• A Guide To Women’s Health

    Women’s sports participation, as in men, produces numerous health advantages including improved cardiovascular fitness, better weight control, increased self esteem and improved bone density. However just like sporting males, there is a risk of sports injury in sporting females. Female U.S college athletes have been reported to have twice the rate of injury in soccer compared to males and a three times higher injury rate in basketball compared to males. Largely these sports injuries in women are related to the participation in a particular sporting activity, although there are physical and hormonal differences between the sexes that do play a role in the injury process and for injury prevention it is good to have a basic knowledge of these factors.

    Generally females reach puberty earlier than males although beyond puberty men have more muscle mass and strength than females, while women have slightly higher body fat. Physiological differences in heart and lung size, where women are generally smaller, mean that men have a higher oxygen carrying capacity. These factors mean that men have a greater physical capacity than women. The general strength and fitness advantages of men may make them less likely to suffer a sports injury than women.

    Women have a wider pelvis to accommodate child birth. This means they have different body alignment compared to men and it has been hypothesised that this alignment difference where the hips are wider, knees are squinted inwards and shins are rotated inwards with a flat arch of the foot, can predispose women to injury. Some studies have shown that women with this posture have reduced hip abductor and external rotation strength and that this may further predispose to certain overuse injuries. A full assessment by a chartered physiotherapist can identify any muscle imbalances and correct these with an exercise programme.

    Hormonal differences which can be exacerbated by sports participation mean that females are four times more likely than men to experience osteoporosis. This is often aggravated by dietary problems which are also much more likely to occur in women rather than men. As osteoporosis can pre-dispose people to stress fractures and fractures, then women are disproportionately affected by these injuries.

    This guide explains the sports injuries which most commonly affect women and how these can be avoided. As ever we provide a jargon explained guide to the most common sports injuries in women together with a straightforward guide to products that can help if you suffer one of these injuries yourself.

    What is a sprained ankle?

    A sprained ankle is one of the most common sports injuries across all sports in both men and women. The reason a sprained ankle is so common in women is that twisting your ankle is a common injury mechanism in netball, basketball, soccer, gymnastics, dance, badminton and tennis. These are the most common participation sports for women and account for the high incidence of ankle sprains in females.

    A sprained ankle is damage to ankle ligaments and soft tissues around the ankle. This soft tissue damage causes bleeding within the tissues and an extremely painful swollen ankle.

    What can you do to prevent a sprained ankle?

    Using an Ankle Brace or Taping the ankle can help to reduce the risk of a sprained ankle. Research from college basketball has shown that the incidence of sprained ankle injury in people with taped ankles was 4.9 ankle sprains per 1000 participant matches, compared with 2.6 ankle sprains per 1000 participant matches in students wearing Ankle Braces. This compared with 32.8 ankle sprains per 1000 participant matches in subjects who didn’t use taping or bracing.

    What should you do if you suffer a sprained ankle?

    Follow the RICE protocol – Rest, Ice, Compression and Elevation – (never apply ice directly to the skin) for effective treatment of a sprained ankle. Ice Therapy can reduce pain but pain-relieving medication from your pharmacist may also be necessary. Don’t put too much weight on the damaged ankle, so a Removable Plastic Cast Walker can be helpful to provide protection and to allow early walking.

    Research suggests that people with ankle instability following a sprained ankle who underwent balance training experienced significantly fewer sprained ankle recurrences during a follow-up period than those who did not follow the balance training programme.

    What is a lower back stress fracture?

    A lower back stress fracture of the back is one of the most common injuries in young female athletes. This injury is particularly prevalent in basketball, soccer, gymnastics, dance and tennis. Lower back stress fractures are usually characterised by lower back pain which is exacerbated by sporting activities and eased by rest, although some people with a stress fracture can be pain free. Typically it is sore when the person bends backwards, particularly if standing on one leg. If a lower back stress fracture is suspected, a doctor may decide to refer for a scan to confirm the diagnosis.

    Injury A-Z: Lower Back Stress Fracture

    What can you do to prevent it?

    Avoid the ‘female athlete triad’ of disordered eating, amenorrhea (absence of menstrual period) and osteoporosis, by maintaining a balanced healthy diet which provides a more than adequate energy source to allow physical training.

    As well as nutrition, training should be carefully monitored by the coach to ensure the lower back is not being overloaded. This is particularly important in adolescent athletes who have just experienced a growth spurt as they are known to be more at risk from this injury. Core strengthening exercises can help prevent back problems by improving muscular control of the spine.

    Guide to Core Strength exercises

    What should you do if you suffer from a lower back stress fracture?

    Treatment involves a complete rest from sporting activities, for a period of six weeks to allow the bone healing. A soothing heat pack can reduce back pain and alleviate back muscle spasm in the early stages. Once the acute back pain has resolved a progressive exercise programme may commence, under the supervision of a chartered physiotherapist. Typically this involves exercises to increase the muscular stability in the lower back.

    Research suggests that a lack of muscular stability in the lower back can lead to low back pain and stress fractures. These core stability exercises are designed to target certain specific muscles which provide support for the lower back. The increased stability can help to reduce postural faults which can predispose a person to back pain.

    What is an ACL rupture?

    The Anterior Cruciate Ligament (ACL) is the most important ligament for knee joint stability and is situated deep within the knee joint. Per hour of athletic sports participation, women have a greater incidence of ACL rupture than men. Research on why this occurs is as yet inconclusive. However several factors have been identified. A smaller ACL in proportion to knee size increases the likelihood of rupture and women generally have proportionately smaller ACLs than men. Other studies have demonstrated that women don.t bend their knees as much as men when landing from a jump, while there is a theory that hormonal changes can lead to increased joint laxity in women.

