Despite the fact that women are conquering world championships and demanding the salaries they deserve, they’re still so often maltreated by the coaches and medical professionals whose job is to care for them. Elite runner Mary Cain—who became the youngest American track and field athlete to represent the U.S. on a World Championships team at age 16—is speaking out on behalf of every female body in professional sports.
In an opinion piece published Thursday by the New York Times, Cain details the alleged abuse and negligent care—including intense pressure to lose weight—she says she experienced under the coaching of Alberto Salazar at Nike’s Oregon Project.
“[W]hen young women are forced to push themselves beyond what they’re capable of at their given age, they’re at risk for developing RED-S,” says Cain in a video for the New York Times. RED-S, or Relative Energy Deficiency in Sports syndrome, occurs when athletes burn through more energy than they’re getting from food. The condition affects menstrual function, immunity, psychological well-being, and bone health. “Suddenly, you realize you’ve lost your period for a couple months. Then a couple months becomes a couple years. In my case, it was a total of three. And if you’re not getting your period, you’re not going to be able to have the necessary levels of estrogen to maintain strong bone health. And in my case, I broke five different bones.”
Sports medicine doctor Jordan Metzl, MD, points out that Cain’s injuries fit the female athlete triad, which presents as amenorrhea, low energy, and/or decreased bone mineral density. Studies have estimated that up to 26.6 percent of female athletes exhibit components of the triad. Any medical professional or coach should have the knowledge to recognize and adjust training when these symptoms arise in their athletes, says Dr. Metzl.
“Every athlete is different, and it’s important to be responsive to the things that athletes are telling you,” says Dr. Metzl. “Women are more likely [than men] to get knee injuries. They’re about five or six times more likely to get ACL injuries. They’re more likely to get stress fractures.” Women who experience amenorrhea over an extended period of time can develop an estrogen deficiency that may lead to a decreased bone marrow density.
Cain says she learned this biology lesson “the hard way”—with broken bones. But she shouldn’t have had to learn anything “the hard way.” Dr. Metzl suggests that even before Cain’s very first injury, the medical professionals in her corner should have recognized the restrictive diet’s negative effects on her body, and adjusted her training and caloric intake accordingly.
“As a sports medicine doctor, I see all kinds of athletes of all different ages in all different sports—and every sport has their issues. In running, it’s overuse injuries,” says Dr. Metzl. The job of the athlete is to communicate when her body isn’t responding well to training procedures; the coach’s job is to listen and adjust the plan accordingly. “The big issue here is just being a good listener, and having a climate where your body’s being respected.”
Cain didn’t find herself in a place where her needs were being met, and it makes me wonder: if the young runner had approached her team as a man, would they have listened to her protests? Would they have decided to adjust her nutrition and training plan? It’s impossible to know. But Cain’s decision to share her experience is the spotlight we needed to illuminate something so often overlooked.
I don’t usually go on group runs, but milling around with fellow runners for my first-ever trail run, as a total trail running beginner, I couldn’t help but catch a buzz. The atmosphere was festive and friendly, and I was positively gung-ho to try my hand (or rather, feet), at running up a mountain.
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The trail “running” part didn’t last long. My run turned to a jog turned to mostly a hike, at least on the uphills. In another situation—a road race, maybe—the self-doubt and light embarrassment that began to bubble up as the gap grew between me and the rest of the group might have turned into full-blown shame. But here’s the thing about trail running: Trail runners won’t let that happen.
Because trail runs take place on, well, trails, runs will typically have organizers called sweepers. These are people specifically designated to stay with the last runners in the group so no one gets stranded on the mountain, sometimes on confusing terrain, often without cell service. On this run, two sweepers, another runner, and I hiked on the uphills, and trotted on the flats and downhills—all following my pace. We finished the three mile loop in about an hour, and I genuinely felt proud.
“I’m not a trail runner,” I confessed to one of the sweepers. “Are you running on a trail? Then you’re a trail runner!” she said.
Photo: Rachel Kraus
Listen, runners love to say stuff like this to novices. It can feel cringey—patronizing, even—to be on the receiving end, when groups of runners are far ahead or lapping you. And while road races will sometimes have well meaning sweepers, too, there often isn’t room for novice or slow runners in races in particular: Pace inclusivity, with infrastructure and spectators that stay in place until the last runner has crossed the finish line, is something still severely lacking from many races.
