Female athletes at risk for gender-related injuries

Anatomic, biomechanical, hormonal and functional factors increase risk

In sports medicine, it isn’t always true that what’s “good for the goose is good for the gander.” When female athletes get injured, health-care professionals need to consider differences between men and women and pay close attention to the anatomic, biomechanical, hormonal and functional factors that are unique to women.

Women have different sports medicine needs than men.
Women have different sports medicine needs than men.

Physical medicine and rehabilitation specialists at Washington University School of Medicine in St. Louis say that paying attention to the factors unique to women can be difficult because fewer women have been involved in research, coaching and sports medicine over the years.

“Biomechanics are different for women than men,” says Heidi Prather, D.O., assistant professor of physical medicine and rehabilitation in the Department of Orthopaedic Surgery. “You have to take that into account when you’re treating a woman for a sports injury.”

Prather and colleague Devyani Hunt, M.D., instructor of physical medicine and rehabilitation in orthopaedic surgery, are concentrating their clinical and research efforts on understanding those differences. They’ve launched the Women’s Health Program to gain a better understanding of the differences and to help female athletes and all women return to full function and peak performance after an injury.

Reporting on issues unique to female runners in the journal Physical Medicine and Rehabilitation Clinics of North America, Prather and Hunt say a woman’s musculoskeletal structure, such as the shape of the pelvis, can become the basis for gender differences in the alignment of the lower body.

“Pain at the knee called patella-femoral pain commonly aflicts runners, but it affects women more than men,” Prather explains. “It’s a problem in the way the kneecap tracks within the groove at the base of the femur, or thighbone. Because a woman’s pelvis is wider, it puts a greater angle of force on the knee where the kneecap aligns with the femur. That puts female runners at greater risk for the problem.”

As a result, she says women and their doctors need to know about that vulnerability. A wider pelvis isn’t something a physician can change, but understanding the causes of these injuries in women should help physicians treat them more effectively.

Another knee problem that’s often different in men and women is iliotibial band syndrome, a common overuse injury in runners that causes swelling and pain on the outside of the knee.

Heidi Prather
Heidi Prather

“We always try to look at whether the iliotibial band has gotten tight from overuse or from worn out shoes, or because it’s compensating for another muscle that’s weak,” Prather says. “Many women with this problem have weakness in a muscle at the hip called the gluteus medius. The iliotibial band tightens up and causes knee pain when it tries to compensate for that weakness, so although the pain is in the knee, the problem really starts at the hip.”

Prather says women and their doctors should look for the root causes of injuries before prescribing therapy. In the case of knee pain caused by weakness in the hip muscles, stretches designed to loosen the iliotibial band won’t fix the problem because they don’t address the cause of the pain. However, appropriate exercises for the hip can strengthen the muscle and reduce risk of pain recurrence.

The female triad

Other issues unique to female athletes include exercising when pregnant, exercise-induced incontinence, and injuries to the anterior cruciate ligament (ACL) in the knee, which are much more common in women than in men. But Prather says some of the most serious problems for female athletes involve the female triad.

“The triad consists of amenorrhea, which means loss of regular menstrual cycle, osteoporosis, which is poor bone mass, and eating disorders,” Prather says. “The problems overlap because both the loss of a regular cycle and eating disorders can increase the risk for osteoporosis. So when a physician treats a woman for stress fracture injuries, for example, that physician needs to make sure to ask her about her menstrual cycle, her diet and her bone health.”

She says some female athletes stop having periods altogether, but she warns that it’s likely that bone health can be affected by irregular periods, too.

“If a woman or girl’s cycle becomes irregular, she may not be ovulating,” Prather says. “Ovulation gives females the estrogen that promotes good bone health. There probably are many women at greater risk than they know because they have a menstrual cycle on occasion and think that’s okay. Well, it may not be good for their bone health in the long term.”

Prather says irregular periods and eating problems in young athletes can cause bone weakness during what should be a woman’s peak years for attaining bone density. And the chances are good that if bones don’t achieve peak bone mass during the developing years, the risk for osteoporosis is greater later in life.

And she stresses that these injuries aren’t limited to elite athletes. Any woman who exercises will face issues that may require help from physicians who understand the problems that are more common in women.

Prather H, Hunt D. Issues Unique to the female runner. Physical Medicine and Rehabilitation Clinics of North America, vol. 16 (3); pp. 691-709, Aug. 2005.

Washington University School of Medicine’s full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.