Medical Examiner

Mary Cain’s Chilling Story Highlights Problems That Plague Many Female Runners

The abuse she suffered at the hands of Nike is horrific, but some of the underlying issues are all too common.

Mary Cain
Mary Cain runs in the IAAF World Junior Championships at Hayward Field on July 24, 2014, in Eugene, Oregon.
Jonathan Ferrey/Getty Images

When she was a teenage track star, Mary Cain joined the Nike Oregon Project, a team helmed by Alberto Salazar, at the time “the world’s most famous track coach,” as she put it. The famous coach was equally awed by Cain, who, as a high school freshman, ran the 1,500-meter race (that’s nearly a mile) in 4 minutes and 11 seconds. “He told me I was the most talented athlete he had ever seen,” Cain explained in a stunning video detailing how their lauded partnership broke down, published Thursday by the New York Times.

Using athletes like Cain, Nike advertises gear that offers support, stability, and customizable features. You’d think that its world-class running program would have the same attributes—that is, that it would be carefully tailored to the needs and goals of its stars. But what Cain found when she arrived was a program that ignored her own biology to the point of destruction. “An all-male Nike staff became convinced that in order for me to get better, I had to become thinner, and thinner, and thinner,” she explains in the video. Salazar gave her an “arbitrary number” for her to hit on the scale. She became fixated on her weight instead of her performance. Salazar’s mandates took an extreme toll on her body: She didn’t get her period for three years and, due to a lack of estrogen, broke five bones. “I was emotionally, and physically, abused,” she says in the video of her experience.

Cain’s story might be superlatively horrifying, and her accusations go well beyond simple misunderstanding of female biology. (They include her coaches essentially ignoring her admission that she was depressed and cutting herself. The Oregon Project was shut down in October, after Salazar was banned from coaching for doping violations.) But the treatment of her weight, and the lack of understanding of how extreme workouts were affecting her body, is part of a much broader problem, and not just one that affects women with large brand partnerships. Many, if not most, female runners, from elite athletes to those training for their first 5Ks, will suffer at some point because of a lack of recognition of their physical needs, and how their bodies differ from men’s.

Amenorrhea—the term for when your period goes away in the absence of pregnancy—is part of what led elite runner Tina Muir to quit the sport altogether in 2017. “There are SO MANY people out there who lose their cycles, yet no one talks about it,” she wrote in post on her website. She’d seen a slew of specialists, was healthy, and ate plenty. Failed by medical science and wanting to get pregnant, the only option she felt was left was to stop logging miles and allow her “body to come out of panic mode.” One estimate suggests that the majority of female runners might experience amenorrhea, which can affect not just fertility, as Christine Yu explains here in Outside, but can also damage cardiovascular health and bone strength. Bones break more easily when the body has been stressed like this, as Cain’s did. And yet still, losing your period can be “a badge of honor, a sign that you’re tough and working hard,” writes Yu. The mythology around amenorrhea enforces running as an act of control against the body.

And that’s just one side of reproductive health. For athletes who do get pregnant, there’s often no clear path for women to take a break to have a kid—even for those able to run competitively through much of a pregnancy. Nike doesn’t give the women it sponsors maternity leave, paying them only as long as they are racing, a New York Times story explained in May. (The accompanying video, featuring Alysia Montaño, Olympian and mom to two, explaining the hypocrisy of Nike’s directive to “dream crazy” is extremely worthwhile). This puts new moms in a bind to get back on the starting line as soon as possible, even at the expense of their own health.

Non-elite runners can struggle against the same standard—that runners be rail-thin and boy-framed—that Cain did. It’s apparent in the available gear options, for example. “Researchers are still a long way from understanding exactly how breasts move during exercise,” Rose Eveleth wrote in a story for Vox, titled “Why Are Sports Bras So Terrible?” The larger your boobs, the harder it can be to find a bra that can adequately support them. Sports bras themselves are a relatively new invention: As Amanda Hess points out in a piece for ESPN, the first woman to run the Boston Marathon in 1967 did so “in a flimsy fashion bra.” Plus-size clothes like running shorts can be harder to find, too, leaving many women to make do with men’s clothing; Nike only introduced a plus-size line in 2017.

All of this derives from a couple misconceptions. There’s the idea that running is a good way to lose a bunch of weight; in reality, it’s important to make up most of the calories burned with extra food. Then there’s the common wisdom that “the thinner you are, the faster you’re gonna run, because you have to carry less weight,” as Cain explained in the Times video. But this simple kinematics equation is true only in the broadest of views, in which the runner is not a woman but a standard-issue machine. Different bodies operate best at different weights; whittling yourself down to a size too far below your set point can mean severe undernourishment, pain, and, well, not-great running. “Not eating much and running off the measured calories I did permit myself wasn’t sustainable,” writes Madison Malone Kircher in New York magazine of how she started running to lose weight, before counting herself among a community “of proud, fat runners.”

Cain’s video makes clear that this isn’t all physiological, either. Not only can eating too little causes your period to halt; fixating on weight can trigger disordered eating and body dysmorphia. These are problems that more commonly affect women. It can be awfully hard to run fast when you’re hungry all the time, and coping with psychological pain over your appearance or what someone else thinks your body should look like. It can be hard to start running in the first place if you’ve been taught that you just don’t look like a runner.

Cain’s story is “a powerful argument for getting more women into coaching,” noted writer Christie Aschwanden on Twitter. And Cain is, in fact, now training athletes herself. In June, after running (and winning) her first race in over two years, she started teaching at Mile High Run Club, a group of treadmill studios in Manhattan. In August, she spoke to high school students at a cross country camp about her return to the sport: “I had to ask myself again why I run, redevelop my love and relationship with running, and kind of go back to being the kid who just enjoyed the challenge and having fun.”