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Updated: Oct 24 2021

The Female Athlete

Images neck stress fracture.jpg mri of the knee.jpg medial knee collapse.jpg differences of the lower extremity.jpg loop.jpg
  • Introduction
    • Physiologic differences exist between men and women
    • Women have
      • a higher body fat %
      • lower maximal oxygen consumption and hemoglobin
      • lower cardiac output
      • decreased muscle mass and strength
    • Athletic injuries
      • woman have increased incidence of
        • patellofemoral disorders
        • stress fractures
        • ACL injuries
  • ACL injury
    • Risk of injury is 2-10x greater than males
      • especially with pivoting sports
    • ACL injury is more common in females due to
      • landing biomechanics and neuromuscular control differences
        • conditioning and strength play the biggest role
        • females land with their knees in more extension and valgus due to hip internal rotation
      • smaller notches
      • smaller ACL size
      • cyclic hormonal levels
        • ACL at greater risk for injury during the first half (preovulatory phase) of the menstrual cycle
      • leg alignment
      • genetic predisposition
        • underrepresentation of CC genotype of a COL5A1 gene sequence in females with ACL ruptures
    • Preventions
      • incidence can be reduced with neuromuscular training (jump training)
  • Female athlete triad (anorexia athletica)
    • A condition seen in female athletes that consists of:
      • amenorrhea
        • resulting from energy imbalance, low body fat, and hypothalamic-pituitary axis changes
        • secondary amenorrhea (cessation of menses for 6 months after at least one normal cycle) is often caused by hormonal disturbances
        • incidence in elite runners is nearly 50%
        • leads to bone demineralization and stress fractures
      • insufficient energy availability
        • insufficient caloric intake
          • is the most common cause of amenorrhea in female athletes
        • may or may not be associated with an eating disorder
      • osteoporosis
        • obtain a DEXA scan in female athletes with a history of amenorrhea and stress fractures
    • Treatment
      • a multidisciplinary approach should include
        • psychological counseling as the core
          • education and counseling for eating behaviors
        • dietary management should begin by establishing an energy balance
          • increase weight/food intake and decrease exercise
          • increase calcium and vitamin D in diet
        • reduced training intensity and cross-training to decrease risk of stress fractures
          • calcium and vitamin D supplements should be taken for osteoporosis
          • may consider cyclic estrogens or progesterones in treating osteoporosis
        • oral contraceptive pills may be beneficial in treating amenorrhea
  • Pregnancy
    • Increased estradiol
      • leads to ligamentous laxity
    • Increased oxygen
      • increased body weight leads to a 16-32% increase in oxygen consumption
  • Title IX
    • No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any educational program or activity receiving federal financial assistance
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