Are young women increasingly getting injured in sports?
Women’s sports have never had more attention. Superstars like Serena Williams, Abby Wambach, Mikaela Shiffrin, Claressa Shields, Breanna Stewart, Kerry Walsh Jennings, and Robin Arzon have captivated us and inspired greater female inclusion in sports.
This is great news for health. And women have more higher level playing opportunities than they did even 10 years ago.
“Playing sports has so many benefits: social, emotional, and physical development, leadership skills, working as part of a team,” says orthopedic surgeon Lauren Redler, MD.
But women are at greater risk for injury than their male counterparts for a variety of reasons, some still to be determined. Multiple theories have been proposed, including anatomy, hormones, training, and increasingly aggressive style of play.
“Sports are a fundamental part of a healthy lifestyle. I always encourage my patients to get involved,” says OB/GYN Tal Sarig-Meth, MD. “However, like most things in life, too much or too extreme of anything can also cause harm.”
An injury, however, does not always mean the end of play.
As prior athletes, Redler and Sarig-Meth well understand the athlete’s desire to get back to their sport.
Redler witnessed devastating injuries to teammates while playing Division 1 lacrosse. Unfortunately, she says, injury rates have not changed much over the years. And female athletes still get injured at higher rates than their male counterparts.
Sarig-Meth competed internationally in synchronized swimming for 10 years and was a fitness trainer in the Israeli military. Today the two doctors bring their love of sports and personal and professional knowledge of its benefits to their careers in health care.
Younger and earlier sports injuries
Classic sports injuries are happening to younger and younger patients.
Due to early sports specialization, young athletes have more repetitive overuse type injuries, such as meniscus tears and shoulder dislocations.
Redler says these injuries can be prevented with proper rest and periodization. Varying training activities and focusing on different sports in different seasons naturally emphasizes different muscle groups and body parts throughout the year to prevent overuse injury, psychological fatigue, and burnout.
“It is a bit counter-intuitive, but being a multi-sport athlete, in different seasons, can not only help prevent injury but also make athletes better at their sports. Almost all professional athletes were multi-sport athletes through their high school years,” says Redler.
Children should play no sport for more than eight consecutive months each year. “For the well-being of our youngest athletes it’s important to prevent a focus on a single sport to the exclusion of other sports, and emphasize free play,” says Redler.
Female hormones and sports performance, injuries, recovery
Like other health research, sports physiology research has mostly focused on male subjects so scientific information about women in sports is limited. Recently, says Sarig-Meth, attention has been brought to the effects the female hormonal system might have on women’s physical function, cognitive function, behavior, and, therefore, on athletic performance and risk of injuries.
This field of research is difficult to study and is in fairly early stages. New theories are being investigated based on the known physiological and cognitive changes that occur throughout the menstrual cycle. Menstrual changes in joint laxity and stability, reaction time, memory, motivation, and premenstrual symptoms are being explored as factors that might affect women in sports.
“There is much more to be explored and discovered," she says, “but right now there is no evidence to suggest that avoiding exercise during distinct phases of the menstrual cycle is necessary.”
Sarig-Meth sees women with hormonal and menstrual problems connected to playing sports at extreme levels, particularly in the younger population. Prolonged and extreme physical activities can create a chronic “stress state” in the body that can shut down the reproductive hormonal system. “This problem is especially common in women in aesthetic sports who tend to limit their caloric intake on top of the physical exhaustion,” she says.
This can cause abnormalities not only with puberty, the menstrual cycle, and fertility, but also can have short- and long-term effects on bone health.
Proper warm-up and exercise are essential
When static stretching is replaced by more active dynamic warmups, such as FIFA 11+ and the Santa Monica PEP (Prevent Injury, Enhance Performance) program, injury rates can be reduced.
During Redler’s college lacrosse career, her team went from a static stretching warmup and eight ACL tears her freshman year to an active dynamic warmup and zero ACL tears over the next three years. “I’ve seen firsthand that these warmups can definitely work,” Redler says.
To play or not to play
Athlete or not, every health care professional we speak to agrees: Playing a sport is better than not.
“Sports provide athletes with an understanding of what it takes to be victorious not only on game day but also in all life goals: a training schedule executed with rigor, self-direction, deliberate preparation, and an unrelenting work ethic,” says Redler. “Given the high importance of these activities, proper training, healing, and recovery is of utmost importance for athletes of all ages. And the physical and emotional complexities of injuries in youth and adolescent athletes are essential to understand.”
Sarig-Meth agrees: “Being an athlete is not only beneficial for physical health, but it also develops lifelong physical and mental resilience, internal motivation, self-discipline, and self-esteem. We need to work together.”
Lauren Redler, MD, is an orthopedic surgeon who specializes in sports medicine for adults and children, with a focus on shoulder, elbow, and knee injuries. She is assistant professor of orthopedic surgery at Columbia University Vagelos College of Physicians and Surgeons.
Tal Sarig-Meth, MD, FACOG, is an obstetrician and gynecologist at ColumbiaDoctors and assistant professor of obstetrics & gynecology at Columbia University Vagelos College of Physicians and Surgeons.