What Every Sport Parent Should Know About Female Adolescent Development

By Dr. Nikole MacLellan, ND (Dr. Kokes)

Adolescence is a time of rapid physical, emotional, and psychological change. For female athletes in particular, these shifts can significantly impact health, performance, and overall well-being. Coaches, parents, and healthcare providers can benefit from understanding these changes to support young women as they navigate this critical stage of development.

Q Angle and Knee Health

One important biomechanical change in female adolescents is the widening of the hips, which increases the Q angle (the angle between the hips and knees).

A larger Q angle can:

• Increase the risk for knee injuries, particularly ACL tears.
• Alter mechanics and balance during movement.
• Require specific strength and stability work around the knee joint.

Research indicates that a higher Q angle is associated with increased lateral forces on the patella and altered knee biomechanics, which may partly explain why adolescent female athletes are at a higher risk of knee injuries compared to their male peers. However, Q angle alone is not the sole predictor of injury risk, highlighting the importance of neuromuscular training and strengthening.

Read more about Injury Prevention for Girls in Sport here.

Brain Changes and Emotional Health

Adolescence also brings about major changes in the brain, which can affect mental health and cognitive development.

• Anxiety and Depression: Girls at puberty experience much higher rates compared to boys, which can affect self-confidence and athletic engagement.
• Complex Strategy: The brain’s capacity for learning and processing complex strategies is very high, making this an ideal time for teaching tactical and strategic skills.
• Moral Development: Adolescents begin to explore morality and altruism in deeper ways, which can heighten sensitivity to feedback and social comparison.

Low Energy Availability

Fueling properly is crucial for female athletes, but adolescence can bring challenges that make this more difficult.

• Increased Belly Fat and Breast Tissue: Hormonal changes lead to fat storage around the midsection and breast development, which may affect body image.
• Lower Hemoglobin Levels: Combined with menstruation and athletic demands, this raises the risk of anemia.
• Risk of Disordered Eating: Pressure around body composition and performance can increase the likelihood of unhealthy eating behaviors.

Low energy availability (LEA) has been linked to menstrual irregularities, impaired bone health, and a higher risk of injury in adolescent athletes. Importantly, recent research suggests many adolescent athletes may under-fuel inadvertently, underscoring the need for education on energy needs during growth and sport.

Read more about fueling female athlete bodies here.

Other Systemic Considerations

Adolescence impacts many other body systems that play a role in sports performance and self-esteem:

• Bone Remodeling and Growing Pains: Bones lengthen before filling out, raising fracture risk without adequate nutrition.
• Heart and Lung Capacity: Since boys generally develop larger hearts and lungs, performance comparisons between genders can become challenging.
• Body Odor and Hair: These normal changes can be a blow to confidence. Grooming and self-care choices should be framed as personal rather than prescriptive.

Vaginal Changes

Vaginal health is another important aspect of adolescent development that often isn’t discussed openly.

• Bacterial Vaginosis: May present with gray discharge and odor.
• Yeast Infections: Often cause thick, itchy discharge.
• Vaginitis: Can cause discomfort and irritation.

It’s also important to remind young women that discharge is normal and naturally changes throughout the menstrual cycle.

Final Thoughts

Female adolescents go through profound changes that affect their physical health, mental well-being, and athletic performance. By understanding these shifts, ranging from biomechanics to brain development, nutrition, systemic growth, and reproductive health, we can better support young women through this transformative stage.

For coaches, trainers, and parents, the goal should always be education, empowerment, and support so that young athletes build not only their skills but also their confidence and resilience.

About the Author

Dr. Nikole MacLellan, ND (better known as Dr. Kokes), is a former national and varsity athlete turned naturopathic doctor specializing in sports medicine, pain management, and performance optimization. With a background in human nutrition, advanced training through the International Society of Sports Nutrition, and sport medicine training at Harvard, she helps athletes and everyday performers recover, thrive, and reach their full potential.

Learn more

You can follow Dr. Kokes on Instagram at @sportsdockokes or learn more about her practice at Proactive Performance.