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Influence of Gender on Risk of Sports Injuries

Running
  • Women have 50% greater risk of some common pathologies sustained whilst running:
    • Anterior knee pain
    • Plantar fasciitis
    • Iliotibial Band Syndrome
  • During the stance phase of running (i.e. when the foot is in contact with the ground) women place the knee at a position of risk:
    • Adduction of the hip (knee comes towards the midline)
    • Internal rotation of the hip (knee points inwards)
    • Ankle eversion (more pressure going on the inside arch of the foot)
  • This is due to weaker muscles:
    • Hip abductors
    • Hip external rotators
    • Hamstrings
  • In this position excessive stresses are placed on:
    • Ligaments especially of the knee and ankle making them prone to injury 
    • Patellofemoral joint (where the knee cap articulates in the knee) producing instability and anterior knee pain
  • Women run more upright:
    • During stance phase of running:
      • Less flexion at the hip 
      • Less flexion at the knee
Landing after jumping
  • Landing from a jump requires strong muscles to absorb the forces
  • Women tend to land flat footed
  • Men tend to land on the ball of their foot:
    • This is the area around the metatarsal heads at the front of the foot
  • Landing on the ball of the foot means more energy is absorbed by the calf muscles and Achilles tendon and so passing less stresses to the knee:
    • To do this requires stronger calf muscles
  • Women bend less at the knee and hips when they land 
  • Consequently, women pass more of the landing forces to their knees subjecting them to greater risk of injury
  • These factors occur due to weaker muscles but with proper training and education they can be improved
  • Injury prevention programmes are particularly good for this 
Plyometrics
  • With activities that involve quick turns and change of direction, strong balanced musculature together with proprioception are critical in order to avoid injuries
  • Women tend to be more quadriceps dominant due to weaker hamstrings than men which puts them at increased risk 
Neuromuscular control
  • Neuromuscular control requires various components working in synergy so as to perform a movement in a controlled manner
  • It involves coordinating movement of multiple joints at the same time and sequentially 
  • Timing of the muscle contraction and in the correct sequence is key
  • It is not unheard of to cause severe injury to a joint simply by untimely contraction of a muscle whilst carrying out a rapid movement
  • This coordination of movement around multiple joints is so that less stress is placed on the joints and ligaments and it involves:
    • Perception
    • Detection
    • Processing of incoming sensory information
  • One of the key causes for the increased risk of injury in females is the lack of neuromuscular control 
  • Neuromuscular fatigue occurs when as the exercise continues over time the muscles start to fatigue and this is more prominent in women:
    • This leads to excessive stresses on joints and ligaments which are therefore put at risk of injury and pain
  • Neuromuscular control can however by improved with correct training:
Metabolic differences
  • Men have higher testosterone levels and women have higher oestrogen levels
  • This results in differences in the way blood sugars and lipids are metabolised, utilised and stored all of which impact sport performance as well as overall health
  • Testosterone helps build more muscle mass so it is easier for men to get stronger:
    • However, its levels are known to reduce in male endurance runners
  • Oestrogen increases the laxity of tendons and ligaments: 
    • This is useful for when giving birth but not when participating in sport
The impact of oestrogen on musculoskeletal tissues
  • The exact impact of oestrogen on musculoskeletal tissues in young active women is still unclear
  • Oestrogen receptors are present in all musculoskeletal tissues:
    • Muscles
    • Tendons
    • Ligaments
    • Bones
  • Various studies have shown that:
    • Menstruating women are at higher risk of ACL injuries
    • As oestrogen level rises during the menstrual cycle so does the risk of ACL injury during this period:
      • The average menstrual cycle is 28 days long but it can vary and between 21 and 35 days is considered normal
      • Day zero is taken to be the first day of menstruation, day 14 time of ovulation which is when the egg is released from one of the ovaries
      • Oestrogen levels start to rise on days 8-11 of the cycle reaching their highest level in days 12-13 and return to original levels by day 16
      • Some studies have measured the ACL to increase in laxity by 1-5mm 
      • For every 1.3mm increase in ACL laxity the risk of ACL injury increased by 4 times thus helping to explain the 2-10 fold increase of ACL injury in women
    • Menopause accelerates bone and muscle mass wastage, and increases risk of musculoskeletal injury
    • Hormone Replacement Therapy (HRT) given to postmenopausal women reduces rate of muscle and bone loss
    • Postmenopausal women have reduced sensitivity to anabolic stimuli that help build muscle
Muscle fibre differences
  • Women tend to have a higher proportion of type I muscle fibres and men more type II fibres (further information on muscle and fibres can be found here
    • This difference is one of the reasons why male athletes tend to be faster and stronger than females
Tendon injuries
  • Women have reduced risk of muscle injuries than men
  • In professional football female players have 50% less muscle strains than males:
    • Females professional football players also have 80% less groin injuries and 35% less hamstring injuries
  • Women compared to men, have reduced risk of Achilles tendon injury than males until menopause, after which the risk equalises
  • Whilst these differences have been found, it is not clear why that is
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