Participation in sports and exercise among women and girls is continuing to increase. And while this is fantastic to see, it has also lead to an increase in the injury rates amongst the female population.
Below we discuss 3 of the most common injuries seen amongst active females, what the risk factors are, and how to prevent these injuries from occurring.
Sitting atop this not so illustrious list is the ankle sprain! Ankle ligament injuries are the most common injury in both males and females, however females over the age of 30 are more likely to suffer an ankle sprain than men in this same age group.
Ankle sprains often occur during activities requiring rapid changes in direction, with an increased risk if they take place on uneven surfaces such as grass. They also commonly occur in sports such as basketball, volleyball, netball, soccer, or football where a player, having jumped, lands on another competitor’s foot.
Other risk factors:
Poor conditioning – if you are not fit enough or strong enough to undertake an activity it will increase your chances of injury. You should be fit to play, not play to be fit if you want to reduce your injury risk!
Fatigue – as we come to the end of strenuous activity and begin fatiguing, you are more likely to injure an ankle.
Not warming up adequately – failing to warm up soft tissue structure prior to strenuous activity increases the likelihood of strains and sprains. The warmup should be considered the most important part of any workout or sporting event as it primes the body for performance and decreases the chances of injury.
Carrying excess weight – additional body weight will increase the forces placed on the ankle while running, jumping etc. Therefore, will increase the likelihood and severity of injury.
How is it likely to happen?
More often than not, the foot will roll out and damage will occur to the outside (lateral) ligament, or ligaments in a particularly nasty injury! Generally, the ankle/foot is in a slightly turned in (inverted) and downwardly pointed (plantarflexed) position at the time of injury. In this position damage occurs to the anterior talofibular ligament (ATFL) before the calcaneofibular ligament (CFL). This occurs because the ATFL is taut in plantarflexion and the CFL is relatively loose. If the ankle rolls inwards then the deltoid ligament can be injured.
What happens if I sprain my ankle?
Pain, reduced movement, swelling, and bruising are common post injury, as is the inability to weight bare. Because ligaments have a relatively poor blood supply, they can take longer to heal than other soft tissue injuries. With repeated injuries ligaments can also become stretched giving the ankle a feeling of instability, and increasing the likelihood of repeat injuries.
What to do if I’m injured
Rest the effected ankle as much as possible post injury. Using anti inflammatory drugs or ice can help reduce pain and discomfort, they won’t help the healing process, and may actually hinder it according to the latest research and advise. Reducing blood supply to the area by elevating the foot may not be helpful either, so just try to manage the pain, get comfortable, and rest initially.
Following this you should encourage the ankle to move. Doing some range of motion exercises, such as drawing out the alphabet with your foot, is a good place to start.
Once you can weight bare again, rehab is the most important thing you can do in order to re-stabilise the joint and regain full function as quickly as possible. If the ligament is stretched, the muscles crossing the ankle will need to take up more of the load, and need to be conditioned to do so. See your preferred muscle expert for advice on this as each rehab program should be tailored to the individual’s circumstances
How to prevent ankle injuries
Strong, stable ankles are less likely to be injured. A strength and conditioning program that involves ankle stability drills, single leg stability drills, hip strengthening, and change of direction drills will go along way to prevent an ankle sprain. Addressing core strength deficiencies and poor biomechanics are also musts when working towards injury prevention.
Seek advise from an experienced movement specialist such as a myotherapist, physiotherapist, or strength and conditioning coach, who can assess and guide you through an individualised program.
Women are up to eight times more likely to sustain an anterior cruciate ligament (ACL) rupture than males. This important ligament aids in keeping the lower leg from sliding forward in the knee. If you follow sports like AFL, soccer, netball, or basketball, you may have seen a player go down after landing awkwardly on one leg, or trying to rapidly change direction.
Why are women more likely to injury their ACL?
There are many theories as to why this difference in injury rate exists, but intrinsic and extrinsic factors are both at play.
Intrinsic factors include joint laxity, hormonal influences, limb alignment, the shape of your boney joint surfaces, and ligament size.
