Sports Reality for Girls

Michael Sokolove has a great article at the NY Times Magazine about sports injuries and the seldom-discussed fact that teenage girls are much, much more likely to both sustain major knee and head injuries than boys of the same age.  Despite the unfortunate title of "Uneven Playing Field", this article is highly recommended reading for parents and coaches of teen athletes of the female persuasion.

A study last year by researchers at Ohio State University and Nationwide Children’s Hospital in Columbus, Ohio, reported that high-school girls who play basketball suffer concussions at three times the rate of boys, and that the rate for high-school girls who play soccer is about 1.5 times the rate for boys. According to the N.C.A.A. statistics, women who play soccer suffer concussions at nearly identical rates as male football players. (The research indicates that it takes less force to cause a concussion in girls and young women, perhaps because they have smaller heads and weaker necks.)

But among all the sports injuries that afflict girls and young women, A.C.L. tears, for understandable reasons, get the most attention. No other common orthopedic injury is as debilitating and disruptive in the short term — or as likely to involve serious long-term consequences. And no other injury strikes women at such markedly higher rates or terrifies them as much.

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The N.C.A.A.’s Injury Surveillance System tracks injuries suffered by athletes at its member schools, calculating the frequency of certain injuries by the number of occurrences per 1,000 “athletic exposures” — practices and games. The rate for women’s soccer is 0.25 per 1,000, or 1 in 4,000, compared with 0.10 for male soccer players. The rate for women’s basketball is 0.24, more than three times the rate of 0.07 for the men.

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So imagine a hypothetical high-school soccer team of 20 girls, a fairly typical roster size, and multiply it by the conservative estimate of 200 exposures a season. The result is 4,000 exposures. In a cohort of 20 soccer-playing girls, the statistics predict that 1 each year will experience an A.C.L. injury and go through reconstructive surgery, rehabilitation and the loss of a season — an eternity for a high schooler. Over the course of four years, 4 out of the 20 girls on that team will rupture an A.C.L.

None of this is to say that girls and women can’t be great athletes.  But there are fundamental differences in the way our bodies are put together that make parenting, mentoring, and coaching girls different than boys in purely physiological terms.

The good news?  New studies indicate that proper training helps a great deal.

[Director of research at the Santa Monica Orthopaedic and Sports Medicine Research Foundation Holly] Silvers, along with a Santa Monica orthopedic surgeon, Bert Mandelbaum, designed an A.C.L.-injury-prevention program that has been instituted and studied in the vast Coast Soccer League, a youth program in Southern California. Teams in a control group did their usual warm-ups before practices and games, usually light running and some stretching, if that. The others were enrolled in the foundation’s “PEP program,” a customized warm-up of stretching, strengthening and balancing exercises. An entire team can complete its 19 exercises — including side-to-side shuttle runs, backward runs and walking lunges — in 20 minutes. One goal is to strengthen abdominal muscles, which help set the whole body in protective athletic positions, and to improve balance through a series of plyometric exercises — forward, backward and lateral hops over a cone. Girls are instructed to “land softly,” or “like a spring.”

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The Santa Monica Orthopaedic and Sports Medicine Research Foundation published results of its trial in the American Journal of Sports Medicine. The research was nonrandomized and therefore not the highest order of scientific research. (The coaches of teams doing the exercises made a choice to participate; the control group consisted of those who declined.) Nevertheless, the results were attention-grabbing.

The subjects were all between 14 and 18. In the 2000 soccer season, researchers calculated 37,476 athletic exposures for the PEP-trained players and 68,580 for the control group. Two girls in the trained group suffered A.C.L. ruptures that season, a rate of 0.05 per 1,000 exposures. Thirty-two girls in the control group suffered the injury — a rate of 0.47. (That was almost twice the rate for women playing N.C.A.A. soccer.) The foundation compiled numbers in the same league the following season and came up with similar results — a 74 percent reduction in A.C.L. tears among girls doing the PEP exercises.

Something to be aware of if any of the young ladies in your life are sports enthusiasts.