But thanks to the sweepers on my first trail run, and their attitude that contained not a trace of the feeling that I was putting them out by making them go slow, I felt genuinely welcomed to the sport.
6 things to expect as the last runner on a group trail run
How did I find myself as a back of the pack runner on a mountain? Six months after I had my son, Hoka reached out to me to see if I would be interested in participating in a trail race training group. I told them that I was six months postpartum, that I hadn’t really been able to run since before my pregnancy, and that when I was running regularly pre-pregnancy, my longest distance was a 10K.
They still welcomed me to try out training with coaches from Sundog Running, fitness tracking from Suunto, nutritionist and mindset coaching, and Hoka gear. I was looking for a way to get back into running, and so with more than a little trepidation, I signed up. My goal: Running a 10K at the Kodiak UTMB trail running festival in Big Bear, California.
To kick off training, the trail running group met up at the Speedgoat UTMB race outside of Salt Lake City, Utah. Some members of the group would be participating in the 10K and 30K races, but plenty of us were just spectating and getting to know each other.
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Are you running on a trail? Then you’re a trail runner.
Despite the fact that I was not racing, I wanted to hit the trails. Hoka provided a pair of the race’s namesake shoes—the Speedgoat 6—in beautifully bombastic shades of orange, red, yellow, and purple. I learned from trail runners that it was a faux pas to have dust and dirt-free trail running shoes, so I needed to log some miles!
So my first night, I decided to join a “shakeout run,” which is a short, relaxed run the day before a larger race.
Photo: Rachel Kraus
The flaw in the plan? The “shakeout run” for Speedgoat racers was short for experienced trail runners, but a still challenging three miler for me. It also took place in the elite-level ski mountains of Utah, which meant steep inclines at high altitude. I had no idea what I was getting into. But if you ever find yourself as a novice or slow runner facing down a mountain, here’s what’s in store.
1. Expect to face actual hills
My preconception of trail running was that trail runs take place on flat or rolling hills. While this is certainly some trail running, it was definitely not the case at Speedgoat. So, my first lesson bringing up the rear on a trail run? Expect to get up a hill any way you can.
2. Expect to hike as well as run
It turns out that a lot of trail running is actually “speed hiking.” Sure, trail runners will run up hills. But even the most experienced will power hike rather than run, because it’s actually a more efficient use of energy, explained my Sundog coaches.
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The sweepers told me that hiking was a big part of trail running, so bringing up the rear in this way felt like I was still participating in the race.
3. Expect to switch up your paces
Both running and hiking on a run was an adjustment, because I have a bit of a mental block about walk-runs “counting” as a run. That was a notion I had to get over during pregnancy and my postpartum recovery. So I applied it to my trail run: Hiking the challenging uphills, and jogging the flats and downhills. Switching between the paces and terrains felt natural, especially because my group followed my lead.
4. Expect to talk!
My next lesson was that trail running in the back of the pack is not a solitary endeavor. I have never, ever completed a three mile run chatting the whole time. But even during the moments of huffing and puffing, the sweepers and other last participant kept me company. We talked about trail running, sure, but also our careers, travel memories, issues like sexism in outdoor sports, and more. I got to know my group to the point that we hugged and exchanged contact information at the end.
5. Expect to stop and smell the roses
There were also moments for reflection and fun. Because I wasn’t worried about making a race time, I got to stop and take photos, even just taking a moment to marvel at a waterfall. A great thing about trail races? They take place in nature. Basking in where you are is part of what it’s all about.
6. Expect to feel a quiet sort of pride
Coming to the end of the trail wasn’t a big showy moment—it was a shakeout run, not a true race. But the accomplishment I felt at being the absolute last person to “cross the finish line” surprised me nonetheless. There’s just something about knowing you’ve gone up a mountain that gets you high on life.
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I knew training for a 10K—which was more than twice the distance of my three mile loop—would not be easy. The road ahead would include struggles finding time for myself, postpartum joint pain, logistical issues, and so much more. But my first trail run, as the last runner in a far more experienced group, was a golden start.
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“I want you to believe that you’ve been doing this your whole life. You’re an athlete. You can do this,” said Kainoa McGee, my surf coach and waterman in Oahu, while holding down my board so I wouldn’t get carried away by waves. I was 30 minutes into my first-ever surf lesson off of Waikiki beach, and the taste of salt water had started to become overwhelming—my attempts to get up on the board for the past half-hour had me crashing back into the ocean with each try.
