Aug 2, 2018
Males, Females, and Injuries

In the five most common sports injuries, there are a number of sex-based differences. Experts say knowing about them is important for athletic trainers in order to work with all student-athletes effectively.

“Sexual dimorphism is common in sports medicine, and we see difference between female and male athletes all the time,” Cordelia Carter, MD, Assistant Professor of Pediatric Orthopaedic Sports Surgery and Sports Medicine at the Yale University School of Medicine, said in an Orthopedics Today report. “Recognizing and being aware of this is key in order for us to effectively prevent injuries in all of our athletes, as well as to customize management so that we may achieve better outcomes. Ultimately, a young athlete’s sex effects his or her outcomes, so understanding difference amongst patients can help us improve care for all.”

Here’s how sex-based differences can impact treatment for five common sports injuries:

  • Stress fractures: Many athletes have experienced these. However, female athletes struggling with the female athlete triad — characterized by low energy availability, low bone mineral density, and menstrual dysfunction — may be at greater risk for them.

“We need to ask our young athletes about their eating, their nutritional status,” Elizabeth Matzkin, MD, Surgical Director and Orthopedic Surgeon at Brigham and Women’s Hospital in Boston, said. “We need to ask our young female athletes about their menstrual status, if they are of age, and we need to educate. We need to educate parents, athletes, athletic trainer[s] and coaches, and everyone involved in managing athletes’ care.”

  • ACL injury: Female athletes have a higher ACL tear rate, though prevention programs that work to modify landing patterns can be successful. Females also tend to report lower levels of function after injury and are less likely to return to sport after an ACL tear than males.

“When we look at female athletes, especially we want to ensure when they go back to sports following an ACL reconstruction that they are not just physically ready but also physiologically ready,” Dr. Carter said. “The fear of reinjury oftentimes prevents females from returning to sports. As surgeons, we can think about changing our technique. As physical therapists and others who care for athletes following surgery, we need to change not just duration, but the type of rehabilitation that we do.”

  • Hip impingement: Another common condition, hip impingement can decrease range of motion. Because females typically have less muscle mass than males, they also have less hip stability. As a result, they have higher rates of femoroacetabular impingement
  • Concussion: Female athletes have a higher concussion rate than their male counterparts. Although there are a number of anatomical and biomechanical factors at work, such as estrogen’s effect on prolonging or changing concussion symptoms, those aren’t the only differences.

“Some of this may be secondary to self-reporting,” Dr. Matzkin said. “There have been studies that have shown girls are more [likely] to report a head injury, whereas boys may want to tough it out or not report it and also fear that if they report it, they are going to be pulled from a game or miss the next game.”

  • Shoulder instability: Compared with females, males have a higher incidence of primary anterior shoulder instability. As a result, they face increased risk for second and third shoulder dislocation.

“Not only is the initial or primary traumatic shoulder instability event more likely to take place in males but furthermore, males have a significantly higher incidence of recurrent shoulder instability as well,” Dr. Carter said.

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