The benefits of playing sports are well known, but the impact may be greater for females. According to the Women’s Sports Foundation, high school girls are less likely to get pregnant and more likely to do better academically if they participate in sports. Girls and women also have more confidence, self-esteem, and lower levels of depression.
The downside of all this physical activity is that it comes with risk. Women tend to be more susceptible to certain injuries as well as sports or exercise-related issues.
The female body
A number of changes occur during the menstrual cycle that can affect women in sports. Ligaments and joints can loosen, hormones fluctuate, and excess fluid can all contribute to throwing a body out of whack.
Our wider pelvis can help with pregnancy and childbirth, but when it comes to movement, this change in pelvic width becomes a disadvantage. The angle of the hips is changed, which affects the way stress travels through the leg to the knee to the ankle and foot, says Kelley Humphries, Doctor of Chiropractic and Fellow at Logan University’s Human Performance Center in St. Louis.
“It is common to hear that an athlete has knee pain, yet she has no history of direct injury or trauma to the knee,” says Dr. Humphries.
Poor landing mechanics from this imbalance can cause ACL injuries, which are seen in women’s soccer more than any other sport, says Dr. Vijay Jotwani, Houston Methodist primary care sports medicine physician who is also a team physician for the Houston Dash, a professional women’s soccer team. He says the highest rate of ACL tears seems to occur in the pre-ovulation phase – days 9-14 – of a woman’s cycle.
An ACL injury involves damage to the ligaments that hold the bones of the knee together. It is often identified by a “pop” heard or felt in the knee at the time of an injury. Pain, swelling, instability and a limited range of movement typically follow. Treatment ranges from bracing and physical therapy to surgery to repair the ligament.
“There is an epidemic of ACL tears, as well as other injuries of the knee, ankle, and leg,” confirms Dr. Joe Guettler, orthopedic surgeon and director of Sports Medicine Education and Research at Beaumont Hospital, Royal Oak, MI. “Studies have shown that female athletes participating in sports like soccer or basketball are three to five times more likely to injure their ACL than males.” Most of these injuries occur in women between the ages of 15 and 25.
It’s a myth that men get more concussions than women. In some sports, such as in soccer, women actually have higher rates of concussion, says Dr. Beth McQuiston, MD, RD, board certified neurologist, and medical director for Abbott’s Diagnostics. Lacrosse and field hockey also see a higher incidence of concussion in women.
Studies show that females are also more likely to have post-concussion syndrome (PCS), which causes symptoms such as headache, dizziness, fatigue, irritability, and anxiousness as well as sleep and memory problems. Concussion symptoms also last longer in women, especially when it comes to symptoms that affect memory. Women are also more likely to see a doctor for continued symptoms.
Why are women more affected? Some researchers believe that it’s due to our smaller, less muscular necks, making our heads more susceptible to trauma. Others have found that if a woman has a concussion at the stage of her menstrual cycle when progesterone levels are high, there’s an abrupt drop in the hormone. This fast drop may contribute to or worsen concussion symptoms.
Dr. McQuiston says concussion awareness is vital for every woman to help prevent injury, because after all, “you can’t treat what you don’t know.”
Female Athlete Triad
Another issue that female athletes have to deal with concerns the Female Athlete Triad. This term describes “the interrelationship of three distinct conditions: low energy availability, menstrual dysfunction, and low bone mineral density,” says Dr. Liz Joy, MD, MPH, President elect of the American College of Sports Medicine, and President of the Female Athlete Triad Coalition.
It’s important to note that a female doesn’t need to have all three components to have the Triad. Athletes who participate in sports where leanness confers a competitive advantage like gymnastics and long distance running are at greater risk, she says, but any female athlete can be affected.
A health care provider diagnoses the Triad after going over the patient’s history, physical exam, and lab tests. Treatment is largely focused on reversing the low energy availability. A multidisciplinary team usually sees patients. Sometimes medications are used to treat nutritional deficiencies or mental health conditions.
Since women have a limited window of opportunity to achieve peak bone mass and a limited ability to regain bone mass that is lost, a significant long-term consequence of the Triad is osteopenia or osteoporosis. This sets women up for fragility fractures later in life, says Dr. Joy, who has seen women in their 20s with bone mineral density of women in their 60s and 70s.
A new study in the Journal of the American Academy of Orthopaedic Surgeons has found that women with Triad symptoms are at greater risk of bone stress injuries and fractures. The study also found that female athletes diagnosed with poor nutrition or low energy availability are two to four times more likely to sustain a sports-related injury.
“It is important for athletes, parents, and coaches, to realize that a successful athlete is one who is meeting their energy requirements, not the ‘skinniest’ athlete,” says Dr. Joy. “Skipping meals, eliminating food groups along with ‘bad’ or perceived unhealthy foods are certainly red flags. Likewise, skipping periods, or the loss of periods, is also a signal.”
When it comes to injuries in general, training programs that teach proper landing methods and basic injury prevention techniques can decrease risk. Dr. Guettler has some tips to help reduce the possibility of injury:
• Hit the gym – strengthening the muscles of the thighs and hips can definitely help the knee
• Take a few extra minutes to stretch and warm up
• Work on dexterity – if muscles learn to react more quickly, injury can often be avoided.
Sport-specific maneuvers should be worked on both during practice and prior to play.
Athletes can be evaluated for level of risk, and then consult with a coach, trainer, or sports medicine professional to help guide toward a proper individualized training program, adds Dr. Humphries. Key elements that should be included and addressed in the following order, are:
• Proprioceptive (body position) training
• Functional training
Because sports and exercise are good for females, the risk of injury should not discourage participation. Be aware of the risks and protect yourself. “The message to female athletes is to fuel your body to meet the demands of activities of daily living and sport, ensure that training is not excessive, and maintain adequate, healthy stored energy,” says Dr. Joy.
To learn more about ACL Injuries, visit the American Academy of Orthopaedic Surgeons: http://www.orthoinfo.aaos.org/topic.cfm?topic=A00549
Review the symptoms of brain injury and concussion at the Centers for Disease Control and Prevention: http://www.cdc.gov/concussion/signs_symptoms.html