Women And Sport Injuries - Why It's A Different Game

By Michael Lasalandra - Beth Israel Deaconess Medical Center Correspondent

It's a fact: women athletes are more prone to suffering certain sports injuries than their male counterparts, particularly when it comes to knee and ACL problems.

The difference lies in the interplay between form, alignment, body composition, physiology, and physical performance.

"Men and women are obviously built differently," says Dr. Bridget Quinn, a primary care sports medicine physician at Beth Israel Deaconess Medical Centerwho specializes in female athletes. "By around age 10 to 12, when these physical differences become more prominent, we start to see girls perform differently than boys."

This is when girls begin puberty and hormonal differences exhibit themselves.  Girls reach skeletal and physiological maturity earlier than boys. Beyond that, women have more body fat and less lean body mass due to increased estrogen while men have more androgens.

Women's bodies are more lax or flexible than men's, Quinn said. Women have wider pelvises than men and less developed musculature. These factors affect the alignment, strength and movement of women's extremities.

This can lead to a condition known as miserable malalignment, where women's feet roll inward or pronate, are flat, and the force on their kneecaps is exacerbated by an internal rotation of their thigh bones and weakness in their inner quadricep and pelvic muscles.

All these things place increased force on the knees, often resulting in kneecap injuries such as patellofemoral syndrome. The kneecap is pulled towards the outside of the knee and does not track properly, resulting in rubbing and pain that can limit form and function. It can also lead to other injuries including patella dislocation or subluxation, where the kneecap comes out of its groove.

Injuries to the ACL -- the anterior cruciate ligament, one of the four major ligaments of the knee -- are also more common in women due to the same factors, Quinn said.

"The rate of ACL injuries is three to six times higher in women than men, especially in soccer and basketball," she said. "There's a lot of research going on about this. These are usually non-contact injuries, resulting from sudden deceleration movements or jumping. When women land, they land more upright."

Programs are in place in many locations to help teach women how to land in less vulnerable positions and to have more neuromuscular control. They also focus on strengthening due to the laxity of women's joints, especially hamstring strengthening that is vital for controlling deceleration. "Studies have shown these decrease ACL injury rates," Quinn said.

There is also some thought that ACL injury rates may be tied to hormones and the menstrual cycle, but this has not yet been fully explained, she said.

Women are also prone to shoulder injuries, Quinn noted. "Men are stronger up top than women," she said. "The combination of not having strong shoulder muscles, including the rotator cuff and periscapular muscles, and having loose supporting tissues can lead to instability in the shoulder."

As a result, women playing sports such as swimming, softball or volleyball typically are at risk for rotator cuff weakness, tightness, and pain, she said.

Strengthening programs exist to help cut down on such injuries.

Another factor separating women athletes from male athletes is the so-called "female athlete triad." This involves a combination of decreased energy availability due to disordered eating (such as not obtaining the right amount of calories compared to what is expended), bone loss, and menstrual disturbances that can interfere with health and performance, she said.

Disordered eating ranges from poor energy intake to anorexia and bulimia, she said.  Bone mass accumulates until 25 or 30 years of age, so women who are not accumulating during adolescence and their 20s enter their 30s at a deficit, she added.  This requires appropriate levels of estrogen that is present during normal menstruation.

The female athlete triad places female athletes at risk for stress fractures and chronic injury, Quinn said.

"This is more prevalent in women's athletics than was previously recognized, especially in athletes who place a high demand on aesthetics, like runners and ballet dancers," she said.

Anemia or iron deficiency is also a risk.

Quinn recommends female athletes be aware of the potential dangers and work closely with their doctor, nutritionist, coach, family, and psychologist.

"Parents, coaches and primary care physicians need to be watching out for these things," she said.
More Sports Medicine Articles: Women And Sport Injuries – Why It’s A Different Game | Common Sports Injuries – How To Protect Yourself | Repetitive Injuries: Physical Therapy Keeps ‘Wounded Warrior’ On Top Of Game | Skiers, Take Note: ACL Injuries Are Serious, But Not Career Ending | Weekend Warriors: Prevent Injuries | Coming Back From ACL Tear | Athletes & Shoulder Arthritis

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For more information, including how to avoid back injuries, the importance of stretching, and treatments for rotator cuff injuries, visit BIDMC's special web section.

To read more about the Sports Medicine Division at Beth Israel Deaconess Medical Center, visit www.bidmc.org/sportsmedicine.

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