Overuse injury tops list when athlete is a girl

Track, field hockey, lacrosse, and gymnastics can put ‘the hurt’ on girls.

Hope Solo, right, tends to her teammate Morgan Brian, who collided with Alexandra Popp of Germany during the Women’s World Cup semifinal on Tuesday. Ryan Remiorz, The Canadian Press via Associated Press. New York Times

By Sydney Lupkin, VICE News, MedPage Today July 2, 2015

Head injuries and synthetic turf have taken their toll on soccer players’ bodies at the 2015 Women’s World Cup, but women take an entirely different kind of beating while they’re making their way up to the pros – especially if they dabbled in track and field in their teens.

In high school, girls are more likely to sustain overuse injuries in sports than boys, according to a retrospective cohort study of nationwide data spanning 20 sports and six school years.

“Identifying high school athletes at risk of overuse injuries is the first step in working to prevent these injuries,” the authors wrote, noting that their study was the largest recent study of high school athletes’ overuse injuries and the first to delve into these injuries across such a wide range of sports.

High school girls sustained 1.88 overuse injuries for every 100,000 athletic exposures, which were defined as either practices or competitions, Thomas M. Best MD PhD, of Ohio State University’s Division of Sports Medicine, and colleagues reported in The Journal of Pediatrics. Boys only experienced 1.26 overuse injuries over the same number of athletic exposures (relative risk 1.50, 95% CI 1.39-1.61).

Of the five most likely sports to cause overuse injuries, girls’ sports made up the top four. Girls’ track and field, girls’ field hockey, girls’ lacrosse and girls’ gymnastics saw 3.82 2.93, 2.73, and 2.72 overuse injuries, respectively, per 100,000 athletic events. Boys’ track and field followed with 2.24 overuse injuries per 100,000 athletic events.

Although soccer wasn’t the hardest on women’s bodies, it was still tougher on the girls than the boys. The girls suffered 1.96 overuse injuries for every 100,000 athletic events, whereas boys suffered 1.53 over the same number of athletic events.

Still, that the fairer sex gets hurt like this more often isn’t exactly new.

Timothy Hewett PhD, of Ohio State University’s Division of Sports Medicine, was not involved in this study but he’s credited with unraveling why girls’ injuries differ from boys’ injuries and has published several of his own studies on the subject.

Here’s how it works: Women have different muscle activation patterns and neuromotor control than men, Hewett said. For example, women don’t activate their gluteus maximus at the same level as men despite its status as the largest, most powerful muscle in the body, leading to an inward collapse of the hip and knee. This creates patellofemoral pain, which Hewett said is the most common overuse injury. Researchers have developed exercises to prevent and rehabilitate these injuries.

He told MedPage Today that Best’s study reaffirms and validates what researchers already knew but on a larger scale and with more sports.

“We’ve looked mainly at soccer and basketball,” Hewett said of previous studies of overuse injuries. “That girls’ track and field and girls’ field hockey were the highest overuse injuries in sports, that’s definitely new. That hasn’t been out there before.”

Best and his colleagues sifted through data collected from the 2006-2007 school year through the 2011-2012 school year via the National High School Sports-Related Injury Surveillance System, which has been nicknamed the High School RIO (Reporting Online). The data came from certified athletic trainers affiliated with the National Athletic Trainers’ Association and employed at randomly selected high schools with at least 1,000 students across eight geographic regions. These trainers reported their students’ injury information online every week to create the dataset.

Pulling from about 19 million athletic events over six school years, Best and his colleagues found 2,834 overuse injuries. They did not weight their case counts to calculate rates or rate comparisons.

To be considered a reportable overuse injury, it had to have been recorded as resulting from participation in an athletic practice or competition, requiring medical attention, and causing the athlete to miss at least a day of athletic activity. It also had be “chronic” or the result of “overuse” rather than “acute,” according to the study methods.

Overuse injured body parts varied by sport, but lower legs, knee and shoulder overuse injuries were the most common, making up 21.8 %, 15.9%, and 11.5% of all overuse injuries, respectively.

Girls were more likely to sustain these injuries earlier in their high school athletic careers than boys, and both sexes were more likely to experience them during practice than competition, according to Best and colleagues.

“We hypothesize that these differences in injury rates may also be attributable to a selection of the elite athletes; meaning those female athletes participating in sports as a senior in high school may have physical builds better able to withstand repetitive exercise, and those who sustained injuries at a younger age no longer participate in sports,” the researchers wrote, adding that as boys experience growth spurts, they “may not realize their full risk of overuse injury based on their mature physical build until their later high school years.”

The student athletes missed less than a week of participation for more than 50% of the overuse injuries studied, but a few prompted the athletes to lose more than 3 weeks of practice and playing time. Girls’ gymnastics and boys’ wrestling experienced the most season-ending overuse injuries.

Alex B. Diamond DO MPH, who directs Vanderbilt University Medical Center’s program for injury prevention in youth sports, told MedPage Today the study uses the “groundbreaking” RIO data to “refine” sports medicine specialists’ understanding of these injuries, which had been limited to smaller studies and anecdotes, he said.

“It really gives us tangible numbers,” Diamond said. “I think where this study can be really helpful is to begin to provide some real guidance on where we should target our future studies and future efforts in regard to overuse injuries and prevention. I think that’s the beauty of this study.”

The study was funded by the CDC, National Federation of State High School Associations, National Operating Committee on Standards for Athletic Equipment, DonJoy Orthotics, and EyeBlack. Study authors declared they had no conflicts of interest.

Reviewed by Henry A. Solomon MD FACP FACC, Clinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo MA BSN RN Nurse Planner

Source MedPage Today

  References
Epidemiology of Overuse Injuries among High-School Athletes in the United States, Allison N Schroeder, R Dawn Comstock PhD, Christy L Collins MA, Joshua Everhart MD, David Flanigan MD, Thomas M Best MD PhD. The Journal of Pediatrics, Volume 166, Issue 3, 600-606. doi: 10.1016/j.jpeds.2014.09.037

Prevention of Overuse Sports Injuries in the Young Athlete, Mark V Paterno PT PhD SCS ATC, Jeffery A Taylor-Haas PT DPT OCS CSCS, Gregory D Myer PhD CSCS FACSM, and Timothy E Hewett PhD FACSM. Orthop Clin North Am. 2013 Oct; 44(4): 553–564. Published online 2013 Aug 29. doi: 10.1016/j.ocl.2013.06.009

Also see
After Heads Bang, Interests Collide for FIFA in The New York Times
Sports specific injury prevention information and tip sheets in Stop Sports Injuries
Overuse Injuries in Children in Ortho Info
Return to play for soccer athletes and risk for future injury in American Academy of Orthopaedic Surgeons AAOS
The growing trend of youth sports specialization in American Academy of Orthopaedic Surgeons AAOS

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