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We’d only just met, but somehow McGee could tell I was the overly ambitious, critical, and overthinking type. As a paddled back after (another) failed attempt, he told me “Get out of your head.” And he was right. My fear of falling off the board was literally making me fall off the board. In that moment, McGee felt like more than just a surf instructor and closer to a life coach. His words could easily be applied to so many areas in my life. I just had to get out of my head.
Trying surfing for the first time
Before an end-of-summer family vacation to Hawaii, I had never surfed a day in my life. I had also never even dreamed of trying the sport until the trip was planned. There aren’t a ton of black female surfers to model after (at least none I’d heard of or seen before), so it’s never been an activity I saw myself doing. But I’ve always been drawn to new experiences, and you can count me in for basically anything that has to do with fitness. I got my first chance during a week at Waikiki and becoming one with the water and waves.
I’m not particularly the strongest swimmer. I know a few basics for survival—treading water, doggy paddle, and I can float on my back…so basically, I know how to not drown! But swimming “athletically” and efficiently isn’t my strong suit. But I’m a six-time marathoner, personal trainer, running coach, indoor cycling instructor, and I dabble in yoga—there’s got to be some athletic capabilities that are transferable, right?
Surfers look so cool, confident, and strong. In my head, I felt like I could replicate that.
My inexperience (and teetering confidence) with water sports wasn’t stopping me from the challenge. Surfers look so cool, confident, and strong. In my head, I felt like I could replicate that in some way. I am a Virgo, after all! Trying new things and learning to master them is kinda my thing. Plus, research shows that new experiences are good for our emotional health, according to UW Medicine. They can gives us a hit of dopamine (those feel-good chemicals) and give us a sense of satisfaction. So I knew it would be hard—but I also knew that if I could pull it off, it would be worth it.
Surf’s up at surfing school
Anytime you want to try something kind of scary for the first time, it’s best to set yourself up for success. So for surfing, the first step was finding the perfect place to take a lesson. On Oahu there are plenty, but finding the right fig was important to me: I’m a pretty hands-on learner, so I was looking for an instructor that would be patient with me and happily answer the wave of questions I knew I’d have. During my first day in Hawaii, I went for a run and ran past a bright, eye-catching yellow school bus that was labeled “surf school bus.” Yes, please. I wanted to know which surfing school on Waikiki was going to bring me back to the days of boarding a yellow school bus (I loved the nostalgia!).
Turns out it was the Ohana Surf Project—an organization that prides themselves on having a “family-oriented approach” and aims to improve the lives of others, just like family. I was sold. I booked a two-hour private lesson for the following day (my birthday) and packed up the essentials: bathing suit, towel, and a good attitude for a day of trying something new, with the very high possibility of failing.
I arrived at the Ohana Surf Project homebase 15 minutes before the start of my lesson. I was given a long-sleeve shirt to throw on top of my bikini and some water shoes to protect my feet from rocks and the reef on the ocean floor. A group of us sat down for a quick orientation and water safety presentation. Turns out, you don’t have to be a strong swimmer to surf (per one of the instructors), and I was elated. Things you do need: balance, upper-body strength, and an aloha attitude. Then we loaded on the surf school bus to head to the beach.
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The water on Waikiki beach is so beautiful it looks fake. Crystal clear blue, white sand, and soft waves crashing in the Pacific Ocean…a total dream. I couldn’t wait to jump in. But first, it was time to meet the man that was going to make my surfing dreams come true.
Meet my coach, Kainoa McGee
After hopping off the bus I was introduced to Kainoa McGee. Born and raised in Hawaii, McGee has been a surf instructor and competitor for more than a decade. I could tell he knew what he was doing: McGee just has that look, like yeah, that man can dominate some waves.
Kainoa McGee and the writer.
When he was assigned to me, another instructor leaned over and said, “You’re in good hands,” and my teetering confidence felt a little stronger. McGee gave me a warm, friendly greeting and we walked over to a shady spot in the grass before heading to the water. The first thing we did was a few exercises to activate our surfing muscles. Warming up? Now this is something I know how to do! We did arm circles to wake up our arms and shoulders (essential muscle groups to paddle) and twisting lunges to get the legs and core ready to go.
