Elite Female Athletes And Their Injuries
3 April 2018
Did you know that in some sports women are 6 times more likely to sustain injuries than their male counterparts? Mikayla Southam, one of our specialist hand physiotherapists explains some of the reasons behind this trend.
Women are presenting more and more with sport related injuries. This is due to a number of different identified reasons:
- Increased participation in competition sport, especially at the elite level
- Historically training programs were designed for males
- Differing hormonal makeup
Are We All Created Equal?
Well, yes and no right? We are finding more and more evidence that the difference between 'males' and 'females' isn't as clear cut as we first thought. Hormones and the endocrine system is so intricate that we now know that their is a spectrum of female and male traits. However, generally speaking, here are some of the established differences:
- Women have shorter legs relative to body length (56% total height in men, 51.2% in women) with a lower centre of gravity.
- Total cross sectional area of muscle is 60% in women and 80% in men.
- Fat per body weight is 22-26% in women and 12-16% in men.
- Women have a wider pelvis and increased hamstring flexibility
- Female athletes have smaller heart size, lower diastolic and systolic pressures and smaller lungs. They also have another metabolic process that can alter there healing and injury rate called the Female Athlete Triad.
The Female Athlete Triad
Although this sounds like an exclusive female mafia group, it is actually a serious concern for female athletes. The combination of high intensity exercise and reduced nutritional input results in altered estrogen and progesterone hormones. An athlete with Female Athlete Triad may lose 2-6% of bone mass/year and develop a bone structure similar to that of a 60 year old. This weakened bone puts her at a 3 fold increase of stress fractures. Estrogen also stabilises collagen and low levels can increase hypermobility syndromes. It also contributes to lower healing rates. If an athlete is faced with this condition, treatment includes a multi-team approach. Some treatment goals are to increase calorie intake, decrease training by 10-20% and add resistance, supplement with calcium and monitor bone density.
At Active Hand Therapy we treat a number of gymnasts who may present with fractures, pain or strains. There is another complication known as Gymnasts Wrists. This is from the repetitive movement of weight bearing on an immature joint that is not designed for this type of thing. Alteration of the growth plate in gymnasts is widely documented. This results in the bones growing at altered rates and pressure creating a wrist joint that functions differently. It not only leads to high levels of pain in the joint but the repetitive strain of the sport increases the risk of fractures. Treatment for Gymnasts Wrists involves dynamic strengthening exercises, splinting and taping, education on technique and other management programs.
Volleyballers have it pretty tough when it comes to injuries of the hand with fingers copping the most damage with up to 44% of documented injuries. Females are found to be have more injuries and Netball and Basketball players have similar incidences. The majority are contact injuries resulting in fractures and dislocations. Treatment may include splinting, taping and oedema management. Simple injuries will often take 4-6 weeks heal.
Unlike Tennis Elbow, this overuse injury can occur in either wrist. Extensor tendonopathy (inflammation of the tendon) usually occurs in the non-dominant hand and flexor tendonopathy in the forehand. This can result in over-stretching of the wrist causing micro-tearing of the soft tissues. Women are more commonly affected due to looser and weaker wrists. Treatment involves targeted dynamic strengthening program depending on the tendons involved. Taping or splinting may relieve and support structures while healing and education on proper stretching techniques.
Really? It's a thing. The joint most affected is the shoulder with the repetitive running motion causing tendonopathy and inflammation of the joint. Arm/hand injuries also occur when a runner falls. leading to impact and torsion injuries. On our last post we went through Sally Pearson's devastating wrist injury.
Reducing the Risk?
So what can we do as players, trainers and medical staff?
- Be aware that training programs can and need to be targeted to individuals.
- Listen to your body and read up on new training techniques.
- Enlist an exercise physiologist who has specialised knowledge in this area, ensure you are eating a well-balanced diet with adequate calories for your training program.
- A dietitian can help with programs or there is a number of Apps that can track calories.
- Be aware of changes in hormones and if you notice a decrease in menstruation or changes to your skin or joints visit your GP for more information.
- Knowing that there are specialist therapists and other injury management health professionals out there can really improve your outcomes.
- Early treatment and finding the right person will get much better results.
- We always encourage people to call one of our therapists for advice - whether you are a weekend warrior, physio, doctor or an elite athlete our team is always happy to chat.
Written by Mikayla Southam
Presented by David Coles at Action Rehab Sports Symposium