SAN FRANCISCO, California—Ways to protect women participating in sports throughout their lifespans are coming into focus, but trainers as well as physicians need to recognize that sex matters, according to experts speaking in a press conference at the 75th annual meeting of the American Academy of Orthopaedic Surgeons (AAOS).1

“[Treating] those who are injured is not enough,”—Letha Griffin, MD, PhD.
Sex and gender greatly impact on the different injury rates of certain joints: women are 4 to 8 times more likely than men to harm the anterior cruciate ligament (ACL) in the knee. While both women and men have the same successful outcomes with ACL surgeries, said Dr. Letha Griffin, MD, PhD, adjunct professor in the department of kinesiology and health at Georgia State University in Atlanta, “we have not solved the problem” of preventing injury in athletic women.

“[Treating] those who are injured is not enough,” she said, because >80% of ACL injuries are likely to produce arthritis a decade later, despite stabilization with surgery.

Boys squeak, girls thud

Dr. Griffin, team physician at Georgia State and panel physician for the Atlanta Ballet, noted that women typically pivot, land, and stop differently than men. “Girls usually are upright and off-center. On the basketball court, boys squeak. Girls thud.” She added that 1 in 100 female high school athletes will tear an ACL, as will 1 in 10 female college athletes.

Less hard evidence exists for a sex difference in foot injuries, yet anecdotal reports suggest the female foot is more prone to posterior tibial tendonitis, tighter Achilles tendons, and more heel pain and stress fractures. Bunions are more prevalent in women, but not all of them may be caused by wearing torturing stilettos, said Naomi N. Shields, MD, a lower extremity orthopaedic surgeon with Advanced Orthopaedic Associates in Wichita, Kansas, and clinical associate professor with the University of Kansas School of Medicine in Wichita. “We have wider hips and a different center of gravity,” Dr. Shields noted, “…we are ligamentously more lax.”

The design of most athletic shoes fails to take into account anatomical differences such as the wider toe area and narrower heel on women. Manufacturers merely downsize the male version, added Dr. Shields, “there are no standards, and the designs are not appropriate to each sport.”

“There are strategies to teach girls to have knees bent and keep the body balanced over the legs, but…there have been no changes in the rates of ACL injuries for women in the past 10 years. We are not getting the message out,” concluded Dr. Griffin.

Reference

1. Griffin L. Sheilds NN. Press conference. Presented at: AAOS 2008 meeting; March 5, 2008; San Francisco, Calif.