880 --> 00:35:51,879
Speaker 4: looking for interventions. I hate when people say, you know, oh,

746
00:35:51,960 --> 00:35:55,520
Speaker 4: we have to constantly adjust training on these things. No,

747
00:35:55,719 --> 00:35:59,200
Speaker 4: let's be proactive instead of reactive. Let's learn about them,

748
00:35:59,280 --> 00:36:02,680
Speaker 4: let's test them, Let's get interventions, and that way women

749
00:36:02,719 --> 00:36:05,000
Speaker 4: and girls can train and compete as.

750
00:36:04,800 --> 00:36:07,200
Speaker 3: They want to on any day of the mental cycle.

751
00:36:07,280 --> 00:36:09,520
Speaker 3: That's the goal, right, Yeah, I.

752
00:36:09,440 --> 00:36:11,920
Speaker 1: Think part of the reach is that people want answers,

753
00:36:12,080 --> 00:36:15,520
Speaker 1: especially as there's more investment, more money, more care about

754
00:36:15,520 --> 00:36:19,960
Speaker 1: these athletes to lose so many top particularly football players

755
00:36:20,000 --> 00:36:22,319
Speaker 1: soccer players, to acl We want to be able to

756
00:36:22,360 --> 00:36:24,520
Speaker 1: have this easy answer of oh, now that we understand it,

757
00:36:24,560 --> 00:36:27,600
Speaker 1: we can fix it immediately. But is it modifiable through

758
00:36:27,640 --> 00:36:30,880
Speaker 1: training versus just being biological in terms of women getting

759
00:36:30,880 --> 00:36:33,880
Speaker 1: their acls torn more commonly, or is it still a

760
00:36:33,880 --> 00:36:37,000
Speaker 1: matter of, like you said, really comprehensive study of all

761
00:36:37,000 --> 00:36:38,440
Speaker 1: the factors that might be contributing.

762
00:36:38,640 --> 00:36:38,799
Speaker 3: Yeah.

763
00:36:39,040 --> 00:36:41,839
Speaker 4: I think the investment, you know, whilst really welcome into

764
00:36:41,840 --> 00:36:46,319
Speaker 4: the research, you know side of things, I think there's

765
00:36:46,360 --> 00:36:49,880
Speaker 4: only so much we can do. So firstly, good quality research.

766
00:36:50,120 --> 00:36:52,760
Speaker 4: You know that we have confidence in the finding. It's slow,

767
00:36:52,920 --> 00:36:56,799
Speaker 4: it takes time. We also need the athletes to be involved. So,

768
00:36:56,920 --> 00:36:59,719
Speaker 4: you know, when we hear the elite female athletes calling

769
00:36:59,719 --> 00:37:03,120
Speaker 4: for more research, by definition that requires them to.

770
00:37:03,120 --> 00:37:06,200
Speaker 3: Take part in research. But they're busy people who've got

771
00:37:06,280 --> 00:37:09,239
Speaker 3: huge demands. So it becomes a little bit of a vicious.

772
00:37:08,920 --> 00:37:11,640
Speaker 4: Circle that they want answers, but the researchers need the

773
00:37:11,680 --> 00:37:14,120
Speaker 4: athletes to take part to get those answers. So you

774
00:37:14,160 --> 00:37:18,400
Speaker 4: know that availability is difficult, So firstly, research is slow. Secondly,

775
00:37:18,480 --> 00:37:20,440
Speaker 4: you know it needs the athletes to be involved in

776
00:37:20,480 --> 00:37:23,319
Speaker 4: that can be difficult. And then I guess thirdly, you know,

777
00:37:23,400 --> 00:37:26,480
Speaker 4: research is about taking a small sample from the population

778
00:37:26,520 --> 00:37:28,520
Speaker 4: and then trying to generalize those findings.

779
00:37:28,840 --> 00:37:30,279
Speaker 3: I'm not entirely sure when it.

780
00:37:30,239 --> 00:37:33,080
Speaker 4: Comes to something like ovarian homown profiles that will ever

781
00:37:33,160 --> 00:37:35,719
Speaker 4: have a universal blueprint For all the reasons that we've

782
00:37:35,719 --> 00:37:39,239
Speaker 4: been talking about, Sarah, it's so individual. Those profiles are

783
00:37:39,239 --> 00:37:41,799
Speaker 4: so variable. You know, my peak of estrogen in this

784
00:37:41,880 --> 00:37:44,919
Speaker 4: cycle might be lower or higher. You know, it's still

785
00:37:44,920 --> 00:37:46,520
Speaker 4: a peak, but it could be lower higher in the

786
00:37:46,560 --> 00:37:49,799
Speaker 4: next cycle. So with all that variability, will research ever

787
00:37:49,840 --> 00:37:52,360
Speaker 4: give us a blueprint? So I think that's difficult. So

788
00:37:52,440 --> 00:37:55,439
Speaker 4: going back to your question, I think that investment, yes, please,

789
00:37:55,560 --> 00:37:56,920
Speaker 4: let's have some for research.

