SHE GOT GAME

 

The world of sports has opened up to women as never before, but so too has the world of sports injuries.

 

by Carrie St. Michel

In ancient Greece, where the Olympics originated, not only were females forbidden from participating in the game's athletic events, they were not even allowed to watch. Women who violated these rules literally paid a high price: They were thrown from a cliff to their death.

Fast-forward to present-day, and it is the women who are likely to be doing the throwing-not of humans off precipices-but in sports from softball to shot put. In recent years, female athletic participation at the recreational, amateur and professional levels has increased exponentially. And the swelling ranks of physically active women has led to the literal swelling of ankles, knees, elbows and assorted other body parts subjected to the rigors of athletic endeavors.

Beware the Knee

"Sports-related injuries in women are almost an epidemic," observes John Itamura, M.D., assistant professor of orthopaedic surgery at the Keck School of Medicine, "especially knee injuries." Itamura estimates that knee injuries among female athletes probably outnumber those in male athletes "by at least four or five to one."

And within that universe of female knee injuries, Itamura does not hesitate to finger the primary sports-injury culprit: tears of the anterior cruciate ligament (ACL), a band of "elastic tissue" in the knee's center that controls rotation and forward motion of the lower leg. Itamura's experience that ACL tears are the most common sports injury he sees among women is by no means unique. Several studies have pointed to the prevalence of ACL injuries in women.

Most recently, in the American Journal of Sports Medicine, researchers evaluated the relative risk of ACL injuries in female versus male athletes at the United States Naval Academy in Bethesda, Md. Among the findings were that women in intercollegiate soccer, basketball and rugby sustained ACL injuries at a rate nearly four times greater than men participating in the same sports. This is consistent with other studies that have found females suffer ACL injuries from four to as much as eight times more often than males.

While there is consensus regarding study results, agreement in response to the obvious question of why women are more susceptible to ACL injuries has yet to be reached.

Theories include:

Itamura suggests that the answer probably can be attributed to a combination of these theories. Orthopaedic surgeon C. Thomas Vangsness, M.D., chief of sports medicine, concurs, but believes that "more research is needed, particularly in relation to estrogen receptors and their impact on women's knee tissue." Physicians at USC University Hospital's Center for Athletic Medicine are currently investigating the role estrogen plays in knee injuries. What is clear, according to Vangsness, is that the risk for ACL injuries, regardless of gender, is always going to be highest in "twisting, stopping, turning sports such as basketball, skiing, soccer and volleyball because these activities involve rotational motions that burden the knee and increase the potential for ligament tears."

And such injuries cannot simply be iced away. Reconstruction of the anterior cruciate ligament, a surgical procedure, is often required. But thanks to technological advances, ACL reconstruction can generally be done through arthroscopic surgery, which, because it is less invasive, can be done on an outpatient basis. Itamura says, "ACL patients used to leave wearing a cast. Now, it's just a brace, and we get them moving right away. We're seeing better results from day one."

Conditioning is Key

While rapid rehabilitation is encouraging, avoidance of an ACL injury altogether is preferable. Sue Lerner, A.T.C., assistant athletic trainer, USC Department of Athletics, recommends the following conditioning regimen for those in high-impact sports that should be followed, at minimum, three times a week:

· Begin with an overall body stretch, paying particular attention to stretching out the hamstrings and quadriceps (5 minutes).

· Next head to the weight room where focus should be placed on increasing both hamstring and quadricep strength so that neither region is subjected to disproportionate stress (25 minutes).

· Plyometric exercises, also known as jump training, should follow. An activity in this category is box jumping, which is jumping from the floor to a sturdy box and back down again. A variety of box heights may be incorporated into the exercise. (20 minutes).

· After plyometrics move to proprioception-exercises designed to enhance both balance and coordination. For example, you could practice walking on a lowered balance beam. Or, to build balance on the ground, stand on one leg, first with eyes open, then with eyes shut (10 minutes).

"Of course, there's nothing that guarantees you won't get an ACL injury," cautions Lerner, "but if you're strong, coordinated and flexible, at least the odds are more in your favor." Itamura adds that this conditioning triad has paid off for members of USC's women's basketball team, who escaped serious knee injuries last season.

Much of the training expertise and specialized equipment available to USC's collegiate athletes is also available to the public through the Center for Athletic Medicine. With prevention in mind, the Center offers exercise prescriptions, fitness training and conditioning programs. Treatment for the full spectrum of sports-related injuries also is available, as are comprehensive rehabilitation programs.

