Prevention and Management of Common Musculoskeletal Injuries in the Adult Female Athlete

Abstract

As the young female athlete transitions from the adolescent stage into a full-grown adult, her entire body again undergoes a multitude of changes, primarily from the effects of estrogen. This sex-specific hormone causes changes in body composition, muscular strength, neuromuscular firing, and bone content. This bodily alteration opens the adult female athlete up to face different types of musculoskeletal injuries, with overuse trauma such as strains/sprains still being the most common. However, injury to the knee in general and anterior cruciate ligament (ACL) in particular is more of an issue for adult female athletes, with ACL tear rates exceeding that of male athletes several folds, especially for those females participating in soccer and basketball. Current research continues to focus on ACL injury in active females, looking at a wide array of potential contributing factors, both intrinsic and extrinsic, some of which can be modified to aid in preventing further injuries. Prevention of musculoskeletal trauma thus remains the focus and is crucial in keeping the female athlete healthy/injury-free, by incorporating proper training regimens/conditioning programs to help reduce the risk of traumatic injuries.

Chapter Review Questions with Scenario

1.1 Scenario

You are a fairly new athletic trainer for a collegiate level female basketball team in a mid-size town. This is your first season working with these women athletes. One half is composed of rookies (junior varsity) and the other half veterans (varsity) players. Recently you have noticed that not all of these females show up every day for practice and that several have had more “off” than “on” days in terms of “scrimmage” games. You have also been providing daily “treatments” as far as local modalities and physical therapy rehab exercises in the training room for over a third of these female athletes for various musculoskeletal complaints. In fact, the majority of the problem lies in the lower extremity and most notably the tibia and knee regions. A couple of females are improving in terms of their symptoms, but the rest is still not making any appreciable gains. Alarmingly, some are actually getting worse. The regular sports season will begin in about 2 months and you are quite concerned that some players may not be able to “start” in their best physical condition.

1.2 Review Questions

• 1. Initially, how should you go about discovering the root of these female athletes’ problem?

• 2. What specific questions should you pose to each woman about her complaints/symptoms?

• 3. What physical sign(s) of overuse injury should you look for to point you toward a potential stress fracture?

• 4. What further actions, if any, should be taken to manage these athletes’ problems?

• 5. How can you ensure that these females will recover in time to start playing basketball once the regular sports season begins?

1.3 Plausible Answers

• 1. First of all, you want to gain the athletes’ confidence as their trainer and confidant. Approach each female in private, chat with her as a friend, and try to find out the underlying reason, i.e., real deal behind them missing practice(s). They may be having problems with their studies at school or issues with their family at home. Allow each athlete to air her concerns, be understanding and supportive.

• 2. You may want to investigate each athlete’s current fitness condition, i.e., previous formal training as she may be deconditioned to begin with; also inquire about other physical activities outside of basketball practices in which she may be participating, such as running, jogging, or other impact maneuvers. Ask specific questions about timing, location, quality, intensity, duration, and associated symptoms.

• 3. Watch for indications of overuse injury, such as pain that does not resolve with rest, persistent pain despite activity/exercise modification, and especially pain with weight bearing.

• 4. Once you have determined the extent of each athlete’s orthopedic injury, talk it over with your head coach before approaching/consulting the team physician about the next step in diagnosis and treatment. Institute “PRICE” measures and depending on their level of response, proceed with the physical therapy rehab program to the level of each athlete’s tolerance.

• 5. Progress with an appropriate conditioning program once the acute symptoms subside, concentrating on body mechanics, muscle balancing, and especially running and landing techniques. If indeed the affected females are engaged in excessive training/workouts beyond their practices, educate them on the importance of not “overdoing it” so that they can maximize their chance of recovery. Gradually incorporate sports-specific drills after they master the “basics.” This way, these athletes’ musculoskeletal injuries can heal in time and they will be physically ready to participate/compete with their teammates.

Chapter Review Questions

• 1. What is the percentage of essential fat in males versus females?

  • (a) 5% and 10–15%

  • (b) 2–4% and 10–12%

  • (c) 3% and 9–12%

  • (d) None of the above

• 2. Which sports tend to have a higher rate of musculoskeletal injuries in females?

  • (a) Handball and lacrosse

  • (b) Soccer and basketball

  • (c) Gymnastics and volleyball

  • (d) All of the above

• 3. Which bones are more commonly involved as far as stress fractures in female athletes are concerned?

  • (a) Tibia

  • (b) Hip and pelvis

  • (c) Ankle and foot

  • (d) B and C

• 4. Cite the incidence and specific anatomical structure which is more readily injured in females vs. males.

  • (a) Five times higher, knee

  • (b) 2–10 times higher, ACL

  • (c) 2–10 times higher, MCL

  • (d) Five times higher, ACL

• 5. Athletic taping becomes ineffective for joint stability after what amount of time?

• (a) 20 min

• (b) 10 min

• (c) 15 min

• (d) 30 min

• 6. Which is the most common mechanism of ACL injury in women athletes?

• (a) Hip external rotation and tibial internal rotation

• (b) Hip internal rotation and tibial external rotation

• (c) Hip and tibial internal rotation

• (d) Hip and tibial external rotation

• 7. Miserable malalignment syndrome is associated with

• (a) Decreased Q-angle

• (b) Genu varum

• (c) Hypomobile patella

• (d) Increased femoral anteversion

• 8. ITB syndrome is associated with

• (a) Weak gluteus medius muscle

• (b) Excessive tibial external rotation

• (c) Genu recurvatum

• (d) Reduced foot pronation

• 9. The most common level of spinal segments affected by spondylolysis is

• (a) L1–L2

• (b) L2–L3

• (c) L3–L4

• (d) L4–L5

• 10. Which of the following should not be adopted as a rehabilitation regimen after an acute injury?

• (a) Maintaining ROM

• (b) PRICE

• (c) Plyometrics

• (d) Muscle strengthening

Answers

• 1. c

• 2. d

• 3. d

• 4. b

• 5. a

• 6. b

• 7. d

• 8. a

• 9. d

• 10. c