Document Type


Publication Date



Background: Optimal athletic performance may be dependent upon an athlete maintaining adequate iron levels through the consumption of dietary forms of iron and subsequent metabolism. Endurance athletes, especially female distance runners, have been identified as being at risk for developing iron deficiency. While iron deficiency is treatable, early diagnosis may be delayed if an adequate medical history and evaluation is not conducted.

Objective: To describe the evaluation, diagnosis, and comprehensive sports medicine treatment of a collegiate cross-country athlete with a medical diagnosis of iron deficiency with anemia and sports-related musculoskeletal pain.

Case Description: A 21-year-old female collegiate crosscountry athlete experienced a decline in her running performance beginning her freshman year of school. She continued to experience degradation in sports performance despite medical intervention. Two-and-a-half years after initially seeking medical attention she was diagnosed with iron deficiency with anemia by a primary care medical doctor. Additionally, the subject required rehabilitation due to the onset of sports-related musculoskeletal symptoms.

Outcomes: Comprehensive treatment for this patient consisted of iron supplementation, therapeutic exercises, manual therapy, and modalities. The athlete was able to compete during her entire cross-country season and earn All-American status at the Division-III level.

Discussion: Sports medicine professionals must consider iron deficiency as a possible differential diagnosis when evaluating endurance athletes. Subtle signs of iron deficiency may, unfortunately, be overlooked ultimately delaying treatment.