Chapter 14Prevention and Management of

Common Musculoskeletal Injuries in the Adult Female Athlete

Mimi Zumwalt, MDMimi Zumwalt, MD

Learning Objectives• Understand the differences in the musculoskeletal Understand the differences in the musculoskeletal

anatomy, physiology, and body composition anatomy, physiology, and body composition between the adolescent and adult female athletesbetween the adolescent and adult female athletes

• Recognize similarities and differences between Recognize similarities and differences between the anatomy, body composition, and the anatomy, body composition, and biomechanics of adult males and female athletes’ biomechanics of adult males and female athletes’ musculoskeletal systemmusculoskeletal system

• Know several of the more common orthopaedic Know several of the more common orthopaedic injuries incurred by adult female athletesinjuries incurred by adult female athletes

• Delineate different prevention measures and Delineate different prevention measures and methods of management for musculoskeletal methods of management for musculoskeletal conditions occurring in adult female athletesconditions occurring in adult female athletes

Introduction

• Female body undergoes morphologic, Female body undergoes morphologic, structural, hormonal, metabolic changes structural, hormonal, metabolic changes from young to adulthoodfrom young to adulthood

• Musculoskeletal & neurological alterationsMusculoskeletal & neurological alterations• Bring about unique orthopaedic trauma Bring about unique orthopaedic trauma

while playing sports or performing while playing sports or performing athletic activitiesathletic activities

Musculoskeletal Anatomy, Physiology, & Body Composition of

Adolescent vs. Adult Females• Puberty in early to mid-teensPuberty in early to mid-teenspelvis pelvis

widened, fat deposits on thighs/ buttocks, widened, fat deposits on thighs/ buttocks, breasts develop under estrogen & bone breasts develop under estrogen & bone stops growingstops growing

• Body composition changes ~ mid 20’s – Body composition changes ~ mid 20’s – bone loss starts, muscle mass declines, fat bone loss starts, muscle mass declines, fat rises dependent on nutrition, mechanical rises dependent on nutrition, mechanical loading/physical activity & hormonal milieuloading/physical activity & hormonal milieu

Musculoskeletal Anatomy, Body Composition, & Biomechanics of

Adult Males vs. Females• Testosterone vs. estrogenTestosterone vs. estrogen

• Essential fat percentage Essential fat percentage higher in females vs. storage higher in females vs. storage fat similar to malesfat similar to males

• Advantage in water sportsAdvantage in water sports• XS endurance exercise XS endurance exercise

opposite effectopposite effect• Fat distribution around upper Fat distribution around upper

body in males vs. hips & body in males vs. hips & lower body in femaleslower body in females

• Females stop growing earlierFemales stop growing earlier

• Males stronger > females, esp. Males stronger > females, esp. upper bodyupper body

• Males w/ broader shoulders, Males w/ broader shoulders, wider chest, & narrower hips wider chest, & narrower hips vs. females w/wider pelvis, vs. females w/wider pelvis, more varus hips & higher knee more varus hips & higher knee valgus anglesvalgus angles• Lower body malalignmentLower body malalignment

• Neuromuscular recruitment Neuromuscular recruitment order differentorder different• Quad dominantQuad dominantACL tearsACL tears

Orthopaedic Injuries/Conditions In Adult Female Athletes

• Olympic female athletic participation Olympic female athletic participation finally in 1912finally in 1912

• Education Amendments Act in 1972Education Amendments Act in 1972• Tremendous rise in female involvement Tremendous rise in female involvement

& sports injuries esp. ACL tears& sports injuries esp. ACL tears• Risky landing positions among othersRisky landing positions among others• Intrinsic &/or extrinsic factorsIntrinsic &/or extrinsic factors

Orthopaedic Injuries/Conditions In Adult Female Athletes

• ““Miserable malalignment syndrome”Miserable malalignment syndrome”• PFPS, etcPFPS, etc

• Foot problems – Achilles tendinitis, bunion, Foot problems – Achilles tendinitis, bunion, lesser toeslesser toes

• Shoulder conditions – laxity, impingement, Shoulder conditions – laxity, impingement, rotator cuff tendinosis/bursitisrotator cuff tendinosis/bursitis

• Elbow tendinosisElbow tendinosis• Stress fracturesStress fractures

• Female athlete triadFemale athlete triad

Prevention of Musculoskeletal Trauma in Adult Female Athletes

• Maximize physical fitness & optimize Maximize physical fitness & optimize extrinsic factors beyond equipment/gearextrinsic factors beyond equipment/gear• Modify landing techniques thru trainingModify landing techniques thru training• Strengthen/balance key muscle groups for Strengthen/balance key muscle groups for

limb supportlimb support• Core conditioning, plyometrics, flexibility, Core conditioning, plyometrics, flexibility,

proprioception, agility drillsproprioception, agility drills• Avoid xs impact activityAvoid xs impact activity

Management of Orthopaedic Injuries in Adult Female Athletes

• PRICE – prevent/Protect, relative Rest, Ice, PRICE – prevent/Protect, relative Rest, Ice, Compression, ElevationCompression, Elevation

• NSAIDs, E-stim devices, orthotics, taping, NSAIDs, E-stim devices, orthotics, taping, (braces)(braces)

• Bone bruise, stress reaction/fxBone bruise, stress reaction/fxxrayxray• Therapy rehab exercisesTherapy rehab exercises

• Strength & conditioningStrength & conditioning• Sports specific drillsSports specific drills

Conclusion

• Morphologic & hormonal changes from Morphologic & hormonal changes from adolescence to adulthood in female athletesadolescence to adulthood in female athletes

• Intrinsic & extrinsic factors dictate type & Intrinsic & extrinsic factors dictate type & frequency of musculoskeletal trauma assoc frequency of musculoskeletal trauma assoc w/different sportsw/different sports

• Conditioning programs help to maximize Conditioning programs help to maximize physical fitness & lower injury ratesphysical fitness & lower injury rates

• If not responsive to Rx, seek ortho careIf not responsive to Rx, seek ortho care

Case Study• You are a fairly new athletic trainer for a collegiate level female You are a fairly new athletic trainer for a collegiate level female

basketball team in a mid-size town. This is your first season basketball team in a mid-size town. This is your first season working with these women. One half is composed of rookies working with these women. One half is composed of rookies (junior varsity) and the other half veterans (varsity) players. (junior varsity) and the other half veterans (varsity) players. Recently you’ve noticed that not all of these females show up Recently you’ve noticed that not all of these females show up every day for practice and that several have had more “off” than every day for practice and that several have had more “off” than “on” days in terms of “scrimmage” games. You’ve also been “on” days in terms of “scrimmage” games. You’ve also been providing daily “treatments” as far as local modalities and physical providing daily “treatments” as far as local modalities and physical therapy rehab exercises in the training room for over a third of therapy rehab exercises in the training room for over a third of these female athletes for various musculoskeletal complaints. In these female athletes for various musculoskeletal complaints. In fact, the majority of the problem lies in the lower extremity and fact, the majority of the problem lies in the lower extremity and most notably the tibia and knee regions. A couple of females are most notably the tibia and knee regions. A couple of females are improving in terms of their symptoms but the rest are still not improving in terms of their symptoms but the rest are still not making any appreciable gains. Alarmingly, some are actually making any appreciable gains. Alarmingly, some are actually getting worse. The regular sports season will begin in about 2 getting worse. The regular sports season will begin in about 2 months, and you are quite concerned that some players may not be months, and you are quite concerned that some players may not be able to “start” in their best physical condition.able to “start” in their best physical condition.