The gender gap in sports injuries

If you enjoy watching sports, you've probably seen some exciting games, some spectacular plays, and unfortunately, some major injuries. From what you see at the game or on television, you might think that sports injuries are more common among male than female athletes.

That may be true for college and NFL football players, since nearly all are male. But, women are actually more prone than men to suffer many of the most common sports-related injuries. There are a variety of reasons for this "gender gap," and there is much about it that remains uncertain. But the recognition of this gap has led to innovative efforts to prevent injuries among women in sports.

Consider the anterior cruciate ligament (ACL). It's a vital structure in the knee that provides stability under stress. Injuries of this ligament are up to 6 times more common among women than men. And a number of other sports-related injuries are also more common among women.

What injuries are most common among female athletes?

• Ankle sprain. This is the most common sports injury in both men and women, but it's particularly common among women.
• Shoulder troubles. Examples include rotator cuff problems (including tendon inflammation, or tendinitis) and instability.
• Knee injuries. These include irritation under the knee cap (called patellofemoral syndrome) and ligament damage (including tears to the ACL), which is especially common among soccer and basketball players.
• Stress fractures. These 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. Eating disorders, including anorexia nervosa, contribute to this triad.
• Plantar fasciitis. Abnormal alignment of the foot and flat feet may contribute to these small tears in the supporting tissues along the arch and heel.

And this is only a partial list – researchers have described a number of other differences in sports injuries between women and men.

Why are women more prone to these injuries than men?

There is probably a combination of factors that contribute to the higher incidence of injuries among female athletes. And we have more theories than actual answers. The most common explanation is that it's due to basic differences between the bodies of men and women. For example, the typical female athlete, as compared with her male counterpart, has:

• higher estrogen levels, along with less muscle mass and more body fat
• greater flexibility (due to looser ligaments) and less powerful muscles
• a wider pelvis, which alters the alignment of the knee and ankle
• a narrower space within the knee for the ACL to travel through
• a greater likelihood of inadequate calcium and vitamin D intake.

Women also tend to move differently than men. For example, when landing from a jump, women tend to land more upright and with the knees closer together. And when female athletes suddenly change direction, they tend to do so on one foot (perhaps due to their wider pelvis), while men tend to "cut" from both feet.