Women’s Health: Risk and prevention in sports injuries

Last modified: Tuesday, February 11, 2014

Since Title IX was enacted 36 years ago, female high school athletic participation has increased by 875 percent and female college athletic participation has increased by 437 percent.

The explosion of female athletic participation has coincided with the recognition that women possess unique anatomical, physiological and biomechanical characteristics that influence participation, performance and injury.

Most literature supports the belief that injury rates are sport-specific rather than gender-specific. But women are more at risk in some respects.


Anatomic differences are the most obvious place to start. In general, women are 3 to 4 inches shorter and 25 to 30 pounds lighter than men. They also tend to have less muscle mass and development, a smaller bone structure, and a wider, shallower pelvic. This results in alignment and biomechanical differences, particularly in the lower extremities.

The combination of these factors is why women have a higher incidence of knee injuries like patellar femoral syndrome and ACL (anterior cruciate ligament) tears. ACL ruptures in females are noncontact injuries. Most of these types of injuries occur in women 15 to 25 years old who participate in pivoting and jumping sports. In fact, ACL injuries in female athletes are 8 times more common than in their male counterparts and account for 80,000 injuries per year.

A strong association exists between ACL injury and development of post-traumatic knee osteoarthritis at a relatively young age, which also occurs with much greater incidence in females than males.

Hormonal differences also play a key role in injuries, particularly in the adolescent athlete.

Estrogen has a role in bone strength and ligament laxity, and even affects the nervous system.

Women are at risk for the “female athlete triad”: a combination of disordered eating, abnormal menstrual cycles and skeletal demineralization.

If your bones are not strong and are subject to increased stress, particularly in running and jumping sports, this increases the likelihood of stress fractures, an injury much more common in women.

Menstrual irregularities are a sign of trouble and warrant further investigation. Some studies have shown up to 66 percent of female athletes have had irregular menstrual cycles, compared with 2 to 5 percent in the general population. And 92 percent of total bone mineral content is achieved before the age of 18. If the cause of bone loss is not caught and addressed early, bone loss is irreversible and leads to lifelong low mineral bone content.

The combination of shorter arms, less muscle mass, and increased joint laxity (loose joints) also put woman at an increased risk for shoulder injuries. Overhead sports like volleyball and softball require repetitive use of these structures. Having two-thirds the absolute power and strength of men leads to faster muscle fatigue and often a subsequent change in mechanics, which stresses the joint structures and contributes to overuse injuries.

How do women level the playing field?

The first step is education and awareness. Over the last decade there has been significant research and increased understanding of these influences affecting injury. In particular prevention could reduce the number of ACL injuries that occur each year. If injury rates for male and female athletes were equal, female athletes could continue the health benefits of sports participation and avoid the longterm complications such as osteoarthritis and osteoporosis.

Train for strength and stability. Strengthening your muscles not only improves your power but also improves balance and coordination. Landing and cutting require high levels of neuromuscular control to maintain stability and performance. A particular type of training called neuromuscular training (has been shown to be particularly effective in injury prevention. Neuromuscular control of the hip, trunk and knee is based on feedback control. It’s important to train the different parts of the body to “speak” to each other. Impaired control of the hip and trunk can increase lower extremity injury.

Develop healthy eating habits. A well-balanced diet, particularly in adolescent females, is an important ounce of prevention. Appropriate levels of calcium and vitamin D are important for bone health and development. Adequate energy intake is vital, particularly as training levels increase.

Dr. Sherri Kuchinskas is a sports medicine physician at Hampshire Orthopedics and Sports Medicine, Inc. This monthly column is coordinated by Cooley Dickinson Hospital.


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