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Prevention and Management of Common Musculoskeletal Injuries in Skeletally Immature Female Athletes

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The Active Female

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Abstract

Young females transitioning from childhood to adolescence undergo a dramatic change in their bodies. In fact, this transitional period is where males and females start to diverge in terms of body composition, skeletal shape, muscular strength, neuromotor control, and bone mass. With the start of menses, female (sex-specific) hormones begin to take an even more significant role in the body by greatly affecting the development/function of skeletal, muscular, and nervous systems. This rapid physiologic/physical change or “growth spurt” during menarche predisposes the female athlete’s body to musculoskeletal injury, i.e., tendons, ligaments, joints, muscles, and bones are all at risk. The skeleton, in particular, is at greater risk due to the presence of open physes or “growth plates” (which are inherently weaker) at the ends of growing long bones. The young female athlete is, therefore, more prone to a multitude of sports-related injuries, particularly those which involve contact, sprinting, jumping, and pivoting; and even at higher risk for certain types of trauma exceeding their adult counterparts. Therefore, heightened awareness and a certain level of precaution need to be taken to help prevent potential injury to young active females. However, if trauma does occur, then appropriate steps need to be taken to treat as well as protect the injured site(s) from further harm for optimal healing and recovery, in order to return female athletes to their preinjury activity level.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, USA

    Mimi Zumwalt

Authors
  1. Mimi Zumwalt
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Corresponding author

Correspondence to Mimi Zumwalt .

Editor information

Editors and Affiliations

  1. Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA

    Jacalyn J. Robert-McComb

  2. Orthopedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Mimi Zumwalt

  3. Functional Biology, University of Oviedo, Oviedo, Asturias, Spain

    Maria Fernandez-del-Valle

Chapter Review Questions with Scenario

Chapter Review Questions with Scenario

1.1 Scenario

You are a pediatrician who has just recently completed a primary care sports medicine fellowship and decided to join a multispecialty group practice in a suburban town. One of your partner’s physician’s assistants (PA) has been involved with taking care of a local youth girls’ soccer team. These young female athletes are under tremendous pressure to win as their team will disband if they do not make the playoffs this season; as a result, these female soccer players have been required to “train” extra hard every weekday before and after practice. Their training program consists of running for a couple of miles around the track, then lifting weights for strength and power, and then run again for another mile or so. Evidently, their coach used to work with male football players, and he is incorporating the majority of football drills into the regular sports workout during the competitive season for these young female athletes. As far as he is concerned, the heavier weight moved the better. “Work through the pain!” echoes his motto. As much as these teenage girls want a good chance at the championship trophy, they are beginning to get discouraged, mainly because they cannot seem to get rid of their muscle aches and pains despite resting on the weekends and taking over-the-counter medications. In fact, their performances during the games have also started to deteriorate a bit, which makes their coach exercise them even harder. The PA is coming to you for advice concerning this group of adolescent females.

1.2 Questions

  1. 1.

    What do you think is happening to these young female athletes?

  2. 2.

    What questions should you ask of these athletes and how will you go about approaching the coach about his female soccer players’ problems?

  3. 3.

    What elements of the history, physical exam, and diagnostic studies should you obtain to help you evaluate and treat these young female athletes?

  4. 4.

    What initial measures should you institute?

  5. 5.

    Who else should you consult for assistance in the management of their musculoskeletal concerns?

1.3 Plausible Answers

  1. 1.

    It appears as though the soccer coach is employing training techniques that are more specific to a different sport and group of athletes and do not fit these adolescent female athletes’ training needs. Their complaints of pain may be coming from overuse injuries because of working out too much and too frequently.

  2. 2.

    You may want to inquire about other types of athletic activity, along with the specifics of the exercises these females are performing. Then, go talk to their trainer before discussing the situation with their coach. Approach him in a nonthreatening manner, explain the fact that his players are trying as hard as they can, but their bodies are not quite used to the rigors of his method of training yet.

  3. 3.

