Treating sports injuries, with a close look at gender differences
October 2011 - When it comes to sports injuries, it's clear that men and women are not equal. Females are more susceptible to certain orthopedic conditions, and it is more than chipped nails at hand. Compared with males, female athletes in specific sports are two to four times more likely to injure their knees, according to the American Academy of Orthopaedic Surgeons.1
HER "KNEEDS"
Patellofemoral pain syndrome (PFPS), also known as chondromalacia patella or runner's knee, is the most common reason for knee pain in girls and women, most prevalent in ages 10 to 35. Two to Four Patients report having symptoms of crepitus and sharp or achy pain behind or around the patella, occasionally accompanied with swelling. This pain increases with any activities that involve flexion of the knee, such as sitting, squatting, running, jumping, and ascending or descending stairs.
Female runners, jumpers, and other athletes such as skiers, cyclists, and soccer players put significant stress on their knees. Studies show that women are twice as likely to have patella tracking problems such as runner's knee. 5-7 A number of factors are currently believed to contribute to the cause of PFPS. Abnormal movement (tracking) of the patella along the femoral groove can increase PF joint reaction force and contact pressure during activities that require flexion and extension of the knee, resulting in pain and dysfunction.
Contrary to what has been assumed in the past, females do not have wider pelvises than their male counterparts. Females do, however, have wider pelvis-to-femoral-length ratios, which may contribute to an increased tendency for genu valgum. Consequently, women also have larger Q angles.8,9 An increased Q angle has been associated with patellofemoral pain, patella subluxation, and chondromalacia.10-14 Although quad weakness, gastroc/soleus tightness, and STJ pronation can contribute to PFPS, women with PFPS have significant weakness in hip abductor and external rotators.15 Without this proximal strength and ability to stabilize, the femur will have an even greater tendency to adduct and internally rotate, creating greater lateral patella contact area. Repetitive knee flexion and extension movements with this misalignment lead only to greater susceptibility for PFPS.
Knowing that these patterns exist in women, it is still critically important to evaluate every woman individually and address their specific impairment. Stretching hip adductors and gastroc/soleus complex and strengthening quadriceps and hip muscles can be helpful. After a single-leg step-down test is pain-free, runners can try running on softer surfaces, and only gradually increase the distance and difficulty of runs. When pain presents and the knee flares up, runners should try a lower-impact form of exercise, such as walking, cycling, or water aerobics, until the pain settles down. Patella taping or a knee support for patella tracking has been shown to reduce pain, and, if swelling presents, ice should be applied.
ACL: ANOTHER CONDITION LURKING
ACL tears are among the most common types of sports-related injuries, with some 200,000 occurring in the United States each year, according to the American Academy of Orthopaedic Surgeons.1 The incidence of ACL injuries among female athletes is significantly higher than among male athletes. Specifically, in playing basketball females are 3 to 6 times more likely to injury their ACL, while for soccer, females are five times more likely.
The ACL is one of the ligaments that stabilize the knee joint by maintaining the tibia's position relative to the femur. Sharp, sudden movement, such as a ski accident or landing from a jump, can tear the ACL. Following an ACL injury, one might experience a "popping noise," swelling, and a loss of control of the knee joint.
Several factors (structural, neuromuscular, biomechanical, and hormonal) explain why women have a higher rate of ACL injury, particularly noncontact ACL injuries. Structurally speaking, women have a narrower femoral notch that may contribute to a higher injury rate due to impingement. At the hip, females have greater active rotation range of motion and increased laxity compared to males.16 When looking at neuromuscular control, it is evident that when women try to control knee motion they demonstrate reduced muscle stiffness compared to males in addition to an over-reliance and early recruitment of their quadriceps muscles before their hamstrings to stabilize the knee. When the ACL is stressed, it would benefit the individual to activate the hamstring since it is an ACL agonist. However, this delayed activation can cost a female her ACL.17 Females exhibit lower muscular endurance compared to males, which is thought to lead to earlier fatigue and increased risk of injury. Research suggests that biomechanical factors such as a woman's body movement patterns during sports, such as sidestep cutting with increased valgus, decelerating with knee extended, and landing mechanics from jumps with greater knee extension and valgus movements (which create increased tibial shear forces), are what makes them more susceptible to noncontact ACL injuries.
Current research shows conflicting evidence of the role of hormones in ACL injuries for females. During the ovulatory period of their menstrual cycle, there may be hormonal changes in women that affect performance. A link between changes in sex hormone concentration and the viscoelastic properties of the tibiofemoral joint has also been shown.
A program of strength training and proper landing mechanics are typically recommended to help prevent ACL tears in athletes. If an ACL injury does occur, a health care professional may begin treatment with a RICE (Rest, Ice, Compression, Elevation) program, which may include a knee brace for compression and added stability, and a physical therapy regimen. Surgery is warranted through a consultation with a physician.
Rehabilitation is key, whether or not treatment involves surgery. A physical therapy program will help an injured person regain knee motion, strength, stability, and neuromuscular control in order to return to her preinjury activity level.