From there it was time to practice my surfing stance. I laid in the grass pretending there was a surfboard under me, and McGee instructed me how to lift up into a standing position. It’s almost like a burpee, with a few modifications. Your hands stay close to your chest, squeezing your core, then you pop up, parallel with the board, with your feet wide and knees slightly bent. On land, I was nailing it! But could I replicate it in the water?
On land, I was nailing it! But could I replicate it in the water?
McGee and I each picked up one end of a surfboard and carried it to the edge of the ocean. It was finally time for me to be put to the test—and the only options were to surf, swim, or sink. I was buzzing with excitement and nerves. We waded in and immediately got crashed by a wave. I didn’t even get a chance to ease into the water and feel out the temperature, but I took it as a sign that it was time to dive in. It was a hot and sunny day; the water felt cool and refreshing. I climbed onto the surfboard and paddled into the water.
More lessons than just surfing
As expected, the first few attempts to get up on the board were a total fail. McGee would give me a big push when a wave was coming, so I didn’t have to paddle too hard. Then I’d try to do what we practiced on land—push up and bring my right leg to the front of the board, stand parallel and balanced. Easier said than done.
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The water felt good, but I was determined to get up on that board. Thirty minutes into my lesson, as I paddled back to McGee for another try, he spoke the words to me that I’ll never forget: You’re an athlete. You can do this. Get out of your head.
Get out of your head.
The next wave came rushing toward us and he gave me a push. The sound of water whooshing under my board rang in my ears. It felt like I was floating. Then I heard McGee yell, “Up!” I carefully lifted my chest, swung my leg forward, and stood up.
I was surfing!
I rode my first wave all the way. I could hear McGee and the instructors cheering for me. The feeling was enthralling, and from that first wave to the end of my session, I was catching waves and taking names.
Imposter syndrome hit me in waves, too
After my private lesson I felt encouraged to keep practicing. Plus, there were plenty of surf shops that offered board rentals. I found the closest shop to my Airbnb and walked in with the intention of picking out a board for the day. Immediately the vibes felt off. The two men working in the shop didn’t acknowledge I walked in or as I browsed the shop’s gear. Finally I asked how much it cost to rent a board. The employee looked me up and down and said, “Have you ever even surfed before?”
I was shocked. That didn’t answer my question, and what exactly does a surfer “look like,” anyway? I told him yes, I have surfed before. Then he tried pushing me into buying a surfing lessons package, instead of answering my original question. After explaining to him that I’d taken a private lesson earlier in the week, he dismissively said, “Oh. Well I guess you can rent one,” before walking away.
There was no way I was giving them business. I walked out of the surf shop pretty discouraged. Did I belong in this space? Am I in over my head to get out there and try on my own? I felt imposter syndrome taking over and headed back to the Airbnb.
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Did I belong in this space? Am I in over my head to get out there and try on my own?
I told my mom about the exchange, and naturally, she went into outraged mom mode. “You’re getting back in that water! You’re a surfer!” she exclaimed. She made it her personal mission to help me find another surf shop that was more welcoming. After a short walk, we stumbled upon a board rental stand at Billabong.
A woman at the front desk greeted us with a friendly smile. I explained to her that I was a beginner, but hoping to rent a board so I could keep practicing. She chatted with me for 20 minutes to explain which board would be the best fit, previewed wave conditions with me, and encouraged me to get out in the water early so I could have a good session. This was the kind of interaction I needed.
Catching waves and building confidence
For the rest of my trip, I rented a surfboard from the Billabong stand. Taking her advice, I woke up around 8 a.m. to eat some breakfast then get out into the water where the more experienced surfers gathered. I made sure to stay out of the way as I watched their technique—the way they paddled, positioned themselves to waves, and so seamlessly got up onto their surfboards.
After “studying” for 30 minutes, I felt ready to catch my own waves solo. There was no push from McGee, but I could hear him saying, “Get out of your head. You’ve been doing this your whole life.”
When a wave came, I paddled hard. I listened for that whooshing sound, and that feeling of water surging beneath my board. I carefully lifted my body, standing up on my surfboard and holding the position. I was doing it.
I rode the wave until it died and my board became still. Plopping back down, I could hear a round of applause from some beach-goers on the sand. Take that, surf shop guy. I am a surfer.
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