Outside the Beltway

Girls Sports Injuries More Severe

James Joyner · Saturday, May 10, 2008 · 5 comments

A long, anecdote-laden New York Times Magazine feature, “The Uneven Playing Field,” examines the fact that, excluding football — which girls generally aren’t allowed to play — female athletes are getting injured far more frequently and seriously than their male counterparts.

Girls and boys diverge in their physical abilities as they enter puberty and move through adolescence. Higher levels of testosterone allow boys to add muscle and, even without much effort on their part, get stronger. In turn, they become less flexible. Girls, as their estrogen levels increase, tend to add fat rather than muscle. They must train rigorously to get significantly stronger. The influence of estrogen makes girls’ ligaments lax, and they outperform boys in tests of overall body flexibility — a performance advantage in many sports, but also an injury risk when not accompanied by sufficient muscle to keep joints in stable, safe positions. Girls tend to run differently than boys — in a less-flexed, more-upright posture — which may put them at greater risk when changing directions and landing from jumps. Because of their wider hips, they are more likely to be knock-kneed — yet another suspected risk factor.

This divergence between the sexes occurs just at the moment when we increasingly ask more of young athletes, especially if they show talent: play longer, play harder, play faster, play for higher stakes. And we ask this of boys and girls equally — unmindful of physical differences. The pressure to concentrate on a “best” sport before even entering middle school — and to play it year-round — is bad for all kids. They wear down the same muscle groups day after day. They have no time to rejuvenate, let alone get stronger. By playing constantly, they multiply their risks and simply give themselves too many opportunities to get hurt.

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Comprehensive statistics on total sports injuries are in short supply. The N.C.A.A. compiles the best numbers, but even these are based on just a sampling of colleges and universities. For younger athletes, the numbers are less specific and less reliable. Some studies have measured sports injuries by emergency-room visits, which usually follow traumatic events like broken bones. A.C.L. and other soft-tissue injuries often do not lead to an E.R. visit; the initial examination typically occurs at the office of a pediatrician or an orthopedic surgeon. Studies of U.S. high-school athletics indicate that, when it comes to raw numbers, boys suffer more sports injuries. But the picture is complicated by football and the fact that boys still represent a greater percentage of high-school athletes.

Girls are more likely to suffer chronic knee pain as well as shinsplints and stress fractures. Some research indicates that they are more prone to ankle sprains, as well as hip and back pain. And for all the justifiable attention paid to concussions among football players, females appear to be more prone to them in sports that the sexes play in common. 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.

Girls are different than boys. Pretending otherwise has had some negative consequences. Depending on the sport, it may be that the girls need different protective equipment, shorter schedules, less practice time, different rules, or more medical attention.