790
00:37:57,040 --> 00:37:58,680
Speaker 3: Don't want to talk myself out of the job.

791
00:37:58,719 --> 00:38:02,320
Speaker 4: It is important with those caveats, but maybe the investment

792
00:38:02,400 --> 00:38:04,279
Speaker 4: needs to go into that sort of wider you know,

793
00:38:04,400 --> 00:38:08,280
Speaker 4: women's sports funding it making sure they have adequate salaries

794
00:38:08,320 --> 00:38:10,880
Speaker 4: so that when they go home, they're not going home.

795
00:38:10,640 --> 00:38:11,799
Speaker 3: To do a second job.

796
00:38:11,880 --> 00:38:13,840
Speaker 4: You know that they can go home and recover that

797
00:38:13,920 --> 00:38:16,680
Speaker 4: they have, you know, enough money to fuel themselves. Well,

798
00:38:17,000 --> 00:38:19,520
Speaker 4: you know that they're on good pit surfaces, all of

799
00:38:19,520 --> 00:38:22,880
Speaker 4: those things. So the investment is super welcome, but it

800
00:38:22,920 --> 00:38:24,000
Speaker 4: needs to do a lot of things.

801
00:38:24,600 --> 00:38:25,879
Speaker 2: Okay, no, we're running out of time.

802
00:38:25,880 --> 00:38:27,759
Speaker 1: But now you maybe think of another question that I

803
00:38:27,760 --> 00:38:30,000
Speaker 1: feel like as an endochronologist, even though it might not

804
00:38:30,040 --> 00:38:32,080
Speaker 1: be your focus, you might be able to answer, which is,

805
00:38:32,440 --> 00:38:35,640
Speaker 1: do women have the same fluctuating levels of testosterone in

806
00:38:35,680 --> 00:38:37,320
Speaker 1: their bodies or does that stay steady?

807
00:38:38,040 --> 00:38:38,279
Speaker 2: Oh?

808
00:38:38,760 --> 00:38:43,320
Speaker 4: So, yes, testosterone does fluctuate, but not to the same extent,

809
00:38:44,200 --> 00:38:48,640
Speaker 4: so the magnitude and the frequency of those fluctuations is

810
00:38:48,960 --> 00:38:52,280
Speaker 4: not as much, so particularly in something like the MENSTU cycle.

811
00:38:52,360 --> 00:38:55,560
Speaker 4: Bioavailable testosterone and now I'm sorry, I feel like I'm

812
00:38:55,560 --> 00:39:00,000
Speaker 4: going into full nerd and science jeogonal but biovailable testostere

813
00:39:00,000 --> 00:39:03,040
Speaker 4: Your own isn't fluctuating to anywhere near the same extent

814
00:39:03,080 --> 00:39:06,080
Speaker 4: as something like bioavailable each to dial. So yes, it

815
00:39:06,160 --> 00:39:08,879
Speaker 4: does change, but not so much in a meaningful way

816
00:39:08,880 --> 00:39:11,279
Speaker 4: that we're really concerned about how that's affecting things like

817
00:39:11,400 --> 00:39:13,360
Speaker 4: muscle strength and muscle capacity and function.

818
00:39:14,080 --> 00:39:15,719
Speaker 2: Yeah, that's a topic for another time.

819
00:39:15,760 --> 00:39:17,799
Speaker 1: I've just started thinking about that because of the ways

820
00:39:17,800 --> 00:39:21,279
Speaker 1: that sometimes testosterone and these like artificial caps on what

821
00:39:21,400 --> 00:39:25,080
Speaker 1: testosterone levels women can or can't have might impact their

822
00:39:25,120 --> 00:39:28,279
Speaker 1: ability to compete. And I wondered if testosterone fluctuated the

823
00:39:28,280 --> 00:39:30,800
Speaker 1: same way, kind of in the same vein, but slightly different.

