Honors English III
24 October 2011
Women and Sports Injuries: An Epidemic
Rachele Burns, a member of the University of Maine Women’s basketball team made her first collegiate appearance in the fall of 2010. Burns, a sophomore, was unable to play her freshmen year because she was recovering from her third Anterior Cruciate Ligament, or ACL, surgery on her right knee. After sitting out her freshmen season Burns was eager to play, but nobody predicted what would happen next. December 18th 2010, Maine was in Florida for a tournament, Burns was in the middle of a one-on-one drill when the unexpected happened. Rachele Burns, number twenty-three and guard for the Lady Blackbears, collapsed and fell to the court; Burns tore her ACL, but this time it was her left knee (Menendez). After only five games into her season she was averaging 3.4 points, 1.2 rebounds, 6 steals, and was shooting 83.3% percent from the free throw line; Burns was a rising star. Burns is unfortunately an example of the terrible epidemic that is becoming a major problem for female athletes. Sports injuries, such as ACL injuries are starting to occur more and more frequently in the athletic population. Athletes, coaches and athletic trainers should teach and enforce the proper techniques to avoid sport injuries, especially in females.
Women are encouraged to participate in sports and be athletes, but there are certain factors that put females at a greater risk of injury. The differences between the anatomy of a male and female may play a role into why women are more likely to get injured. Other contributing factors include training methods, poor conditioning, structural differences between the muscles in the knee and thigh, estrogen levels, the fit of athletic shoes, landing techniques, and the Female Triad (“National Institute of Arthritis and Musculoskeletal and Skin Diseases”).Some injuries that women are more likely to suffer from include joint injuries, hip, back, and shoulder injuries, concussions, femur fractures, and ACL injuries (Kessel).
After going through puberty in the adolescent years, significant differences occur in both males and females, these changes affect the performance of athletes. Unlike their male counterparts, after puberty the muscles of a female become more flexible while the muscles of a male gain power (Kessel). Male athletes tend to have a balanced strength between their hamstring and quads, unlike women. For example, when performing certain actions like running or cutting females do not use their hamstrings as much as males do (Haverbush). The hamstring and quads are very important muscles that aid in stabilizing the knee when performing certain maneuvers such as landing jumps, or twisting, having an unbalanced hamstring and quad strength ratio increases the risk of injury drastically. Females tend to have stronger quads than hamstrings; this why when a female is standing in a straight-legged position her knees will be hyper-extended. This happens because of the significant difference in strength between the quads and hamstring (McPherson). Since women have unbalanced muscle ratios, the ligaments in the knee are used to absorb the force when landing. The knee ligaments are used in order to compensate, or make up for the lack of hamstring muscles. Men use their hamstrings when they land instead of their quads. Using the hamstring stabilizes the knee joint by pulling the tibia back, thus taking the stress of the ACL. Women, on the other hand rely on their quads. Relying on the quads compresses the joint pulling the tibia forward while the ACL is trying to hold it back; this causes stress on the ACL (Kessel). Due to the stress that is being put on the knee ligaments, the risk of injuries, like ACL tears are greater. The risk for injury is greater during the menstrual cycle as well. The University of Michigan at Ann Arbor conducted a study that researched the relationship between women who suffered from an ACL injury and their menstrual cycle. In their study the women provided history of their menstrual cycles, including frequency and regularity, date of their last menstrual period, the average length of a cycle, premenstrual symptoms, and if oral contraceptive or hormone replacement was being used. The University of Michigan found a positive relationship between the two; they observed that during the menstrual cycle the women were more likely to injure themselves (“Sports Prolotherapy Oak Park Illinois a Non-Surgical Alternative for Sports Injuries”). Estrogen and Progesterone influence the cells on the ACL, fibers that make up the ACL, and the blood vessels of the ACL. Studies have shown that when the estrogen levels increase, like during the menstrual cycle, the ligaments strength is decreased. Women who tear their ACL during their menstrual cycle tear it between days five and twelve when the estrogen concentration is at its peak (Creighton). Neuromuscular differences and hormones are vital contributing factors but biomechanics also play a part.
When performing certain movements like jumping, pivoting, turning, and landing the genders accomplish the task differently. When landing a jump, a woman’s knees tend to go inward; this causes weight to be distributed unevenly. Men land with more flexion in their knee, while women land more straight-legged (Kessel). With the differences between how men and women land, which way will reduce the risk of injury? The proper landing technique is to land on the balls of your feet with your knees and your hips flexed (Dilworth). Unfortunately, most athletes do not know the proper techniques because coaches and athletic trainers do not teach the proper way. Coaches can become more focused on the power or height of the jump that they end up forgetting about the safety of the athlete. Coaches should focus on the landing first and then the power and height of the jump instead of vice versa.
Figure 1. This diagram shows how an ACL injury would occur in a female athlete because of improper landing. (Grant)
Training programs for young athletes are designed around young male athletes; they tend to neglect the biological differences between men and women (“Science Daily”). Alison Toth, M.D, director of the Duke Sports Medicine Center said this about the new training programs that are specializing in teaching the proper techniques to female athletes, "Most of them focus on teaching balance and landing techniques, as well as strengthening muscles around the pelvis and legs, to help prevent those injuries," she then goes on to say “"Pre-adolescence would probably be the best time to begin teaching neuromuscular programs so that the young teenage population can begin to incorporate that into their activities. It's easier to train early than to start when someone's already in college, though it's still helpful at the college age." (Howe). Swayne, an Athletic Trainer in Texas also said “Junior high and youth sports' coaches should start teaching both genders about how to prevent knee injuries at a young age. The earlier athletes learn how to use their bodies correctly, the better.” (Dial). Athletic trainers and doctors alike agree that the earlier proper landing techniques are taught the better off the young athlete will be in the future. The hope in teaching the techniques early is that, during a game situation, the athlete will land proper naturally without having to think about it (Dial).
As the awareness of female sports injuries grows, athletic trainers and coaches are starting to take more precautions in order to prevent sports injuries amongst their female athletes. Allison Campbell, a basketball coach at North Shore junior high in Texas, said “…You don't need a big weight room or high school-level facilities for middle school kids to work on jumping and landing." (Dial) proper landing techniques should be incorporated into practices and should become a focal point. Athletic trainers and coaches should include jump drills and make sure they are focusing on the proper way to land instead of how fast or how high the athlete can perform the jump. Jump drills such as wall jumps, broad jumps, and squat jumps can be used to work on landing. Drills that work on improving hamstring strength should also be part of daily workout routines, since the hamstring helps stabilize and support the knee, particularly when landing a jump. Teaching the proper way to jump, run, pivot, and land is a cheap and easy task. Rachele Burns has been through four acl injures, three on her right knee and one on her left knee (Menendez), unfortunately she has become an example for a problem that needs to be resolved, and the best way to fix the problem is to teach how to avoid the injury; for example, women soccer players are two to eight times more likely to tear their ACL, but by adding exercises that work on the neuromuscular strength to their training program the risk of an ACL injury was reduced by two to four times (McDonald). Likewise, female basketball players are four to ten times more likely to tear their ACL than their male counterparts (Brenner). In order to lower these statistics athletes, coaches, and trainers have to change the focus of their training regimens. The more focus that is applied to preventing sports injuries, the lower the risk of a serious sports injury will be and the more beneficial it will be to the athlete and their future athletic career.
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