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Robert R. Cawley, D.O.

Dover, NH 03802

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09/16/2020

Women's Sports Medicine: Common Injuries in Female Athletes

Women are more prone to sports injuries than men - but why? Dr. Jennifer Hopp of Wentworth Health Partners Seacoast Orthopedics & Sports Medicine, who leads the Women’s Sports Medicine Program at the Wentworth-Douglass Center for Orthopedics & Sports Medicine, and Clinical Specialist in Sports Physical Therapy Jacqueline Plante, PT, DPT, SCS, FAAOMPT, of Wentworth-Douglass Hospital’s Rehabilitation Services, explain why this is true, provide helpful tips for at-home care, and offer guidance on when to see a doctor.

Compared to men, women have a smaller body frame which generally means women have less muscle mass. Women also have a lower center of gravity due to having shorter limbs and a wider pelvis which collectively help women have better balance than males. Women have increased flexibility in ligaments which helps during pregnancy but can also lead to greater risk for injury. 

“Women also have a larger “Q-angle,” that creates increased stress on the middle of the knee. The Q-angle is the angle formed by a line drawn from the Anterior Superior Iliac Spine (ASIS), to the central patella and a second line drawn from central patella to tibial tubercle,” said Dr. Hopp.

“In other words, this means increased pressure on the hip, on the middle of the knee, ankles, and feet. A larger Q-angle puts women at risk of having foot pronation (when your foot tracks inward as you move). This means that women are more prone to injuries of the lower extremities,” Dr. Hopp added.

Common Injuries in Female Athletes

Hip Flexor Strain

Snapping or popping sound with movement.

Full intensity or range-of motion activities, interval training, working a sedentary job, lack of stretching

Hip Adductor Strain

Pain in the upper thigh that radiates into the groin and is worse with movement – especially lateral movement like “skaters.”

Field Hockey, Lacrosse, and Soccer Players are at higher risk.

Runners with a very wide lateral swing in their gait or runners who overly correct this lateral swing while running.

IT Band Syndrome

Pain at the outer hip, thigh, or knee, that is usually worse with hill or interval training – especially for runners.

Increased Q-angle, foot pronation, lack of stretching, cycling, running, hiking, aggressive training, worn out/old footwear.

Hamstring Strain

Pain along the back of the thigh that can be sudden or gradual. Hamstrings attach at the sit bones, so it is possible for this pain to be worse while sitting.

Poor flexibility in the lower extremities, a tight low back, and tight hip flexors.  

 

Patellofemoral Syndrome (PFS)

Pain under or below the knee cap

Increased Q-angle, a muscle imbalance such as inflexible hamstrings, or having stronger quadriceps than hamstrings, and if your feet overly pronate.

Pes Anserinus Tendonitis

Pain on the inside of the knee, at the joint line or a little bit below.

Increased Q Angle, tight hamstrings or adductors, and foot pronation.

ACL Tear/Ruptures

A pop or a snap followed by pain, immediate swelling, trouble with bearing any weight on the affected leg, and a generally unstable sensation in the affected knee joint.

Women are FOUR times more likely than men to have an ACL tear or rupture.

Non-contact step/pivot tears (a quick or sudden change in direction), Increased torque on the ACL, increased pressure on the inside of the knee. 

Posterior Tibialis Tendonitis

Pain on the inside of the ankle that is worse with walking, running, or jumping.

Increased Q-angle, low arches, flat feet, or pronation. 

Peroneal/Fibularis Tendonitis

Pain on the outside of the ankle, that is worse with running or jumping.

Tight calf muscles, a rapid increase in training ankle instability, overpronation, old/worn footwear, or trauma such as an ankle sprain. 

Plantar Fasciitis

Pain in the sole of the foot from the heel to the arch.

Tight calf muscles, flat feet, overpronation, unsupportive footwear.

Foot Pronation

Pain in medial foot and ankle that can travel all the way up to the shin. Pain with foot strike is also common. 

Increased Q-angle, tibial torsion (a pigeon-toed appearance), flat feet/low arches, and old/worn-out footwear.

 

 

Tips for at-home care 

First and foremost, if you have persistent pain that does not go away or gets worse with activity, the best course of action is to contact your provider or a women’s sports medicine expert like those at Wentworth Health Partners Seacoast Orthopedics & Sports Medicine and the Wentworth-Douglass Hospital Center for Orthopedics & Sports Medicine.

Foam rollers. To help prevent injuries from the start, Dr. Hopp highly recommends investing in a foam roller.

Understand your anatomy and stretch. By searching the web for musculoskeletal anatomy and understanding where your body hurts and then searching stretches related to pain in that part of the body, you will find many stretches online. For example, you can search “stretches for tight hamstrings.”

For ankle pain, consider searching calf stretches.

Strength training. Strength training can help improve muscle function and help take sports-related impact away from the joints. This is important along with core and stability work to help strengthen the core and low back. Exercises like squats, lunges, and deadlifts can really help strengthen key areas that female athletes need to stay powerful and moving.

Heat and Ice. Heat can be used after a workout to help with pain and soreness just like ice, but some people prefer heat over ice. Ice is generally recommended after an acute injury.

Use medicine sparingly. You shouldn’t need to take over-the- counter medication to be able to get through a workout. Never take pain-relieving medication before a workout as it might mask the pain and hide a serious injury.

Modify your activity while you recover from injury. Refrain from interval training and choose flat roads to run or cycle on. High Intensity Interval Training (HIIT) is not recommended. Standard interval training walk/jog progressing to walk/run may be recommended to help build endurance and get you back to your pace/distance. Cyclists should also consider decreasing their time or distance on the bike.

At Wentworth Health Partners Seacoast Orthopedics & Sports Medicine, providers work closely with Wentworth-Douglass Hospital’s Rehabilitation Services team to ensure continued and close monitoring of care. Physical therapists can “play detective” by assessing body mechanics to figure out why someone is in pain while exercising or completing various tasks.

Physical therapists look at three major areas in their assessment: flexibility related to the muscle and tendons; mobility, or how the joints move; and muscular strength and stability.

Jacqueline Plante said, “Everyone’s assessment is different. One person may be lacking in flexibility but is very strong and has good mobility while another person might have every component at an adequate level but struggle to put all the pieces together.”
Physical therapists like those at Wentworth-Douglass Hospital’s Rehabilitation Services will work closely with patients to gain control of their movement.

It is time to see the doctor if…
• You are still in pain after self-treatment.
• The pain is worsening despite modifications. For example, if you are a runner and now cycling hurts.
• The pain has forced you to drastically change your workout routine.
• The pain worsens with activity.
• You have pain at rest

Learn more about the services we offer at the Wentworth-Douglass Center for Orthopedics & Sports Medicine or call (603) 742-2007 to make an appointment.

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Musculoskeletal

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