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Female athletes and injuries

This is an excerpt from Women and Sport by Ellen Staurowsky.

Like all athletes, female athletes risk injury and pay the price for participating and competing. While the practical limits of this chapter prevent us from delving into an expansive discussion of the physical injuries that female athletes may sustain in their playing careers, the two most reported and discussed injuries that female athletes experience are anterior cruciate ligament (ACL) tears and concussions. Awareness of gender-specific treatment and recovery strategies have been found to be important in fully understanding why these injuries occur within female athlete populations and how female athletes recover from them.

According to Dr. Pietro Tonino, director of sports medicine at Loyola University Medical Center, the more girls who enter the sport system, the more likely it is that ACL injuries will occur (Loyola University Health System, 2014). The American Orthopaedic Society for Sports Medicine reports that female basketball and soccer players are two to eight times more likely than male athletes to experience an ACL injury. Greater female athlete susceptibility to ACL injuries peaks during adolescence and then declines (Dharamsi & LaBella, 2013).

Among the reasons cited for the great incidence of ACL injuries in female athletes compared to male athletes include hormonal and neuromuscular factors (Dharamsi & LaBella, 2013). The onset of puberty, with changes in hormonal levels leading to growth spurts and variable muscle development in female athletes leading to subsequent changes in the center of gravity, appears to account for the higher incidence of ACL tears in female athletes.

At a neuromuscular level, compared to male athletes, female athletes exert less control of knee motion during training, relying more on quadriceps muscles than their hamstrings. Girls also tend to exhibit greater prevalence of asymmetry in muscle strength, with one leg being stronger than the other. This kind of imbalance creates a situation in which the ACL is under greater strain. Girls tend to have less core strength, which results in shifts away from the center of support (Zazzali, 2013). And girls employ different mechanisms when landing from jumps, relying on bones and ligaments (Dharamsi & LaBella, 2013). When female athletes land in a bent-knee position, they are more likely to rely more on the quadriceps (muscles in front of the thigh) to stabilize the knee and balance. Male athletes, in contrast, are more likely to mobilize hamstring muscles (the muscles behind the thigh), which are typically stronger (Brody, 2010).

Expressing concern for the rise in the number of female athletes he sees in his practice, Tonino noted that “many of these injuries could be prevented with a simple warm-up program that could be done in minutes” (Loyola University Health System, 2014, para. 3). One such program is the Federation International Football Association’s (FIFA) 11+, a warm-up that takes about 20 minutes to complete. In teams who did the warm-up twice a week, FIFA found a 30 to 50 percent reduction in the rate of ACL injuries among players (Loyola University Health System, 2014). See chapter 5 for a more in-depth discussion of ACL injuries in female athletes.

As a result of news coverage and lawsuits, there has been an increasing awareness in the past decade regarding athletes’ vulnerability to concussions. In simplest terms, a concussion is an injury to the brain, regarded in scientific circles as a type of mild traumatic brain injury. As such, athletes who suffer from them potentially face an array of serious short- and long-term health consequences. Headaches and dizziness are the two most commonly reported symptoms. While loss of consciousness occurs in about 10 percent of athletes who experience concussions, other symptoms include nausea along with vomiting and headache, which may signal acute gastroenteritis. Dizziness is associated with the possibility that the heart is not functioning properly (acute cardiac compromise). Athletes who have been concussed could also experience amnesia, distorted vision, lack of balance, sleep disturbances, depression, and attention deficit disorder (Eichelberger, 2013; Harmon et al., 2013).

Among college athletes with no history of concussion who underwent baseline testing, 59 percent reported concussion-like symptoms in the prior year. At the high school level, 50 to 84 percent of athletes with no history of concussion reported concussion-like symptoms in the prior year (Harmon et al., 2013).

Among individuals of high school and college age (15 to 25 years), motor vehicle crashes are the leading cause of concussions, followed by sport-related hits and injuries. In the United States, approximately 300,000 sport-related concussions are reported each year. Athletes are more likely to experience concussions when they are competing in a game rather than at practice. And while football reports the highest concussion rate among high school athletes, girls’ soccer reports the second highest incidence (8.2%), followed by boys’ wrestling (5.8%) and girls’ basketball (5.5%). In gender-comparable sports, girls had a higher concussion rate (1.7 per 10,000 athlete exposures) than boys (1.0 per 10,000 exposures; Marar, McIlvain, Fields, & Comstock, 2012). Concussion prevalence among high school athletes in Maine who completed baseline preseason testing using a program called ImPACT revealed that out of 2,312 female athletes, 14 percent reported a history of one or more concussions, 3.8 percent reported a history of two or more, and 1.0 percent reported a history of three or more concussions (Iverson, Gerrard, Atkins, Zafonte, & Berkner, 2014).

Comparisons between male and female athletes who compete in sports with similar rules (i.e., soccer, basketball, softball/baseball, wrestling) reveal that female athletes experience a higher number of symptoms than male athletes. Further, the concussion symptoms last longer for female athletes, and it takes girls and women longer to recover (Harmon et al., 2013).

A number of reasons have been offered to explain why female athletes may suffer symptoms longer and experience symptoms with greater severity. First, there is some speculation that the neck muscles for female athletes are not as well developed or as large as those of male athletes. Second, estrogen and differences in terms of the flow of blood to the brain may contribute to more severe symptoms among female athletes and the length of their recovery from concussion. Third, core strength for female athletes may also be a consideration (Franks, 2013; Harmon et al., 2013).

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