FORGET CANKLES, WATCH HER ANKLES
According to the American Academy of Orthopaedic Surgeons, 25,000 people sprain their ankle each day. The ligaments of the ankle hold the joint in position. They protect the ankle joint from abnormal movements-especially twisting, turning, and rolling of the foot. Ankle sprains occur when a ligament surrounding the ankle is stretched beyond its normal range or torn. The ATFL is the ligament most prone to injury.
Women are more susceptible to ankle injuries partly due to nature and nurture. Women have narrower feet than men, and their heels-in particular-are narrower compared to the front of the foot. However, women wear high-heeled shoes, which place the ankle joint in an "open-packed" and a most unfavorable and unstable position.
Female athletes have specifically been shown to have a higher incidence of ankle sprains than men. This is most likely due to several factors, including increased laxity and decreased muscle strength and coordination. Research has shown that women have much greater amounts of ligament laxity, particularly of the lateral ankle, than men.18 Also, the number of ankle injuries reported per 1,000 person-days of exposure to sports was 1.6 for men and 2.2 for women.
Also, even with athletic shoes, various studies indicate that women athletes are more likely than men to sustain ankle injuries. Research has shown that among female collegiate volleyball players, ankle injuries account for the highest percentage of injuries. Women who played soccer had the highest incidence of ankle injury, beating out field hockey and lacrosse players.
Most ankle sprains need only a short period of protection to heal. The healing process takes about 4 to 6 weeks. The physician should advise a patient to incorporate a safe and protective range of motion early in the healing process to prevent stiffness. Improved motion may also help patients improve their sense of balance and proprioception. If an ankle has a chronic tear, it can still be highly functional because overlying tendons help with stability and motion.1
It is important to note that once a person has sprained an ankle, it is more likely that they will sprain it again. Even lovers of high heels should understand that they are vulnerable once they have a history of ankle sprains. A program that incorporates weight-bearing strengthening, balance, and proprioception training will aid in recovery.
Although a regular program of strengthening (heavily focused on peroneal and posterior tib), stretching and whole lower-extremity exercise can help in recovery, wearing an ankle support can help reduce swelling and support ligaments. Braces should be worn once an injured person returns to a high level of activity and as a prophylactic measure.
TREAT HER RIGHT
Now that you know the facts, educate the females you encounter and encourage them to take action. Perform quick screen evaluations for PFPS, ACL, and ankle stability for the females you treat. Check to see if they are candidates for orthosis. Compliance is key, so give appropriate products and exercises that will suit them. Teach simple hip strengthening, landing mechanics, or balance drills that will enable them to protect themselves from these injuries because the truth is that they are more susceptible.
October 2011 - When it comes to sports injuries, it's clear that men and women are not equal. Females are more susceptible to certain orthopedic conditions, and it is more than chipped nails at hand. Compared with males, female athletes in specific sports are two to four times more likely to injure their knees, according to the American Academy of Orthopaedic Surgeons.1
HER "KNEEDS"
Patellofemoral pain syndrome (PFPS), also known as chondromalacia patella or runner's knee, is the most common reason for knee pain in girls and women, most prevalent in ages 10 to 35. Two to Four Patients report having symptoms of crepitus and sharp or achy pain behind or around the patella, occasionally accompanied with swelling. This pain increases with any activities that involve flexion of the knee, such as sitting, squatting, running, jumping, and ascending or descending stairs.
Female runners, jumpers, and other athletes such as skiers, cyclists, and soccer players put significant stress on their knees. Studies show that women are twice as likely to have patella tracking problems such as runner's knee. 5-7 A number of factors are currently believed to contribute to the cause of PFPS. Abnormal movement (tracking) of the patella along the femoral groove can increase PF joint reaction force and contact pressure during activities that require flexion and extension of the knee, resulting in pain and dysfunction.
Contrary to what has been assumed in the past, females do not have wider pelvises than their male counterparts. Females do, however, have wider pelvis-to-femoral-length ratios, which may contribute to an increased tendency for genu valgum. Consequently, women also have larger Q angles.8,9 An increased Q angle has been associated with patellofemoral pain, patella subluxation, and chondromalacia.10-14 Although quad weakness, gastroc/soleus tightness, and STJ pronation can contribute to PFPS, women with PFPS have significant weakness in hip abductor and external rotators.15 Without this proximal strength and ability to stabilize, the femur will have an even greater tendency to adduct and internally rotate, creating greater lateral patella contact area. Repetitive knee flexion and extension movements with this misalignment lead only to greater susceptibility for PFPS.
Knowing that these patterns exist in women, it is still critically important to evaluate every woman individually and address their specific impairment. Stretching hip adductors and gastroc/soleus complex and strengthening quadriceps and hip muscles can be helpful. After a single-leg step-down test is pain-free, runners can try running on softer surfaces, and only gradually increase the distance and difficulty of runs. When pain presents and the knee flares up, runners should try a lower-impact form of exercise, such as walking, cycling, or water aerobics, until the pain settles down. Patella taping or a knee support for patella tracking has been shown to reduce pain, and, if swelling presents, ice should be applied.