824
00:39:30,800 --> 00:39:33,319
Speaker 1: I wanted to ask this too. You know, sometimes when

825
00:39:33,360 --> 00:39:36,200
Speaker 1: we talk about why it's so important to research cisgender

826
00:39:36,200 --> 00:39:39,120
Speaker 1: women's bodies and understand how their physiology is different than

827
00:39:39,120 --> 00:39:42,719
Speaker 1: that of cisgender men, those conversations sometimes can be weaponized

828
00:39:42,760 --> 00:39:46,160
Speaker 1: by those who oppose transgender inclusion in sports, even when

829
00:39:46,200 --> 00:39:49,520
Speaker 1: there's also very little research out there about transgender athletes

830
00:39:49,520 --> 00:39:52,920
Speaker 1: and their specific individual experiences. So I wonder how you

831
00:39:52,960 --> 00:39:55,680
Speaker 1: see the balance of sort of understanding that cisgender women

832
00:39:55,680 --> 00:39:58,759
Speaker 1: and sisgender men are physiologically different from each other, while

833
00:39:58,800 --> 00:40:02,920
Speaker 1: also not drawing huge conclusions about transgender competitors.

834
00:40:03,640 --> 00:40:06,359
Speaker 4: Yeah, so now I'm really getting out of my area

835
00:40:06,400 --> 00:40:10,040
Speaker 4: of expertise, and I work with some colleagues who've, you know,

836
00:40:10,160 --> 00:40:13,319
Speaker 4: really got some expertise and experience with with transathletes.

837
00:40:13,360 --> 00:40:14,759
Speaker 3: So I wish they were sat here with me.

838
00:40:15,440 --> 00:40:18,040
Speaker 4: What I will say is Yeah, I don't think that

839
00:40:18,080 --> 00:40:22,120
Speaker 4: we As we talk about some sex differences between cisgender

840
00:40:22,200 --> 00:40:24,600
Speaker 4: men and cisgender women, I don't think they should be

841
00:40:24,680 --> 00:40:29,240
Speaker 4: necessarily or at all actually extrapolated into the trans athlete space.

842
00:40:29,560 --> 00:40:33,360
Speaker 4: I think that's doing transathletes a disservice. I personally feel

843
00:40:33,360 --> 00:40:36,759
Speaker 4: that as a researcher who's been researching cisgender women or

844
00:40:36,800 --> 00:40:39,600
Speaker 4: varying hormones for the last twenty five years, that does

845
00:40:39,640 --> 00:40:42,520
Speaker 4: not give me the expertise or the knowledge or the

846
00:40:42,680 --> 00:40:45,439
Speaker 4: right to speak to trans physiology. So I haven't really

847
00:40:45,480 --> 00:40:47,680
Speaker 4: answered your question there, but I agree with you that

848
00:40:47,719 --> 00:40:50,160
Speaker 4: I think we should be cautious. You know, my area

849
00:40:50,200 --> 00:40:53,359
Speaker 4: is specifically focused on this, and it cannot be used

850
00:40:53,400 --> 00:40:55,759
Speaker 4: to speak about something you know that may well be

851
00:40:55,800 --> 00:40:58,080
Speaker 4: again more nuanced or different.

852
00:40:58,640 --> 00:41:01,879
Speaker 1: Yeah, that makes sense. It's always hard on this show

853
00:41:01,920 --> 00:41:04,120
Speaker 1: because it's a show about women's sports. We want to

854
00:41:04,120 --> 00:41:07,600
Speaker 1: talk about women, but obviously that category is broad, and

855
00:41:07,680 --> 00:41:09,799
Speaker 1: so sometimes it might feel like we're leaving out non

856
00:41:09,840 --> 00:41:13,840
Speaker 1: binary or trans women or otherwise, and it can be

857
00:41:13,880 --> 00:41:17,400
Speaker 1: complicated to talk about these topics. But this was so fascinating.

858
00:41:17,480 --> 00:41:19,400
Speaker 1: I could keep you here so much longer. Just keep

859
00:41:19,440 --> 00:41:21,879
Speaker 1: peppering you with questions that I probably should have learned

860
00:41:21,880 --> 00:41:23,560
Speaker 1: and sex at or at least at some other point

861
00:41:23,600 --> 00:41:25,520
Speaker 1: over the course of my forty plus years on this earth,

862
00:41:25,800 --> 00:41:28,160
Speaker 1: and yet I haven't thank you so much.

863
00:41:28,280 --> 00:41:29,360
Speaker 2: This was so fantastic.

864
00:41:29,520 --> 00:41:32,680
Speaker 4: You're very welcome. Thank you for the really great, insightful questions.

865
00:41:33,080 --> 00:41:34,720
Speaker 4: I hope that the listeners find them useful.

866
00:41:37,760 --> 00:41:40,120
Speaker 1: Thanks so much to doctor Elliott Sale for joining us.

867
00:41:40,160 --> 00:41:42,040
Speaker 1: We got to take another break when we come back.

868
00:41:42,120 --> 00:41:45,839
Speaker 1: Some stats that help put the WNBA's injury issues in perspective.

869
00:41:46,080 --> 00:41:56,360
Speaker 5: That's next, Welcome back slices.

