Neuromuscular and Hormonal Factors Associated With Knee Injuries in Female Athletes
- 2.1k Downloads
Female athletes who participate in jumping and cutting sports are 4 to 6 times more likely to sustain a serious knee injury than male athletes participating in the same sports. More than 30 000 serious knee injuries are projected to occur in female intercollegiate and high school athletics in the US each year. The majority of these injuries occur by non-contact mechanisms, most often during landing from a jump or making a lateral pivot while running. Knee instability, due possibly to decreased neuromuscular strength and coordination or increased ligamentous laxity, may underlie the increased incidence of knee injury in females. Neuromuscular training can significantly increase dynamic knee stability in female athletes. Female sex hormones (i.e. estrogen, progesterone and relaxin) fluctuate radically during the menstrual cycle and are reported to increase ligamentous laxity and decrease neuromuscular performance and, thus, are a possible cause of decreases in both passive and active knee stability in female athletes. Oral contraceptives stabilise hormone levels during the menstrual cycle and may function to either passively or actively stabilise the knee joint.
The long term objective of clinicians and researchers should be to determine the factors that make women more susceptible than men to knee ligament injury and to develop treatment modalities to aid in the prevention of these injuries. The immediate objectives of this review are to examine how female and male athletes differ in neuromuscular and ligamentous control of the lower extremity. The review will examine the effects of neuromuscular training on knee stability. The effects of female hormone levels and oral contraceptives on neuromuscular control of the female athletes’ knee will also be discussed.
KeywordsAnterior Cruciate Ligament Anterior Cruciate Ligament Injury Knee Injury Female Athlete Knee Laxity
The author would like to thank Greg Myer for his critical reading of this manuscript, and Frank Noyes for his invaluable input and support.
- 1.Chandy TA, Grana WA. Secondary school athletic injury in boys and girls: a three-year comparison. Physician Sports Med 1985; 13 (3): 106–11Google Scholar
- 3.Gerberich SG, Luhmann S, Finke C, et al. Analysis of severe injuries associated with volleyball activities. Physician Sports Med 1987; 15 (8): 75–9Google Scholar
- 7.Whiteside PA. Men’s and women’s injuries in comparable sports. Physician Sports Med 1980; 8 (3): 130–40Google Scholar
- 10.The National Federation of State High School Associations. The 1996 National High School Sports Participation Survey. Kansas City (MO): The National Federation of State High School Associations, 1996Google Scholar
- 11.National Collegiate Athletic Association. NCAA injury surveillance system. Overland Park (KS): National Collegiate Athletic Association, 1993Google Scholar
- 12.Albohm M. How injuries occur in girls sports. Physician Sports Med 1976; 2: 46–8Google Scholar
- 15.Malone TR, Hardaker WT, Garrett WE, et al. Relationship of gender to anterior cruciate ligament injuries in intercollegiate basketball players. J South Orthop Assoc 1993; 2 (1): 36–9Google Scholar
- 24.Weesner CL, Albohm MJ, Ritter MA. A comparison of anterior and posterior cruciate ligament laxity between female and male basketball players. Physician Sports Med 1986 14: 149–54Google Scholar
- 27.Sanborn CF. Menstrual dysfunction in the female athlete. In: Teitz CC, editor. Scientific foundations of sports medicine. Philadelphia (PA): BC Decker, Inc., 1989: 117–34Google Scholar
- 30.Noyes FR, Mooar PA, Matthews DS, et al. The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Burg Am 1983; 65 (2): 154–62Google Scholar
- 35.Moller-Nielson J, Hammar M. Women’s soccer injuries in relation to the menstrual cycle and oral contraceptive use. Med Sci Sports Exerc 1989; 21 (2): 126–9Google Scholar
- 37.Barrett GR, Hartzog CW Jr, Ruff CG. Clinical comparison of intra-articular anterior cruciate ligament reconstruction using autogenous semitendinous tendon in males versus females. 23rd Annual Meeting of the American Orthopaedic Society for Sports Medicine; 1997 Jun 22–25; Sun Valley (ID), 809–10Google Scholar
- 39.Dunnam LO, Hunter GR, Williams BP, et al. Comprehensive evaluation of the University of Alabama at Birmingham women’s volleyball training program. NSCA J 1988; 10 (1): 50–2Google Scholar
- 40.Marsit JL, Kraemer WJ. Beginning off-season workout for high school volleyball. NSCA J 1992; 14 (3): 62–6Google Scholar
- 43.Skelly WA, DeVita P. Compressive and shear forces on the tibia and knee during landing. In: Proceedings of the 6th Biennial Conference of the Canadian Society for Biomechanics. Montreal (QC): Canadian Society for Biomechanics, 1990: 59–60Google Scholar
- 46.Davies G. Compendium of isokinetics in clinical usage. 4th ed. La Crosse (WI): S&S Publishers, 1984Google Scholar
- 56.Gill GN. Hormonal regulation of the ovary. In: West JB, editor. Best and Taylor’s physiological basis of medical practice. Baltimore (MD): Williams and Wilkins, 1985: 921–33Google Scholar
- 59.Hatcher RA. Contraceptive technology. 16th ed. New York (NY): Irvington Publishers Inc., 1994: 109–10Google Scholar