Problems for the Female Athlete

Problems for Women Athletes

There certain types of sports injuries that are found more commonly in women athletes than in men.( A Rigorous Comparison Between the Sexes of Results and Complications After Anterior Cruciate Ligament Reconstruction , Proceedings of AOSSM Annual Meeting, Sue Barber-Westin, Frank Noyes, MD). Some of these come from structural causes and some are due to the nature of the different physiology that exists between the male and female bodies. Some arise due to a combination of both structural and physiological.

More and more studies are reporting increases in the occurrence of knee pain in the female athletes. These range from patella (knee cap) tracking issues
like chondromalecia patella, or Osgood-Schlatter, a bone separation due to tendon tension of the thigh muscle to worse injuries to the ligaments that hold the knee together. These injuries are observed more frequently now since we have more females participating in strenuous physical activities such as marathons and contact sports. Through the years females have been  participating in a greater array of the sports activities. We observed females participating in high impact sports such as Lacrosse, softball, in American football, tennis and there is an increase in young girls participating in soccer, as well as track and field. This has brought to light these problems that need to be addressed.

Along with the other knee injuries mentioned above, We find that there is a high incidence of the anterior cruciate ligament or "ACL" injuries and tears in young female athletes. We find statistically that there is a greater percentage of occurrence in females than males. This it appears is due to two complicating factors. The first being structural in nature. We observe the female pelvis to be wider and shorter than the male pelvis.(#1)  This structural variant creates a peculiar anatomical position for the femur bones (thighs). Whereas in the male pelvis femur bones project inferiorly almost parallel one to the other. In the wider
female pelvis the femur bones leave the hip joints and angle slightly to the
center.(#2) The femur meets up with the lower leg bone the tibia, which
continues on a more inferior track to the foot,  creating an angle at the knee joint  angle which is greater than what is seen the male body. This arrangement of joint and bone gives us what's called the Q angle.(#3) When we  observe the  mechanics of walking, running and in general weight bearing on the foot , lower leg , thigh , hip , and spine we understand the necessity for structural stability.
(#4) This Q angle which in the female is greater than in the male causes an instability at the knee upon compression. This strain forcing the knee medially and
slightly posteriorly is seen to be responsible for many types of injury to the
lower leg,  iliotibial band, patellar,  as well as the knee and in particular the ACL .

Understanding that structural imbalance will cause these types of injuries especially to the anterior portion of the knee we also have to discuss other physiological occurrences in the female body . There are studies that have demonstrated that the hormonal ebb and flow particularly concerning estrogen render the female athlete more prone to knee and ACL injuries. Evidence demonstrates that during certain portions of the menstrual cycle there appears to be an effect of estrogen and other hormones on the body. (The effect
of relaxin on the female anterior cruciate ligament: Analysis of mechanical
properties in an animal model, Jason L. Dragoo, et al. Jan 2009) The
manner in which estrogen prepares the body for fertilization, implantation,
gestation, and  birth has far-reaching effects throughout the body. It seems that one of these effects is to soften tendons and ligaments. This is in preparation in the pelvis for softening tendon and ligament to allow the expansion of the pelvis during birth and to adapt to the changing body anatomy, weight and posture, during the nine months of gestation. Unfortunately this effect of increased estrogen circulating in the blood does not only effect  the pelvic area. The softening of ligament is also occurring at other articular surfaces such as the knees. This has been well documented in various studies illustrating that at certain points in the menstrual cycle the female athletes tend to have a propensity for knee injury. (The effects of the menstrual cycle on anterior knee laxity: a systematic review, Sports Med. 2006, .Zazulak BT et al.)  The study opens a larger discussion as to what is occurring in the female athlete taking contraceptive pills that regulate their estrogen cycle and how that effects the entire body. However, that is a discussion better left for another blog.

The most informed way to begin to analyze knee injuries in the female athlete is to understand the concepts noted here. We have discussed the occurrence of structural problems such as the Q angle that occur in the normal female pelvis. When  we are dealing with a further distorted pelvis and low back from strain or
injury,  so common in athletes in
training, we must then understand there being even a greater Q angle and even a
greater chance of knee injury and pain. To the chiropractor maintenance of the
posture; the balance between pelvis, lower extremities, spine, upper
extremities and head, is paramount. The Chiropractor is an expert in observing
and finding postural distortions and aiding the patient in correcting the distortions, returning structural balance. At times this might include modification of exercises specifically foot positioning, modification of bicycle riding or spinning; giving attention to foot position on the pedal to accommodate the knee properly. The proper employment of Core exercises is very important. There are times athletic shoe selection might be important or the use of custom made shoe inserts, or
Orthotics . Most chiropractors as well have training in nutrition and can guide
the patient in dealing with the nutritional necessities of their sporting
activities, and if they wish, the use of natural products in the correction of
minor hormonal imbalances. In our clinic, at Barron Chiropractic, we treat
these conditions with combinations of therapies. We use interferential
electrical stimulation using standard, Russian, or European protocols. We also
treat these types of injuries often with cold laser which has been found to
hasten the healing. We have found that this combination of therapy accompanied
by taping and strapping has been very effective.