ACL: ANOTHER CONDITION LURKING
ACL tears are among the most common types of sports-related injuries, with some 200,000 occurring in the United States each year, according to the American Academy of Orthopaedic Surgeons.1 The incidence of ACL injuries among female athletes is significantly higher than among male athletes. Specifically, in playing basketball females are 3 to 6 times more likely to injury their ACL, while for soccer, females are five times more likely.
The ACL is one of the ligaments that stabilize the knee joint by maintaining the tibia's position relative to the femur. Sharp, sudden movement, such as a ski accident or landing from a jump, can tear the ACL. Following an ACL injury, one might experience a "popping noise," swelling, and a loss of control of the knee joint.
Several factors (structural, neuromuscular, biomechanical, and hormonal) explain why women have a higher rate of ACL injury, particularly noncontact ACL injuries. Structurally speaking, women have a narrower femoral notch that may contribute to a higher injury rate due to impingement. At the hip, females have greater active rotation range of motion and increased laxity compared to males.16 When looking at neuromuscular control, it is evident that when women try to control knee motion they demonstrate reduced muscle stiffness compared to males in addition to an over-reliance and early recruitment of their quadriceps muscles before their hamstrings to stabilize the knee. When the ACL is stressed, it would benefit the individual to activate the hamstring since it is an ACL agonist. However, this delayed activation can cost a female her ACL.17 Females exhibit lower muscular endurance compared to males, which is thought to lead to earlier fatigue and increased risk of injury. Research suggests that biomechanical factors such as a woman's body movement patterns during sports, such as sidestep cutting with increased valgus, decelerating with knee extended, and landing mechanics from jumps with greater knee extension and valgus movements (which create increased tibial shear forces), are what makes them more susceptible to noncontact ACL injuries.
Current research shows conflicting evidence of the role of hormones in ACL injuries for females. During the ovulatory period of their menstrual cycle, there may be hormonal changes in women that affect performance. A link between changes in sex hormone concentration and the viscoelastic properties of the tibiofemoral joint has also been shown.
A program of strength training and proper landing mechanics are typically recommended to help prevent ACL tears in athletes. If an ACL injury does occur, a health care professional may begin treatment with a RICE (Rest, Ice, Compression, Elevation) program, which may include a knee brace for compression and added stability, and a physical therapy regimen. Surgery is warranted through a consultation with a physician.
Rehabilitation is key, whether or not treatment involves surgery. A physical therapy program will help an injured person regain knee motion, strength, stability, and neuromuscular control in order to return to her preinjury activity level.
FORGET CANKLES, WATCH HER ANKLES
According to the American Academy of Orthopaedic Surgeons, 25,000 people sprain their ankle each day. The ligaments of the ankle hold the joint in position. They protect the ankle joint from abnormal movements-especially twisting, turning, and rolling of the foot. Ankle sprains occur when a ligament surrounding the ankle is stretched beyond its normal range or torn. The ATFL is the ligament most prone to injury.
Women are more susceptible to ankle injuries partly due to nature and nurture. Women have narrower feet than men, and their heels-in particular-are narrower compared to the front of the foot. However, women wear high-heeled shoes, which place the ankle joint in an "open-packed" and a most unfavorable and unstable position.
Female athletes have specifically been shown to have a higher incidence of ankle sprains than men. This is most likely due to several factors, including increased laxity and decreased muscle strength and coordination. Research has shown that women have much greater amounts of ligament laxity, particularly of the lateral ankle, than men.18 Also, the number of ankle injuries reported per 1,000 person-days of exposure to sports was 1.6 for men and 2.2 for women.
Also, even with athletic shoes, various studies indicate that women athletes are more likely than men to sustain ankle injuries. Research has shown that among female collegiate volleyball players, ankle injuries account for the highest percentage of injuries. Women who played soccer had the highest incidence of ankle injury, beating out field hockey and lacrosse players.
Most ankle sprains need only a short period of protection to heal. The healing process takes about 4 to 6 weeks. The physician should advise a patient to incorporate a safe and protective range of motion early in the healing process to prevent stiffness. Improved motion may also help patients improve their sense of balance and proprioception. If an ankle has a chronic tear, it can still be highly functional because overlying tendons help with stability and motion.1
It is important to note that once a person has sprained an ankle, it is more likely that they will sprain it again. Even lovers of high heels should understand that they are vulnerable once they have a history of ankle sprains. A program that incorporates weight-bearing strengthening, balance, and proprioception training will aid in recovery.
Although a regular program of strengthening (heavily focused on peroneal and posterior tib), stretching and whole lower-extremity exercise can help in recovery, wearing an ankle support can help reduce swelling and support ligaments. Braces should be worn once an injured person returns to a high level of activity and as a prophylactic measure.
TREAT HER RIGHT
Now that you know the facts, educate the females you encounter and encourage them to take action. Perform quick screen evaluations for PFPS, ACL, and ankle stability for the females you treat. Check to see if they are candidates for orthosis. Compliance is key, so give appropriate products and exercises that will suit them. Teach simple hip strengthening, landing mechanics, or balance drills that will enable them to protect themselves from these injuries because the truth is that they are more susceptible.