    Injury A-Z ACL Injury

    What can you do to prevent it?

    Balance and proprioception training under the supervision of a physiotherapist may be effective in reducing ACL injuries in cutting and turning sports such as netball, basketball and soccer. These balance exercises are designed to enhance the proprioceptive system by improving sensory function around the knee. Previous research studies have suggested that people who practised wobble board training experienced significantly fewer knee ligament injuries.

    A knee brace provides support to previously ACL injured knees and helps to prevent knee ligament injuries. Wearing a knee brace during high risk activities such as skiing can reduce the risk of a knee injury, because it provides 30% more resistance to stresses placed on the knee ligaments.

    Expert Update Dr Donald Shelbourne on ACL injuries

    What should you do if you suffer an ACL injury?

    Conventional treatment for an ACL rupture is reconstructive knee surgery where the torn ACL is replaced by a graft that is taken from the Patella tendon or one of the Hamstring tendons. Research has shown that there is no significant difference in the outcome following the use of either of these grafts. The rationale for ACL reconstruction is that it restores knee stability. This is seen as essential for a return to sports, particularly sports that require cutting and turning because without this stability the knee can give way again and cause further damage to other structures within the knee. However other research has shown that the level of subsequent knee damage and degeneration is similar in all ACL damaged knees, whether those knees are reconstructed surgically or rehabilitated conservatively. Stability and reassurance for the knee can be enhanced by using a knee brace, especially during high risk activities such as skiing.

    What is Patellofemoral Pain Syndrome?

    The Patellofemoral joint is formed by the back of the knee cap and the front of the thigh bone. Patellofemoral Pain Syndrome is a common cause of pain around the knee cap (Patella) in females. As the knee straightens and bends the knee cap glides in a groove on the thigh bone called the ‘Patellofemoral groove’. This movement is controlled by the thigh muscles.

    If the knee cap doesn’t track correctly in the ‘Patellofemoral groove’ this is called Patellofemoral maltracking, which produces abnormal stresses on the back of the knee cap. This is thought to be responsible for the Patellofemoral Pain Syndrome.

    Injury A-Z Patellofemoral Pain Syndrome

    What can you do to prevent it?

    Patellofemoral maltracking can be influenced by lower limb alignment. It is thought that Patellofemoral maltracking is more likely to occur in individuals who have an inwardly rotated hip / knee position, where the knee caps are squinting inwards. Because of their wider pelvis women are more prone to this type of posture than men and experience Patellofemoral Pain Syndrome more.

    Specific strengthening and stretching exercises prescribed by a physiotherapist can reduce alignment exaggerations and reduce stresses around the knee cap. Weakness of the Gluteus Maximus and Gluteus Medius muscles may cause the thigh to fall inwards during running. Other issues include tight, shortened Calf, Rectus Femoris, Adductor Longus and Hamstring muscles. In addition to the exercises an orthotic can help improve the alignment issues.

    What should you do if you suffer from Patellofemoral Pain Syndrome?

    Aggravating activities such as running should be avoided. An alternative method of maintaining fitness during this period is running in water. This can be achieved using a Buoyancy Aid, but it is important that these exercises are pain free.

    Ice Therapy can be effective to relieve the pain around the knee cap. Ice packs can be used for around 20 minutes every two hours. The Aircast Knee Cryo/Cuff can be used for the home treatment of knee pain. It provides continuous ice cold water and compression for six hours and significantly reduces knee pain and knee swelling.

    What is IlioTibial Band Friction Syndrome?

    IlioTibial Band Friction Syndrome is known as ‘Runner’s Knee’. IlioTibial Band Friction Syndrome can occur more often in women due to alignment differences that may predispose to this condition. The wider pelvis and squinted in knee posture, together with pronated feet may mean that there is increased stress on the outer part of the knee.

    It produces pain on the outer-side of the knee joint, which may radiate up the thigh or down the outer-side of the shin. It is exacerbated by running and cycling. Usually, the knee pain from Runner’s Knee is only present during activity and settles during rest. However, in some cases pain can become present out of sports, especially when going up or down stairs.

    Injury A-Z IlioTibial Band Friction Syndrome

    What can you do to prevent it?

    Runner’s Knee is an overuse condition that is aggravated by excessive running and cycling training, due to the IlioTibial Band rubbing against the outer part of the lower thigh bone during repetitive knee bending exercises. To prevent it make sure that you gradually increase your training load – there should be no sudden increases in workload as this can cause inflammation of the tissues.

    The wider female pelvis and squinting in knee posture that this may produce can lead to inward rotation of the shin and increased pronation of the foot (uncontrolled lowering of the arch). This can lead to increased tension in the IlioTibial Band on the outer side of the thigh when running. Improving muscular control of the Gluteus Medius and Tensor Fascia Latae muscles may be helpful under the guidance of a physiotherapist. In addition an insole that supports the arch of the foot can help to control increased pronation.

    What should you do if you suffer from IlioTibial Band Friction Syndrome?

    IlioTibial Band Friction Syndrome is an inflammatory condition, so ice packs and Non-Steroidal Anti-Inflammatory medication (NSAIDs) prescribed by your doctor can be effective in the early stages.

    Once the inflammation has settled down a physiotherapist can assess posture and lower limb alignment in order to give specific stretching and strengthening programme if these factors are thought to contribute to the problem.

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