Female Injuries In Sports

Pain & Rehab Forum [Moderated]
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Hi Guys,

I’ve been diving down this rabbit hole of female sport performance and the gap between female injuries compared to men. I work as a basketball coach for an all girls high school and also am a strength and conditioning coach and I tend to get more female athletes to train with me than men.

As a coach for athletes the biggest stress we deal with is the health of our athletes. My school has drawn much attention to the fact that female injury rates are higher than men in sport. The reasons behind them are what I am struggling with and not that we will ever have a definitive answer but the answers I am getting have brought me to think deeper about the subject.

Here are some of the main points that have been brought up by sport performance coaches as well as some of the athletic trainers that work in my school about why the female athlete is more prone to injury during sport activity:

  1. greater flexibility and less powerful muscles
  2. a wider pelvis, which alters the alignment of the knee and ankle
  3. a narrower space within the knee for the ACL to travel through Some of this may hold true, but is this really the main driver as to why females are getting inured at higher rates or why they are getting injured at all? A lot of coaches, PT’s, athletic trainers and so on want to address these problems as biomechanical. I have heard things like programming differently for individuals who are anteriorly compressed vs. posteriorly compressed. I also have gotten recommendations to specifically fix Gait cycles, none of which I have practiced. I do try to cue athletes to perform better technique because I believe it drives efficiency in performance. I am more concerned with trying to create comfort for athletes and find positions in which they adapt to progressively over time. It is hard for me to obsess over biomechanics because we as humans all move in unique ways and move in “compromised positions” daily, especially in sport.

For me I have been thinking along the lines of a few different points such as do female injury rates compared to males in sports really have that much disparity? Female participation in sport compared to male is about 25% female participation compared to 45%,male participation, with females now just starting to increase their participation, so isn’t it a little premature to start comparing? Also what is qualified as an injury in this case? It seems females suffer from more stress fractures and ACL tears but is that because of their anatomy or is this just what happens when humans play sports and are dealing with overuse?

Also something I have been considering is psychological considerations. What about athletes personalities and eating disorders? Many athletes deal with introversion, conformity, perfectionism, rigidity and obsessive-compulsive disorder all of which can lead to eating disorders. There is also Western Cultures athletic participation being considered a “man’s thing”. Achievement, agressiveness and desire to win all by tradition are considered masculine qualities. There seems to be more belief that winning is a male athlete proving his masculinity while females can win and still have to prove their femininity. This combined with personality traits can lead female athletes to feel less dominant and confident and build more impulse, tension and anxiety. One more thing to add is the “win at all costs” pressure for an athlete or harsh expectations from parents/coaches/society which can lead to a number of problems for an athlete such as eating disorders. All of these psychological stresses can lead females to eating disorders, menstrual dysfunction and osteoporosis so maybe we need to take a closer look at these factors when it comes to female injury rates in sports rather than how they are anatomically.

I would like to get your thoughts on this subject as I am trying to connect with more people and educate myself more. I look forward to hearing from you.

Thanks,
Brian

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Brian,

This is a very complex topic but I will do my best to continue you on the rabbit hole you have started down. I would not take the stance that there are many gender differences here in terms of biomechanics but it is more related to the global participation in physical activity that you mentioned. Overall, males are more active than females (Varma et al has them averaging 1.5hrs/week of moderate level PA while males are 2.5hrs). This likely contributes to the noted strength deficits as much as any other factor. There is a paradox forming in the sports medicine world where many injuries are attributed to overuse when I would likely categorize even more as underprepared. There are athletes exceeding the early sports specialization recommendations, while not getting sufficient sleep or being under fueled but this is a smaller subset than the group that is only participating in one sport 2x/week for one hour. This cohort is not meeting physical activity guidelines as well as being overly specialized. While females are more likely to suffer injuries like ACL tears, there is evidence that increasing lower extremity strength can reduce the risk of injuries overall (O’Kane). There is also non-gender specific evidence that working on skills/neuromuscular training has a profound effect on injury risk reduction (Emery).

I do not think the phenomenon is directly related to a gender difference, but as much a societal difference in sports participation as well. There is a higher percentage of participation in repetitive load sports like swimming and running among female athletes. If that is case, some of the BSI research would state it is as much the sport that may predispose the athlete to stress fracture as the gender participating in it. The opposite side of the coin though is the evolution of female athlete triad into relative energy deficiency syndrome (RED-S) as there has been a realization that males suffer from many adverse physiological effects if under fueled as well.

This topic is extremely complex. If you have not, I would recommend giving the pieces on youth resistance training as I addressed many of the components there.

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Dr. Miles,

I appreciate your response. A lot of really good points here. I completely agree about athletes being under prepared more than it is about over use, especially at a young age. There is definitely a problem with sports specialization, my high school basketball athletes do not even need to take physical education because they play a sport.

Great point about the difference not being gender related but more likely that female athletes are participating in more repetitive load sports. Add that with the fact that most young athletes are not training or have very little training background and you have a good idea of why injuries can occur. Sleep and nutrition strategies definitely play their role in this matter as well, which as you said, make this topic extremely complex given there are so many different factors that tie into it.

I have read the pieces you wrote about youth resistance training, they are excellent. I appreciate your work and look forward to more of it, especially on this particular topic.