EXCERPT

Preventing Sports Injuries In Women New guide offers help to female athletes who want to get in the game and stay there

When it comes to mental toughness and a desire to be the best, male and female athletes are very much alike. But when it comes to their bodies, there are significant differences that are often not recognized. And for the female athlete, these differences can lead to inadequate training and unnecessary injuries. Dr. Gloria Beim is an orthopedic surgeon and co-author of “The Female Athlete’s Body Book: How to Prevent and Treat Sports Injuries in Women and Girls.”

The Female Athlete’s Body Book: How to Prevent and Treat Sports Injuries in Women and Girls by Gloria Beim, M.D. and Ruth Winter, M.S.


WHY CAN’T A WOMAN BE MORE LIKE A MAN?

This refrain echoes through the arenas, playing fields, and locker rooms of the world. The fact is we women athletes cannot and should not be more like male athletes. Our female bodies are constructed and function differently from men’s, and that gives us both advantages and disadvantages. Unfortunately, many coaches, physicians, and athletes have not recognized the differences; as a result, female athletes often have inadequate training, suffer unnecessary injuries, and may not reach their full potential.

The enactment of Title IX in 1972, federal legislation that prohibited sex discrimination in sports, has spectacularly fueled female participation in athletic activity. The number of women in sports has increased 22 percent in 10 years. In fact, 40 percent of high school athletes are girls. The emphasis on fitness has encouraged females of all ages to participate in sports, most of them just for the sake of fun.
As an orthopedic specialist who treated female patients from amateurs who play just for fun, to Olympic athletes seeking gold medals, I have seen many injuries that could have been prevented or that should have received earlier treatment. One of the most important of parts of my treatment of female athletes is teaching them how to continue their sport and prevent injuries. I urge them to participate in year-round or off-season conditioning. Year-round conditioning not only decreases the risk of injury but also enhances performance.

If you are an athlete who wants to excel, prevent injuries, and receive appropriate treatment, this book will help you educate yourself about both your vulnerabilities and advantages. You will learn about your body, how it works, and what that means for your chosen sport. In this introduction, I will discuss how some of the differences between male and female bodies affect women’s sports; the dangers of the female triad; why your knee is one of the most vulnerable parts of your anatomy; and the influences of puberty, menstruation, menopause, and pregnancy.

SEX MAKES A DIFFERENCE: FEMALE ATHLETES ARE UNIQUE

There are a lot of myths about women athletes, but here are a few things that are true — things that aspiring and practicing athletes should bear in mind.

THE VULNERABLE FEMALE KNEE

Historically, for example, it was believed that women’s wider pelvis and shorter stature gave them a lower center of gravity and thus a better sense of balance. The truth is that men and women have only small differences in their centers of gravity, which are determined by height and body type rather than sex. A wider female pelvis, however, is important in other ways. For many women, a wide pelvis can produce an increased angle at the knee (Q angle), which can make the knee more vulnerable to injury than a man’s knees.

Men and women also are different when it comes to flexing their knees. When women bend their knees, their thighbones (femurs) give less support to their kneecaps (patellae). This is why female athletes frequently suffer from the Patellofemoral syndrome, which includes many types of knee pain and injury. Those who play sports such as volleyball, basketball, and soccer expose themselves to increased risk for knee problems because in these pivoting sports, they often have less muscle protection at the knee than do their male counterparts.

CHURNING AND BURNING

Men metabolize energy differently than women. Metabolism is the way you process food into tissue elements and into energy for use in the growth, repair, and general function of your body. A woman’s resting metabolic rate (RMR) is 5 percent to 10 percent lower than a man’s. If you have developed your muscles through sports, however, your RMR will burn increased calories while you are at rest. If you don’t exercise and are on a weight-loss diet, you will deprive your muscles of protein and conditioning, decrease the size of your muscles, and lessen your RMR. So commit yourself to regular aerobic exercise . It will increase your metabolism and assist you in maintaining a healthy weight.

HOW MUCH OXYGEN CAN YOU CARRY?

The fellows around you may have still another advantage. Men have approximately six percent more red blood cells; therefore, their blood may be able to carry oxygen to body tissues more efficiently than yours can. You also have a lower amount of iron stored in your body. In addition, if you menstruate, you lose iron during your periods and you probably have a lower dietary intake of iron than men do. This combination of factors often results in iron deficiency anemia, so check Chapter 20 on Nutrition.

THROWING A BALL

In general, females have shorter limbs relative to body length than males do, especially in the arms (upper extremities). This relative shortness, combined with a female’s generally narrower shoulder girdle, may cause you to have a shorter lever arm, which can affect throwing mechanics in many ball-and-racquet sports. In turn, you may also be more prone to specific injuries, which will be addressed in later chapters.

BONES, HORMONES, AND ATHLETIC PERFORMANCE

You’ve probably heard about osteoporosis, the thinning of the bones that can occur in nutritionally deprived girls and in many women after menopause. If you are a young female on a starvation (anorexic) diet or if you are postmenopausal, you may develop decreased bone density, which can increase your risk of broken bones during athletics. If you have been through menopause and you want to pursue a sport, you would be wise to have your doctor do a bone density scan. Your doctor can tell you whether you are at risk and what you can do about it.