870
00:41:56,400 --> 00:41:57,920
Speaker 1: We always love that you're listening, but we want you

871
00:41:57,960 --> 00:41:59,839
Speaker 1: to get in the game every day too, So here's

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00:41:59,840 --> 00:42:02,600
Speaker 1: our good game play of the day. Follow doctor Elliot

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00:42:02,600 --> 00:42:05,040
Speaker 1: Sayle on social media. We'll link to her profile in

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00:42:05,120 --> 00:42:08,080
Speaker 1: our show notes. And we're always interested in reading more

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00:42:08,120 --> 00:42:10,600
Speaker 1: about this topic. So if you read a great scientific

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00:42:10,640 --> 00:42:13,919
Speaker 1: study or hear of a great story about this, send

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00:42:14,000 --> 00:42:15,720
Speaker 1: it our way. You can hit us up on email

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00:42:15,760 --> 00:42:18,320
Speaker 1: Good game at wondermedianetwork dot com or leave us a

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00:42:18,400 --> 00:42:21,759
Speaker 1: voicemail at eight seven two two four fifty seventy and

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00:42:21,840 --> 00:42:25,120
Speaker 1: don't forget to subscribe, rate and review slices. It's so

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00:42:25,320 --> 00:42:30,080
Speaker 1: easy watch the upsetting amount of injuries this WNBA season,

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00:42:30,520 --> 00:42:35,560
Speaker 1: rating out a review As of August eleventh, per a

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00:42:35,640 --> 00:42:39,279
Speaker 1: tracker by the Next Tubes and reporter Lucas Siehoffer, with

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00:42:39,400 --> 00:42:41,400
Speaker 1: four weeks to play, there have already been one hundred

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00:42:41,440 --> 00:42:44,960
Speaker 1: and eighty seven injuries this WNBA season, twelve more than

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00:42:45,000 --> 00:42:47,480
Speaker 1: there were the entirety of the twenty twenty three campaign,

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Speaker 1: and on pace to eclipse the two hundred three injuries

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00:42:50,680 --> 00:42:53,760
Speaker 1: suffered last season. A total of seven hundred and sixty

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Speaker 1: four games have been lost this season between all injured players.

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Speaker 2: Now, why is this happening?

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00:42:59,440 --> 00:43:04,120
Speaker 1: Well, more games, less rest, and more players to potentially

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00:43:04,160 --> 00:43:06,920
Speaker 1: get injured. Frankly, with thirteen teams now in the league,

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00:43:07,360 --> 00:43:11,719
Speaker 1: however you slice it, slices, this sucks. It's never fun

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00:43:11,719 --> 00:43:13,640
Speaker 1: to start working on our episodes and realize we have

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Speaker 1: to announce that another player has gone down. But one

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Speaker 1: thing that does give me some solace folks like doctor

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00:43:19,760 --> 00:43:22,800
Speaker 1: Elliott Sayle, who are working tirelessly to help us find

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00:43:22,800 --> 00:43:25,800
Speaker 1: some answers and make the game safer for every athlete

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Speaker 1: who suits up. Now it's your turn, y'all, rate and review.

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Speaker 1: Thanks for listening, See you tomorrow. Good Game, Doctor, Kirsty,

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00:43:33,440 --> 00:43:37,120
Speaker 1: Good Game, athletes who still kick ass during their period you,

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00:43:37,320 --> 00:43:39,560
Speaker 1: anyone who underestimates period pain.

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00:43:39,960 --> 00:43:42,040
Speaker 2: Those craps can be killers sometimes.

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Speaker 1: Good Game with Sarah Spain is an iHeart women's sports

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Speaker 1: production in partnership with Deep Blue Sports and Entertainment. You

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00:43:51,760 --> 00:43:54,880
Speaker 1: can find us on the iHeartRadio app, Apple Podcasts, or

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00:43:54,920 --> 00:43:58,520
Speaker 1: wherever you get your podcasts. Production by Wonder Media Network,

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00:43:58,760 --> 00:44:01,240
Speaker 1: our producers are Alex and Misha Jones.

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00:44:01,560 --> 00:44:04,160
Speaker 2: Our executive producers are Christina Everett.

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00:44:03,880 --> 00:44:06,720
Speaker 5: Jesse Katz, Jenny Kaplan and Emily Rutder.

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00:44:07,120 --> 00:44:10,480
Speaker 1: Our editors are Emily Rutter, Britney Martinez, Grace Lynch, and

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00:44:10,560 --> 00:44:11,360
Speaker 1: Gianna Palmer.

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Speaker 2: Our associate producer is Lucy Jones.

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Speaker 1: Production assistance from Avery Loftus and I'm Your Host Sarah

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Speaker 1: Spain