The Female Athlete

side image

Female Athletes: Why We Get Hurt the Way We Do

March 31, 2010

In my last article, I spoke about the Female Athlete Triad - the adverse metabolic effects of over-training for female athletes. As women's participation in female athletics has continued to grow, common musculoskeletal injury patters due to over-training have also emerged. Female injury patterns typically seen include anterior knee pain, overuse stress injuries and acute ligament and cartilage injuries, which occur in a disproportionate amount when compared to male athletes. These injury patterns are felt to be due to the difference in female structure, ligamentous properties and differences in static and dynamic joint control. These differences will be discussed today.

Structurally, female athletes in general have a wider pelvis than their male counterparts (important for childbirth), causing differences in their hip and knee static (standing) alignment: hips positioned more toward mid-line (varus) and internally rotated (torsion), lower legs from the knee down more rotated outward and positioned away from mid-line (valgus) and feet tend to be more pronated. This fundamental difference in alignment contributes to injuries due to overuse and overloading of the hip, knee and foot.

Ligamentous properties also differ between men and women. In general, hyperlaxity of ligaments is more prevalent in women than men. This increased ligamentous laxity is thought to be in part due to higher estrogen levels in women, as studies have shown that with increased estrogen concentration, decreased tensile strength of ligaments (ACL) results. This hormonal difference between men and women, particularly during the ovulation phase of menstruation when estrogen levels are high, has been hypothesized as a possible reason for high rates of ligamentous injury in female athletes.

Diminished joint stability, especially of the hip, knee and ankle is another area of difference between female and male athletes. Joint stability is achieved through static and dynamic structures and plays an important part in determining athletic success or failure due to injury. Structures that contribute to static stability include bony alignment and congruency of a joint, ligaments and the joint capsule. Dynamic stability is provided by the muscles crossing the joints and is controlled by both voluntary and involuntary muscle transactions. Proprioception, the ability to know joint position in space, is how the involuntary muscle activity is controlled. It is a feedback system used by the brain to keep a joint out of high risk injury positions. Muscle groups activating above and below a given joint also contribute to joint stability by improving overall alignment of the joint while it moves through a particular activity such as running or jumping ( think of those core muscles)! Studies have shown that in response to proprioceptive input, female athletes activate primary hip and knee stabilizing muscles at a slower rate and with less strength than their male counterparts. This difference in dynamic joint control develops during puberty and results in a gender specific decrease in neuromuscular control and stability especially with landing and pivoting activities, resulting in an increased rate of overuse, overload and ligamentous injury in female athletes.

As previously noted, the above fundamental differences in the female athlete body set us up for specific patterns of injury, particularly in the hip, knee and ankle/foot. These patterns will be discussed in our next issue. The therapists at Independence Physical Therapy are highly trained professionals and specialize in managing all types of injuries suffered by Female Athletes if ALL ages and ALL levels! Feel free to call us at (860) 536-1001 if you have any specific questions or concerns regarding your female athlete. We're here to help!


To read an archived Female Athlete article, make a selection from below:

The Female Athlete Triad