There Is No Gender Gab

Training and locker rooms were once largely “Men Only,” but not anymore. In fact, while women make up 52 percent of the population, they comprise 60 percent of the nation’s health-club memberships.

Not surprisingly, along with this increase in activity there has been an increase in sports-related injuries suffered by women. The big question causing considerable debate within sports medicine circles has to do with the relative risks women face in sports activities: Are women at more risk of injury than men?

At the present time this is pretty swampy medical ground and  home to some pretty muddy statistics. But what are the sporting facts of life? Well, women do tend to sustain more injuries than men. For example, after reviewing the injuries sustained by male and female basketball teams during two consecutive seasons, researchers from Northwestem University Medical School, Chicago, found that women sustained 60 percent more injuries than the men.

In their paper, which was published in The American Journal of Sports Medicine (10:5, 297-99, 1982), the authors reported that both sexes had similar ankle injury rates (which was the most frequently injured body part), but the women incurred considerably more knee and thigh injuries as well as more sprains, strains, and contusions. Women are at a greater risk, apparently. Now the question is whether or not their added risk of injury is based on inherent differences between the sexes. To answer this question we first need to know what the real differences are that would affect sports performance and if these differences are really to blame for women’s injuries.

We do know that women tend to be more flexible than men, which is good because this can mean fewer muscular difficulties. However, the characteristics of the female body often breed trouble. Women may be predisposed to knee injuries because their wider hips cause their major leg bone, the femur, to turn slightly
inward, putting more pressure on delicate knee joints. This wider pelvis and angling thighbone may lead to a number of problems including a chronic condition known as runner’s knee, in which the kneecap shifts sideways and rubs against nearby cartilage. This extra width at the hips can also cause a stretching of the quadriceps muscles, which leads to tendon and knee pain. Finally, women in general have only 80 percent of the muscle mass that men do, so pound for pound there is less muscle support for the knee.

Are these differences reflected in actual injury rates, like those uncovered by the Northwestern University researchers? Many experts believe that they are, but like everyone else, experts can make perfect sense and still be wrong.

For years we’ve known that among women’s sports, basketball has the highest injury rate. This isn’t terribly surprising, considering that men’s basketball has the highest injury rate among noncollision collegiate sports. However, studies have suggested that female players sustain more injuries, lose more time while they recover, and require surgery more frequently than male basketball players.

When this problem was first recognized, several investigators concluded that women’s knees were not as tight as men’s knees and this added laxity meant a greater predisposition to injury. However, we now know that there is no significant difference between the knee laxity of males and females.

Other researchers thought that the added risk might be due to women’s smaller ligaments or perhaps to those biomechanical differences we mentioned. While these factors haven’t been dismissed, a more likely candidate for blame has been found: inadequate conditioning.

How conditioning (or lack thereof) takes its toll is best explained by a study comparing injuries sustained by two Oklahoma City varsity basketball teams (The Physician and Sportsmedicine, 6:10, 92-95, 1978). While the boys’ team showed a consistent rate of injury throughout the season, the members of the girls’ team were
about six times as likely to be injured in the first three months of the season compared to the last two months of play, when their injury rate was nearly identical to the boys’ team. This suggests that the girls were in poorer condition at the start of the season, so they were injured frequently until they were conditioned and more experienced.

A study released just as this book was going into production confirms the importance of conditioning and adds another element for injury prevention. The National Athletic Trainers’ Association (NATA) in June of 1987 reported the results of the first nationwide survey of injuries among girls who play high school basketball. They found that Z3 percent of the more than 400,000 girls playing the game were sidelined at least once during the preceding school year. Their recommendations for curbing the injury rate: Improve
physical conditioning programs and institute a five-minute warm-up period after halftime. The latter suggestion was based on the fact that fully 60 percent of all game-related injuries occurred during the
second half of the play. Many of these injuries could be prevented, according to NATA, by simple stretching and flexibility exercises prior to the start of the second half.

So in reviewing the available literature (which is none too extensive), women may be inherently more susceptible than men to muscular injuries due to a difference in muscle mass. And, due to their overall alignment, iwomen may be at greater risk of knee problems in general. On the other hand, women may not be as likely to sustain a ligamentous injury. However, most of the injury rate difference between men and women in sports could be erased with improved strengthening and conditioning programs for women. There may be other factors influencing women’s injury rates in sports, but it may be a while before these are revealed. The problem is that we’ re not sure yet how much of what we’re learning is true and how much is statistical aberration.

If you’re concemed about being injured in your chosen sporting endeavors, whether you’re a pro or a rank (or unranked) amateur, you largely create your own risk of injury by choosing how prepared you are for action. Want to avoid injury? A good place to start would be to incorporate the protective stretching and conditioning exercises at the end of this book into your activity schedule.

Here’s some encouraging news: in the November 1984 issue of The Joumal of Musculoskeletal Medicine, when highly trained athletes are compared, there is no difference in injury rates between the sexes. This means that as opportunities open up and better conditioning and training programs are initiated for women, the rate of injury to women should continue to decline.