Extrinsic factors include the type of sport played, the individuals level of conditioning, and the type of equipment used.
What are the Risk Factors?
Risk factors that predispose women and girls to ACL injuries including:
Biologic and hormonal factors – Female sex hormones effecting joint laxity, and your biological makeup inherited from your parents plays a role in the likelihood of injury.
Landing technique – Female athletes in general seem to land with their knees in a more valgus (or turned-in) position and with less hip and knee flexion.
Muscle imbalances – Female athletes also tend to have quadriceps that are much stronger than their hamstrings, an imbalance that can predispose to ACL injury.
Poor strength & conditioning – reductions in general motor control and core strength/stability resulting in compensatory movement pattern predicted risk of athletic knee, ligament and ACL injuries.
These risk factors are modifiable with training and conditioning such as strength, balance, or flexibility, leading to a reduction in ACL risk. Other modifiable risk factors that can be ameliorated to reduce the risk of ACL injury are:
Training surface – hard, uneven, or loose surfaces increase the chance of injury
Equipment – use good quality footwear and athletic equipment to decrease the likelihood of injury
What can I do to prevent ACL rupture injuries?
A thorough functional movement assessment can accurately predict the likelihood of ACL injury in females (but not in males oddly enough), so if you play sport/s that involves jumping and landing, or changing directions suddenly, and would like to reduce your risk of suffering a serious injury then find an experienced movement specialist and make an appointment to discuss your concerns. Many sports injury specialists exist in the myotherapy, physiotherapy and sports medicine fields.
Female athletes are more likely to sustain stress fractures, particularly in sports that require repetitive running or jumping such as long-distance running, basketball, volleyball, and soccer to name a few. Stress fractures are especially common in the foot or lower leg (tibia) among women with the “female athlete triad,” a combination of inadequate calorie and nutrient intake, irregular menstrual periods, and bone loss.
The Female Athlete Triad
Abnormal menstruation – amenorrhoea (the abnormal absence of menstruation) in women can lead to an increased likelihood of suffering a stress fracture compared to those who are menstruating normally.
Disordered eating – defined as an inadequate energy consumption, which may be related to poor quality, quantity, frequency, or awareness of appropriate sports nutrition. The emphasis on thinness and reduction in body fat in particular sports, such as gymnastics, endurance running, and ballet dancing, may lead to an increased incidence of eating disorders in susceptible individuals. Other psychological risk factors include low self-esteem, poor coping skills, perfectionism, obsessive compulsive traits, and anxiety.
Reduced bone density – women with the Triad are at higher risk for low bone mass leading to weakened bones, called osteoporosis in its severe form. This type of bone loss can cause an increased risk of fractures, including stress fractures.
What are the other risk factors?
Stress fractures can also be related to training error, overuse, malalignment, and hard running surfaces. So it is important to seek advice on footwear, training load, as well as biomechanics and technique for your given activity.
Research has also shown that athletes who have suffered a stress fracture had reduced bone strength, reduced cross-sectional area of bone (thinner bones) and reduced muscle cross-sectional area compared with athletes who have not suffered a stress fracture.
Flat feet that are unable to absorb load and therefore soften the impact of the feet striking the ground for the rest of the body. This places increased stress on the lower leg bone (Tibia) and can be a factor in the development of this issue.
How to prevent stress fractures
Be on top of your diet – Being aware of the nutritional requirements required for strong, healthy bones is a good place to start. Ensuring that your calorie intake is sufficient to support the activity being undertaken is also vital to maintain performance and stay injury free.
Monitor your training – allowing your body time to recover, ensuring good technique is being used, and having your biomechanics assessed and monitored will all help reduced the likelihood of sustaining a stress fracture.
If you are interested
A common issue that didn’t make the list was foot pain, and in particular
plantar fasciopathy (or plantar fasciitis as it’s commonly known). This is very common among females who are middle aged, are pregnant, or wear healed and rigid shoes for long periods of time. More can be found out about this here. Additional info on foot pain can also be found here.
Written by Dan Hammond, Myotherapist (Bachelor Health Science – Myotherapy) and Master Functional Trainer (CertIV Fitness). 2019
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