Issue 6 Stories
Physicians Perspective

Providing Specialized Personalized Care for Female Athletes

More and more females are participating in sports at all levels these days, which in all likelihood means that more and more females will have a need for sports medicine care. As with other areas of health care, sports medicine is tailored specifically to each gender, due to anatomic and physiologic differences between males and females. Starting at the time of puberty, differences in body makeup become more prominent and may cause females to experience different types of injuries. In addition, nutrition, training and other health issues all need to be addressed in a gender-specific manner.

Female-Specific Injuries

As a female athlete, it’s important to know which issues are most likely to occur, so measures can be taken to prevent injury in the first place. For instance, female athletes are affected by noncontact anterior cruciate ligament (ACL) injuries two to ten times more frequently than their male counterparts. ACL injuries commonly occur when an athlete cuts or stops while landing, with the highest risk for females occurring when skiing or playing basketball, field hockey, lacrosse and soccer. Research suggests that females are at increased risk due to alignment of the legs, landing mechanics and decreased strength in the hamstring muscles. With appropriate identification prevention measures applied to young women who may be at increased risk, incidence of noncontact ACL injuries can be reduced by up to 50 percent.

Patellofemoral injuries, such as anterior knee pain, patellar dislocations and patellar cartilage wear, also occur frequently in female athletes. Risk factors for women include malalignment of the pelvis, knee and foot; muscle weakness and/or imbalance; altered patellar position; and trauma. With proper recognition of these factors, dislocations and maltracking of the patellofemoral joint can be treated with operative and nonoperative interventions that address both soft-tissue injuries as well as the bony anatomy.

The shoulder is another body part where females have significant differences in comparison to male athletes. Female athletes are at greater risk for shoulder injuries due to increased biomechanical load resulting from joint laxity, increased muscle and joint flexibility (range of motion), and decreased upper-body strength. High-risk sports associated with shoulder injuries in females include diving, gymnastics, swimming, tennis, volleyball and throwing sports.

Finally, studies have found that female athletes sustain significantly greater numbers of concussions than male athletes—in fact, a few studies have shown the number of concussions sustained by female athletes to be double the number sustained by male athletes, particularly in basketball, soccer and volleyball. Female athletes also may sustain more severe concussions, for two reasons. First, women tend to have smaller heads and more slender necks, so they can experience nearly 50 percent more head acceleration during head trauma. Second, hormonal differences between males and females may play a role in effects on the brain after injury, worsening postconcussion symptoms, such as headache, nausea and dizziness, for females. These factors also can lead to a longer postconcussion recovery period for females.

Other Health Issues

In addition to recognizing common injuries for female athletes, it’s also important to note that other health issues may arise due to participation in sports. In female athletes, menstrual dysfunction is two to three times more common than in nonathletes. Among female athletes, 10-15 percent have absence of menstrual cycles or lengthened menstrual cycles, which can lower estrogen and/or progesterone levels and lead to lower bone mineral density and a higher incidence of stress fractures and infertility. These low bone density levels also can lead to increased fractures from falls later in life. And since bone mineral density is determined by the bone mass achieved during adolescence and young adulthood, it is crucial for young female athletes to participate in impact sports and strength training in order to maximize bone density.

Among college-age female athletes, studies show that 15-62 percent report a history of disordered eating, a condition that can result from pressure to optimize performance and modify appearance. This is a psychiatric disorder with distortion of body image and significant nutritional and medical complications, including a mortality rate of up to 18 percent for untreated anorexia. For those reasons, recognizing the signs of an eating disorder in our patients and working to get them care are important parts of their orthopedic visits.

Finally, women who are pregnant should consider exercise recommendations specific to their situation. Exercise is recommended throughout pregnancy, with benefits including decreased weight gain and back pain; improved balance, well-being, energy levels and sleep patterns; improved labor; and a quicker postpartum recovery. However, other factors related to sports medicine, such as nutritional needs, appropriate use of X-ray imaging and physical therapy, and the effects of medications on maternal and fetal health, should always be considered. During pregnancy the female athlete also must be aware of changes to the body’s response to exercise, including increased heart rate, cardiac output, blood volume and respiratory rate.

Dedicated to Caring for Female Athletes

Providing education to raise awareness about the issues and injuries that specifically affect female athletes is an essential part of the care we provide at the Sentara Sports Medicine Center and at Sentara Martha Jefferson Orthopedics. Our program is designed to provide female athletes with comprehensive, coordinated care from sports medicine experts who understand the unique needs of women in sports. We look forward to working with you!

Matthew J. Panzarella, MD, Sentara Sports Medicine Center

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