Introduction
Did you know that sports-related injuries are not the same for men and women and certain injuries occur more commonly in women? Also injuries of the bones, muscles, tendons, and ligaments can happen at any time? The good news for patients is that treatments are available that are tailored to the special needs of women – enabling them to get back to their everyday activities. This podcast – featuring Dr. Jennifer Baima, a physiatrist specializing in women and sports medicine within the Women’s Orthopedic and Joint Disease Center at Brigham and Women’s Hospital – will answer commonly asked questions.
What is a sports injury?
The most widely recognized sports injuries occur in an instant, when an athlete absorbs an unexpected blow. Most people do not realize that sports injuries, such as tendinopathy, also can occur from repetitive use during running, jumping, lifting weights and sports. While it is the acute injury that gets most of the attention, being aware of common injury patterns will help to prolong an athlete’s ability to enjoy playing sports at any age. For example, the most common sports injury is an ankle sprain. Often, this turns into a vicious cycle when ankle ligaments are stretched out and become too loose to work and hold the ankle joint in the right position for running. But with the proper care and treatment, an athlete’s performance will not suffer.
What are the most common sports-related injuries in women?
Mild ankle sprain, when there is acute stretching of the ligaments on the outside of the ankle joint, is more common in women. An acl tear also is more common in women. The ACL, or anterior cruciate ligament, is a band of collagen that helps to stabilize the knee joint and stretching of the ligament or a tear can occur even without contact injury in sport. In young female athletes, stress fractures are more common. Stress fractures are tiny breaks that occur when bone is weak from too much activity, not enough nutrients, or a hormonal imbalance.Since these three symptoms are all related, we call this the female athlete triad.
What are the physiologic reasons why injuries, such as mild ankle sprains and acl tears, are more common in women?
We are still learning about how injuries to the ligaments are different in women and men. One theory is that women have looser ligaments than men due to our different hormones. Women are clearly subject to different neuromuscular imbalances than men due to our wider hips and the more narrow position of our knees. Neuromuscular imbalance means that some of the weaker muscles are not being used in the way that they should be for optimal performance. Overall, the female body responds differently to exercise than the male body. Gender-specific training will likely decrease these injuries. Acl tear may occur due to many reasons such as a more narrow notch where the acl passes through the upper thigh bone, higher estrogen levels, and neuromuscular imbalances. We cannot change the shape of our thigh bones or our hormones, but we can do something to correct these neuromuscular imbalances through physical assessment and exercise prescription. Stress fractures are more common in women from the hormonal influence of estrogen on bones. When we exercise too much, it is harder to make and store estrogen in fat cells. An imbalance in nutritional intake and activity output can play into not having enough estrogen. It is important to have this evaluated to get the most out of your exercise training.
What are other factors that place women at higher risk for these kinds of injuries?
We all know about how women get osteoporosis from not getting enough exercise or calcium with vitamin D. Other factors that place women at higher risk are relatively loose ligaments as compared to men, wider hips when corrected for knee position, and weak quadriceps and hamstrings. Many people don’t know that the medial quadriceps muscle is at a mechanical disadvantage due to its position in women. Often strengthening this muscle decreases pain in the front of the knee.
Are the treatments different?
Yes. Not only do women have different anatomy than men, they have a different response to exercise. Women need to lift weights for a longer period of time than men to achieve similar results. They have to work harder at landing with their hips in line with their knees when running or jumping. Although oral and topical pain regimens are often the same, exercise protocols should be gender- based to allow for these differences in strength training response and lower limb alignment. Here at Brigham and Women’s Hospital, we are working to explore these differences in order to give you the best treatment.
What can we do for women of all ages who like to exercise?
At the Women’s Orthopedic and Joint Disease Center, we diagnose and treat the full spectrum of symptoms. We have doctors who specialize in both nonsurgical and surgical treatments of these disorders and injuries. Bracing helps prevent ankle sprain as does strengthening the muscles on the outside of the ankle. We cannot change the shape of our knees or the pulsing of our hormones, but we can diagnose and treat causes of muscle weakness and loose ligaments that can lead to acl tears with neuromuscular assessment, pain control, and physical therapy.
What services are available at brigham and women’s hospital?
Here at Brigham and Women’s Hospital we are leading the way in gender-specific treatment of musculoskeletal conditions to keep women in the game. We know that mild ankle sprain is not from wearing high heels. There is one reason why women are more prone to ACL tears, neuromuscular imbalance, that we are working to change. At the gretchen s. And edward a. Fish center for women’s health we have physiatry, endocrinology, rheumatology, cardiology, gastroenterology, gynecology, psychiatry, and nutrition all working together to help women function in top form. For example, female athlete triad involves stress fracture, a decrease in the number of menstrual periods per year, and nutritional deficiencies. It likely involves cardiovascular dysfunction due to hormone deficiency. A patient with this condition may need to see physiatry, nutrition, endocrinology, and even cardiology. Women can see doctors of all different specialties with a common interest in gender-specific medicine who team up to keep you in top form for whatever activities you enjoy.
Dr. Baima, thank you for your time and for providing this valuable information on women and sports medicine. For more information on the Women’s Orthopedic and Joint Disease Center or to make an appointment, call 1-800-BWH-9999 or visit us at www.brighamandwomens.org.
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