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Clinical Corner

Women and Sports Injuries

Why It's a Different Game

In general, women suffer more athletic injuries than men, especially when it comes to the knee. Dr. Bridget Quinn, of the  Sports Medicine Program at BIDMC, answers questions about the potential cause of sports-related injuries in women and how they might be prevented.

Q: Why do women tend to suffer from more sports-related injuries than men?

A: Men and women are obviously built differently. By around age 10 to 12, when these physical differences become more prominent, we start to see girls perform differently than boys. Girls reach skeletal and physiological maturity earlier than boys. Plus, women have more body fat and less lean body mass due to increased estrogen while men have more androgens. Women's bodies are more lax or flexible than men's. They have wider pelvises and less developed musculature. These factors affect the alignment, strength and movement of women's extremities.

Q: So why, in particular, are knee problems an issue for women?

A: Women's feet roll inward or pronate, are flat, and the force on their kneecaps is exacerbated by an internal rotation of their thigh bones and weakness in their inner quadricep and pelvic muscles. This places more force on the knee, often resulting in kneecap injuries such as patellofemoral syndrome. The kneecap is pulled towards the outside of the knee and does not track properly, resulting in rubbing and pain that can limit form and function. It can also lead to other injuries including patella dislocation or subluxation, where the kneecap comes out of its groove.

Q: What about ACL tears?

A: Injuries to the ACL -- the anterior cruciate ligament, one of the four major ligaments of the knee -- are also more common in women due to the same factors. In fact, the rate of ACL injuries is three to six times higher in women than men, especially in soccer and basketball. There's a lot of research going on about this. These are usually non-contact injuries, resulting from sudden deceleration movements or jumping. When women land, they land more upright.

Q: Is there anything women can do to prevent these knee injuries?

A: Programs are in place in many locations to help teach women how to land in less vulnerable positions and to have more neuromuscular control. They also focus on strengthening due to the laxity of women's joints, especially hamstring strengthening that is vital for controlling deceleration. Studies have shown these decrease ACL injury rates.

Shoulder Instability

Q: What about shoulder injuries?

A: Women are also prone to shoulder injuries. Men are stronger up top than women. The combination of not having strong shoulder muscles, including the rotator cuff and periscapular muscles, and having loose supporting tissues can lead to instability in the shoulder.

As a result, women playing sports such as swimming, softball or volleyball typically are at risk for rotator cuff weakness, tightness, and pain. Strengthening programs exist to help cut down on such injuries.

Q: Does diet play a role in sports-related injuries in women?

A: Yes. It's called the "female athlete triad." This involves a combination of decreased energy availability due to disordered eating (such as not obtaining the right amount of calories compared to what is expended), bone loss, and menstrual disturbances that can interfere with health and performance. Disordered eating ranges from poor energy intake to anorexia and bulimia, she said. Bone mass accumulates until 25 or 30 years of age, so women who are not accumulating during adolescence and their 20s enter their 30s at a deficit. This requires appropriate levels of estrogen that is present during normal menstruation. The female athlete triad places female athletes at risk for stress fractures and chronic injury. This is more prevalent in women's athletics than was previously recognized, especially in athletes who place a high demand on aesthetics, like runners and ballet dancers. Anemia or iron deficiency is also a risk.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted March 2010

Contact Information

Sports Medicine & Shoulder Surgery
Carl J. Shapiro Department of Orthopaedics
Beth Israel Deaconess Medical Center
Carl J. Shapiro Clinical Center, 2nd Floor
330 Brookline Avenue
Boston, MA 02215
617-66-SPORT (667-7678)