Since the passage of Title IX in 1972, which prohibited sex discrimination in sports, there has been a dramatic increase in the number of women participating in high school and collegiate athletics. Women participating in high school sports have increased from approximately 200,000 in 1972 to more than 2.6 million in 2000. For many, participation goes beyond the school years.While most injury patterns are shared by the sexes, there are certain clinical entities unique to women. These factors typically relate to musculoskeletal anatomy and hormone differences. Performance differences can be attributed to the higher muscle mass and cardiovascular capacities of men versus women.

Hormonal Influences The term female athlete triad refers to the relationship among athletic women of amenorrhea, disordered eating and premature osteoporosis. Women at risk usually participate in sports with subjective judging; endurance sports such as running or swimming; or sports with weight classifications. The consequences of eating disorders range from stress fractures to mental illness, malnutrition and death. More commonly, women with a low body fat stop menstruating regularly. An initial orthopedic presentation is that of a stress fracture. Long-term consequences affect bone mass and osteoporosis later in life.

Hormone variations may affect ligamentous laxity in women and contribute to instability of the knees, shoulders, ankles and hips. Women have higher rates of instability about the kneecap. Some studies suggest that the menstrual cycle may affect injuries to the anterior cruciate ligament (ACL). Prementstrual symptoms adversely affect performance, training and contribute to injuries. Pregnancy is associated with hormone variations. While exercise is typically safe and an obstetrician should be consulted, there are injury patterns that occur in pregnant women. Sciatica is common and joint can demonstrate increased laxity.

Anatomic Considerations The female pelvis along with increased angulation at the knee makes disorders of this joint common, including patellar instability as mentioned above and rupture of the ACL. It is thought that for a given sport the incidence of ACL injuries is higher in women versus men. The influence of the menstrual cycle is debated. Efforts to design training regimens to prevent such injuries have had mixed results.

Ligamentous laxity is more common in females and plays a role in many joint disorders. Among the most troublesome is shoulder instability. In addition, there is a sex differences in ankle and hip disorders.

Stress fractures most commonly occur in the foot, but can affect the tibia and hip. A stress fracture occurs as a result of repetitive low energy stress such as running. Hormonal factors must be considered and a history of irregular menstruation is frequently present. Stress fractures may not be seen on x-ray. Rest and activity modification is the most typical treatment.

While the benefits of activity greatly outweigh a sedentary lifestyle, there are sex specific differences in anatomy and physiology of women that need to be considered. Women must maintain a proper diet and an appropriate body weight to prevent amenorhea and associated bone abnormalities. In addition it is important to maintain musculoskeletal strength and flexibility.

Dr. Elliott Leitman, M.D., orthopedic surgeon, is on staff at Jennersville Regional Hospital in West Grove. He graduated from Boston University School of Medicine. He completed an internship and residency at Albert Einstein Medical Center and a fellowship in Sport Medicine and Joint Replacement at Graduate Hospital in Philadelphia. Dr. Leitman is board certified in Orthopedics and has been in private practice since 1988. His office is located in West Grove, across the street from the Hospital. He can be reached at 610-869-5757.

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