1. Chapter 14 Prevention and Management of Common Musculoskeletal Injuries in the Adult Female Athlete Mimi Zumwalt, MD

2. Learning Objectives Understand the differences in the musculoskeletal anatomy, physiology, and body composition between the adolescent and adult female athletesUnderstand the differences in the musculoskeletal anatomy, physiology, and body composition between the adolescent and adult female athletes Recognize similarities and differences between the anatomy, body composition, and biomechanics of adult males and female athletes’ musculoskeletal systemRecognize similarities and differences between the anatomy, body composition, and biomechanics of adult males and female athletes’ musculoskeletal system Know several of the more common orthopaedic injuries incurred by adult female athletesKnow several of the more common orthopaedic injuries incurred by adult female athletes Delineate different prevention measures and methods of management for musculoskeletal conditions occurring in adult female athletesDelineate different prevention measures and methods of management for musculoskeletal conditions occurring in adult female athletes

3. Introduction Female body undergoes morphologic, structural, hormonal, metabolic changes from young to adulthoodFemale body undergoes morphologic, structural, hormonal, metabolic changes from young to adulthood Musculoskeletal & neurological alterationsMusculoskeletal & neurological alterations Bring about unique orthopaedic trauma while playing sports or performing athletic activitiesBring about unique orthopaedic trauma while playing sports or performing athletic activities

4. Musculoskeletal Anatomy, Physiology, & Body Composition of Adolescent vs. Adult Females Puberty in early to mid-teens  pelvis widened, fat deposits on thighs/ buttocks, breasts develop under estrogen & bone stops growingPuberty in early to mid-teens  pelvis widened, fat deposits on thighs/ buttocks, breasts develop under estrogen & bone stops growing Body composition changes ~ mid 20’s – bone loss starts, muscle mass declines, fat rises dependent on nutrition, mechanical loading/physical activity & hormonal milieuBody composition changes ~ mid 20’s – bone loss starts, muscle mass declines, fat rises dependent on nutrition, mechanical loading/physical activity & hormonal milieu

5. Musculoskeletal Anatomy, Body Composition, & Biomechanics of Adult Males vs. Females Testosterone vs. estrogenTestosterone vs. estrogen Essential fat percentage higher in females vs. storage fat similar to malesEssential fat percentage higher in females vs. storage fat similar to males Advantage in water sportsAdvantage in water sports XS endurance exercise opposite effectXS endurance exercise opposite effect Fat distribution around upper body in males vs. hips & lower body in femalesFat distribution around upper body in males vs. hips & lower body in females Females stop growing earlierFemales stop growing earlier Males stronger > females, esp. upper body Males w/ broader shoulders, wider chest, & narrower hips vs. females w/wider pelvis, more varus hips & higher knee valgus angles Lower body malalignment Neuromuscular recruitment order different Quad dominant  ACL tears

6. Orthopaedic Injuries/Conditions In Adult Female Athletes Olympic female athletic participation finally in 1912Olympic female athletic participation finally in 1912 Education Amendments Act in 1972Education Amendments Act in 1972 Tremendous rise in female involvement & sports injuries esp. ACL tearsTremendous rise in female involvement & sports injuries esp. ACL tears Risky landing positions among othersRisky landing positions among others Intrinsic &/or extrinsic factorsIntrinsic &/or extrinsic factors

7. Orthopaedic Injuries/Conditions In Adult Female Athletes “Miserable malalignment syndrome”“Miserable malalignment syndrome” PFPS, etcPFPS, etc Foot problems – Achilles tendinitis, bunion, lesser toesFoot problems – Achilles tendinitis, bunion, lesser toes Shoulder conditions – laxity, impingement, rotator cuff tendinosis/bursitisShoulder conditions – laxity, impingement, rotator cuff tendinosis/bursitis Elbow tendinosisElbow tendinosis Stress fracturesStress fractures Female athlete triadFemale athlete triad

8. Prevention of Musculoskeletal Trauma in Adult Female Athletes Maximize physical fitness & optimize extrinsic factors beyond equipment/gearMaximize physical fitness & optimize extrinsic factors beyond equipment/gear Modify landing techniques thru trainingModify landing techniques thru training Strengthen/balance key muscle groups for limb supportStrengthen/balance key muscle groups for limb support Core conditioning, plyometrics, flexibility, proprioception, agility drillsCore conditioning, plyometrics, flexibility, proprioception, agility drills Avoid xs impact activityAvoid xs impact activity

9. Management of Orthopaedic Injuries in Adult Female Athletes PRICE – prevent/Protect, relative Rest, Ice, Compression, ElevationPRICE – prevent/Protect, relative Rest, Ice, Compression, Elevation NSAIDs, E-stim devices, orthotics, taping, (braces)NSAIDs, E-stim devices, orthotics, taping, (braces) Bone bruise, stress reaction/fx  xrayBone bruise, stress reaction/fx  xray Therapy rehab exercisesTherapy rehab exercises Strength & conditioningStrength & conditioning Sports specific drillsSports specific drills

10. Conclusion Morphologic & hormonal changes from adolescence to adulthood in female athletesMorphologic & hormonal changes from adolescence to adulthood in female athletes Intrinsic & extrinsic factors dictate type & frequency of musculoskeletal trauma assoc w/different sportsIntrinsic & extrinsic factors dictate type & frequency of musculoskeletal trauma assoc w/different sports Conditioning programs help to maximize physical fitness & lower injury ratesConditioning programs help to maximize physical fitness & lower injury rates If not responsive to Rx, seek ortho careIf not responsive to Rx, seek ortho care

11. Case Study 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. One half is composed of rookies (junior varsity) and the other half veterans (varsity) players. Recently you’ve 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’ve 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 are 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.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. One half is composed of rookies (junior varsity) and the other half veterans (varsity) players. Recently you’ve 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’ve 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 are 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.