AMENORRHEA AND OSTEOPOROSIS

Surprisingly, anorexic young females and postmenopausal women are not the only ones at risk for low bone density. High endurance athletes such as marathon runners or triathletes may be vulnerable even in their 20s because the continuous exertion required by their sports can lower their estrogen levels causing them to stop menstruating. This may weaken their bones. Cessation or irregularity of menstruation can be a problem in female athletes. Athletes who develop abnormal periods (oligomenorrhea) also have reduced bone mineral density, as much as 20 percent lower than that of women athletes who have normal periods. Oligomenorrhea is most prevalent in endurance athletes. Twenty-eight percent of female college varsity athletes, 13 percent of female basketball players, and 57 percent of female cross-country runners reportedly have menstrual irregularities. Ballet dancers and cyclists also have shown a higher incidence of amenorrhea (absence of menstruation).

Studies show that most menstrual problems that occur in women who exercise are due to inadequate food intake rather than to the exercise itself. Bone mineral density has been shown to be inversely related to age of menarche (a woman’s first menstrual period); athletes with delayed menarche appear to enter adulthood with irreversible bone loss. Some believe it is caused by exercise-induced raising of the male hormone testosterone and the lowering of the female hormone estrogen in women athletes. Whatever the cause, failure to reach peak bone mass, premature bone loss, and poor mineralization of bone (because of stress) all make the athlete who does not have periods (amenorrheic) more susceptible to stress fractures.
Infertility is another important consequence of athletic amenorrhea. Exercise-associated infertility is usually considered reversible with reduction in training.

If you are suffering from menstrual irregularities or an absence of menses, your doctor may recommend calcium supplements, nutritional counseling, decreased training, and medications to increase bone density.

THE FEMALE ATHLETE TRIAD

A serious and potentially fatal nutritional aberration is known as the female athlete triad — eating disorders, stress fractures, and amenorrhea. It involves a female athlete who focuses on being thin or lightweight, eats too little, and/or exercises too much. The prevalence among female athletes has been reported to range from 15 percent to 62 percent depending on the activity, according to WomenSport International. Athletes in any sport can develop one or more parts of the triad. At greatest risk are women who are involved in sports that reward thinness because of appearance (i.e., figure skating, gymnastics) or improved performance (i.e., distance running, rowing). Some female athletes suffer low self-esteem or depression, and may focus on weight loss because they think they are heavier than they actually are. Others feel pressure to lose weight from athletic coaches or parents.

Recognizing the female athlete triad is the first step in treating it. See your doctor right away if you think you might have an eating disorder, miss several menstrual periods, or suffer a sports-related stress fracture. Give the doctor your complete medical history, including prior fractures, prior surgeries, calcium or vitamin supplements, medications (including birth control pills), alcohol consumption, and family history of osteoporosis or other bone disorders.

The doctor will give you complete physical and pelvic examinations and may use laboratory tests to check for pregnancy, thyroid disease, and other medical conditions. In some cases you may also get a bone density test. Treatment for the female athletic triad often requires help from a team of medical professionals including a doctor, a nutritionist, and a psychological counselor.

More annoying than life-threatening concerns include breast discomfort, a common complaint of women who exercise, especially among those who have large breasts. During the menstrual phase, fluid retention can make even women with small breasts uncomfortable. Tight-fitting garments and activities such as jogging or swimming and exercise in cold weather may also cause nipple trauma. A properly fitted sports bra will usually counteract breast discomfort. A note of caution: breast trauma in contact sports has been shown to increase the risk of breast cancer; consequently, chest guards are very important for athletes such as soccer goalies and softball catchers.

CARING FOR YOUR UNIQUE ATHLETIC FEMALE BODY

Your anatomy and physiology are significantly different from that of a male athlete. You must be aware your body’s needs to avoid injury and undergo the best training techniques available. Overall, female athletes have the same number of serious injuries as male athletes do, yet in some sports women are more susceptible to certain types of injuries, such as noncontact injuries to the anterior cruciate ligament (ACL), a major stabilizing structure in the knee.

By reading this book you will gain the knowledge necessary to reduce the chance of injuring yourself while pursuing your sport. Should you experience an injury, the descriptions of the most current treatments available will help you recover. We hope this book helps you perform at your best and get the most from your sport.

Note: This book was written by two authors who have chosen to write from a single, first-person point of view for the sake of simplicity.

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Excerpted from “The Female Athlete’s Body Book: How to Prevent and Treat Sports Injuries in Women and Girls,” by Gloria Beim, M.D. and Ruth Winter, M.S. Copyright 2003. All rights reserved. Reprinted by permission of Contemporary Books a division of the McGraw-Hill Companies. No part of this publication may be reproduced or distributed in any form or by any means without the prior written permission of the publisher.