The Center additionally features sports-specific programs. For example, skiers-both those who want to improve technique as well as those recovering from an injury-can take advantage of the Center's ski simulator. The simulator, which is operated under the supervision of a physical therapist, mimics the experience of a downhill run. As Vangsness explains it, this innovative piece of equipment promotes proper balance and posture while strengthening injured or poorly conditioned muscles, enabling skiers and snowboarders to hit the slopes as prepared as possible. Vangsness adds that the public also can utilize the Center's isokinetic machines-computerized equipment that analyzes muscle strength, power and endurance.

Education is a key component of the Center's outreach efforts. Seminars, open to the public, are frequently held on subjects such as avoiding injuries from skiing and long-distance running. A seminar on sports injuries specific to women is planned.

Head-to-Toe Prevention

While the knee is most susceptible to sports injuries, no portion of the anatomy can be considered an injury-free zone. Consequently, it is essential that athletically active women adopt a year-round, head-to-toe prevention program.

Veteran athletic trainer Lerner recommends starting with the shoulders, as this region often is subjected to repetitive movements (softball, swimming and volleyball) that could lead to weakened muscles and joints that are vulnerable to injury. She recommends weight training focused on strengthening the rotator cuff (a group of muscles surrounding the shoulder joint). Also, she suggests specifically prescribed exercises with one- to two-pound dumbbells. Such exercises may also ward off tendonitis, an inflammation of shoulder tendons resulting from overuse.

Just as shoulder strength should be maximized, so too should back and abdominal muscles. By making each of these areas equally strong, neither should be burdened with inordinate stress. As Lerner says, lumbar strains, along with assorted other lower-back maladies, generally result from overloading muscles and ligaments that have not been warmed up or adequately conditioned to withstand the particular activity. Lerner says that many of the lumbar strains she sees are also due to lifting weights improperly, so the guidance of a professional trainer should be sought before embarking on a strength-training program.

And, as part of that program, absolutely do not overlook the hamstring muscles, which are located at the back of the thighs, Lerner says. In her experience, which spans more than two decades of training collegiate athletes, hamstring strains most often occur from overexertion or not warming up properly. To avoid overexertion, keep the "10 percent rule" in mind, she says. The basic concept, she explains, is that you should increase the frequency, duration and intensity of an activity by only 10 percent per week. For instance, if you walked 10 miles the first week of your program, you should not walk more than 11 miles the second week. Adding too much, too soon, almost always invites injury.

To reduce the likelihood of sports injuries, Lerner additionally stresses the importance of stretching out thoroughly both before and after engaging in any physical activity. She also suggests doing a little shopping, because the phrase "dressing for success" has an athletic application. For example, if your shoes are worn out, or just do not fit right, Lerner says it is time to invest in a new pair. You might also want to buy a pair of high-top athletic shoes, as this style of footwear can help prevent ankle sprains, an injury that, according to the American Orthopaedic Foot and Ankle Society, accounts for one in five sports-related injuries.

If you have a history of sprains, you also might consider wearing a lace-up brace that can be retightened while exercising. As a further means of possible prevention, Lerner suggests strengthening exercises such as heel lifts, ankle rotation and stretching out your calf muscles and Achilles tendons (back of lower leg) both before and after working out.

James Tibone, M.D., the Moss Foundation Professor in Sports Medicine in Memory of Dr. Robert K. Kerlan and professor of clinical orthopaedic surgery, says that women who are susceptible to tendonitis should take care to treat the symptoms as soon as they appear, using ice packs and taking ibuprofen to reduce swelling. One thing he urges people not to do, however, is treat a sports injury by simply immobilizing the affected limb. "Some people, when they have an injury, just won't use the arm or leg for a while. The problem with that is that the limb gets stiff and becomes that much harder to rehabilitate. If you're injured in a sport, stop playing the sport for a while, but don't stop using the arm or leg," he says.

Scoring a Victory

Although injuries are an inherent risk of any athletic endeavor, steps can be taken to reduce their incidence, USC physicians and trainers believe. USC University Hospital's Center for Athletic Medicine has made spreading the prevention message a priority. Not only are members of the public encouraged to attend Center-sponsored seminars, but Center physicians and trainers are visiting high schools throughout greater Los Angeles in an effort to make student athletes aware that injury prevention is among their most powerful competitive tools.

Itamura, Vangsness, Tibone and Lerner also believe the message must resonate with females as they continue to enter the athletic arena in record numbers. Women have made tremendous advances in sports, as witnessed by such events as last year's Women's World Cup soccer matches, they say, and with their motivation to achieve victories, women athletes must also score victories over injuries.

 

 

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