    Pertinent questions you will want to ask about these athletes’ histories should include their previous playing experience, whether it is their first competitive season (rookie) or are they veterans at this game. You also would want to know about their past and present physical fitness profile to determine if indeed they are in good enough shape to undergo rigorous training outside of their soccer workouts. Try to rule out alternative causes of musculoskeletal complaints other than strains and sprains, such as stress reactions or fractures. Perform a thorough physical exam of the involved bones and joints. Obtain radiographs and, if these are negative, then order bone scans and/or magnetic resonance imaging to further delineate details of the orthopedic pathology. Check out laboratory blood work to see if any abnormal indices are present to indicate a metabolic or endocrine source contributing to their problem.

  4. 4.

    As for the initial treatment of these soccer players, institute the PRICE principle after talking things over with their trainer and coach. Discuss decreasing the training volume and intensity, cross-train with other activities so as not to stress the injured extremities, and hopefully maintain physical fitness. Avoid provocative exercise maneuvers while attempting to modify regular practice so that these athletes do not become completely deconditioned in the meantime. Once they are over the acute inflammatory stage, gradually increase their training to tolerance to help get them back into the game.

  5. 5.

    Do hold the affected young females back from any sort of impact activity and seek consultation from an orthopedist or surgical sports specialist if they are not responding to your treatment, especially if you are worried about stress fractures.

Chapter Review Questions

  1. 1.

    When is the final adult stature attained in females?

    1. (a)

      12–13

    2. (b)

      14–15

    3. (c)

      16–17

    4. (d)

      18–19

  2. 2.

    Neuromuscular control and development most specifically target which anatomical structure in adolescent females, as compared to males as far as injury is concerned?

    1. (a)

      Shoulder

    2. (b)

      Knee

    3. (c)

      Wrist

    4. (d)

      Hip

  3. 3.

    What anatomical structures are involved with the “miserable malalignment syndrome”?

    1. (a)

      Pelvis and knee

    2. (b)

      Knee and foot

    3. (c)

      Hip and leg

    4. (d)

      All of the above

  4. 4.

    Name different ways to help prevent musculoskeletal injuries.

    1. (a)

      Go as hard and fast as possible to build up strength and stamina

    2. (b)

      Use other players’ equipment and play in bad weather

    3. (c)

      Wear fancy name brand running shoes

    4. (d)

      None of the above

  5. 5.

    What are the best recommended first-aid measures for musculoskeletal injury management?

    1. (a)

      Rest, ice, compression, elevation

    2. (b)

      Rest, ice, compression, elevation, medication

    3. (c)

      Protect, rest, ice, compression, elevation

    4. (d)

      ROM, rest, ice, compression, elevation

  6. 6.

    Which of the following intrinsic factors make a person more susceptible to injuries?

    1. (a)

      Movement skills

    2. (b)

      Intensity of activity

    3. (c)

      Previous injury

    4. (d)

      Equipment

  7. 7.

    Which structure of tibia is affected by Osgood–Schlatter’s disease?

    1. (a)

      Tibial plateau

    2. (b)

      Tibial tuberosity

    3. (c)

      Tibial plafond

    4. (d)

      Tibial shaft

  8. 8.

    Dislocation of patella is most commonly seen in females aged

    1. (a)

      6–10 years

    2. (b)

      10–14 years

    3. (c)

      14–18 years

    4. (d)

      18–22 years

  9. 9.

    Which is the most common ligament injured in lateral ankle sprains?

    1. (a)

      Deltoid ligament

    2. (b)

      Calcaneonavicular

    3. (c)

      Posterior talofibular

    4. (d)

      Anterior talofibular

  10. 10.

    Spondylolysis in spine is defined as

    1. (a)

      A defect in the lamina between the superior and inferior articular facets

    2. (b)

      Translational movements between vertebral bodies

    3. (c)

      Disc protrusion between two vertebral segments

    4. (d)

      Trabecular defect within the vertebral bone

Answers

  1. 1.

    c

  2. 2.

    b

  3. 3.

    d

  4. 4.

    d

  5. 5.

    c

  6. 6.

    c

  7. 7.

    b

  8. 8.

    c

  9. 9.

    d

  10. 10.

    a

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Zumwalt, M. (2023). Prevention and Management of Common Musculoskeletal Injuries in Skeletally Immature Female Athletes. In: Robert-McComb, J.J., Zumwalt, M., Fernandez-del-Valle, M. (eds) The Active Female. Springer, Cham. https://doi.org/10.1007/978-3-031-15485-0_14

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