Know how to prevent and treat common sports injuries in girls and young women
More girls than ever are hitting the gym, the field, the track, the rink — many at elite levels. Not surprisingly, as the number of girls and young women participating in sports goes up, so does the number of injuries. Without the right diet and conditioning — and sometimes even when following ideal training regimens — young athletes can fall prey to the same injuries that affect adult athletes. Savvy coaches and parents will monitor athletes under their supervision to avoid injury. But when an injury does happen, it's important to know how to intervene quickly to help ensure a healthy recovery.
Studies show that injury prevention programs (IPPs) really work. Although these programs vary widely, depending on the sport and the participant's age, IPPs typically focus on developing and strengthening key muscles; improving movement patterns, sport technique and balance; and avoiding common errors. Parents of young female athletes should talk with coaches and trainers about what IPPs are in place.
Good nutrition plays a critical role, too. Beyond a healthy, balanced diet, girls and young women might also need supplemental vitamins and minerals to stay in peak condition. Some nutritional supplements have been shown to improve performance.
Two supplemental nutrients in particular are important to consider:
- Calcium. Some girls and young women, concerned with maintaining an ideal weight or "being thin," avoid eating higher calorie dairy products. But this can lead to a lack of adequate calcium intake. Athletes under age 18 should get 1,300 milligrams (mg) of calcium daily, while those over age 18 should aim for 1,000 mg a day. Food sources of calcium include dairy products, almonds, broccoli, kale, canned salmon with bones, sardines and soy products such as tofu.
- Iron. Because of menstrual blood loss, girls and young women can be at higher risk of iron deficiency, which affects both sports endurance and performance. Vegetarians also can be at higher risk, since red meat is a top source of dietary iron. Nuts, beans, seafood and dark green leafy vegetables such as spinach and kale are other iron-rich foods. Young athletes should be screened regularly, with a simple blood test, to detect iron deficiency.
Young female athletes are at risk of a spectrum disorder known as the female athlete triad. The triad includes low energy availability, low bone mineral density and menstrual dysfunction. Girls with only one of the triad's components are at higher risk of muscle and bone injuries; having two or all three of the triad components increases the risk even further. Parents and coaches need to be able to recognize the following signs and symptoms that can be part of the triad:
- Eating disorders such as bulimia or anorexia
- Stress fractures
- Frequent dieting
- Menstrual irregularities
- Excessive exercise
- Obsessive or perfectionist behavior
Even when an athlete does everything right, an injury can happen. In most cases, staying calm and getting the right treatment will help speed recovery.
Adolescent athletes are prone to foot and ankle injuries. In fact, these injuries account for almost 30 percent of all young athletes' visits to sports medicine clinics. High on the list of common injuries are lateral ankle sprains, which girls get at higher rates than boys do. In one study, researchers found that female basketball players experience 25 percent more minor ankle sprains than males do. Why? Women's feet are smaller, proportionally, than men's, and shaped differently, which can leave girls and young women, especially competitive athletes, more vulnerable to ankle injury.
A lateral ankle sprain involves tears to one or more ligaments in the ankle. The sprain typically happens when the ankle is suddenly twisted or flexed during active movement. The first sign of a sprain is immediate pain, often followed by swelling, especially on the outside of the ankle. Putting weight on the ankle is usually quite painful. Diagnosing a sprain involves seeing a doctor for an exam, which can include X-rays.
Health care professionals use a grading scale for sprains:
- Grade 1 is the least severe, with mild swelling and a minor ligament tear.
- Grade 2 involves moderate swelling and a complete tear of one ligament.
- Grade 3 (severe) includes significant swelling and pain and tears of at least two ligaments.
Doctors typically treat a sprain with a protective brace or a walking boot. Then a standard regimen of rest, ice, compression and elevation follows. Once the swelling and pain go down, physical therapy is usually recommended. At first the emphasis is on upper body and cardiovascular fitness, while the ankle is rested. Once the pain is gone and full range of motion is regained, ankle strength and stability exercises are started, along with sport-specific exercises.
- Rest the injured foot and ankle from bearing weight as much as possible.
- Wear a compression wrap to help reduce swelling.
- To relieve pain and swelling, elevate the ankle and foot above the heart.
- Apply ice to the area for 20 minutes, three to four times daily.
- Follow the doctor's or physical therapist's exercises to regain range of motion, strength and stability.
Patellofemoral pain syndrome
Patellofemoral pain syndrome refers to pain in the region of the kneecap (patella). Pain in the kneecap area can result from overuse, improper training, problems with control of hip and leg muscles, or kneecap misalignment. Unfortunately, the syndrome is common in young female athletes, particularly climbers, runners and volleyball players.
Girls with patellofemoral pain syndrome typically feel a dull pain in the fronts of their knees when they exercise — any activity that bends the knees can trigger the pain. They can also feel pain after sitting with their knees bent for a long time, such as in a classroom or on a plane. They might hear cracking or popping sounds in their knees, or feel pain while climbing stairs or getting up after sitting for a while. If these signs and symptoms occur, consult a sports medicine physician or physical therapist.
The health care professional might request X-rays or simply do a physical exam of the hips, legs and feet, with special focus on the knee that hurts.
The usual treatment for patellofemoral pain syndrome is pain management and resting from the activities that provoke the pain. Physical therapy can improve lower extremity movement patterns and tracking of the kneecap in its groove. The exercises involve not only the knee but also the hips, legs and core. The goal is to protect the knee by strengthening the lower body and correcting movement patterns that cause the kneecap to not track properly. The health care professional might also consider a shoe insert (orthotic), as well as taping around the kneecap to relieve pain during rehabilitation. A brace can be used to relieve pain and promote proper movement of the patella.
- Stop the activity that is causing the knee pain and switch to a low-impact activity such as swimming or biking until the pain goes away.
- Apply ice to the knee for 20 minutes several times a day.
- Ask a health care professional about using over-the-counter anti-inflammatory medications such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), which help reduce pain.
The anterior cruciate ligament (ACL) is one of four major ligaments in the knee. ACL injuries generally involve a tearing of the ligament (sprain). Typically the injury occurs during pivoting or jumping movements or when quickly changing direction. These injuries are more common among athletes who play soccer, football and basketball. Female athletes have been found to be significantly more at risk of ACL injuries than are male athletes. Although the reasons for this aren't fully understood, some studies suggest that female hormones and anatomy make girls and young women more susceptible. Other research has found that suboptimal movement patterns in the legs can predispose girls and women to ACL injuries. For example, inward movement of the knee during a single-leg squat or when landing from a jump has been correlated with an increased risk of ACL injury.
At the time of an ACL injury, there may be a popping sound, after which the knee gives way, followed quickly by pain and swelling. The knee can lose its full range of motion and feel tender and unstable when the injured person is walking.
Studies have found that noncontact ACL injuries can be prevented with the right training program. Correcting suboptimal movement patterns with a program of specific exercises for the core, hip and leg muscles can reduce the risk of ACL injury. Parents of young female athletes should talk to sports medicine professionals, coaches and trainers to discuss the best approach to ACL injury prevention.
A physical examination of the injured area is typically all that's needed to diagnose an ACL injury. In some cases, the doctor can also request X-rays, magnetic resonance imaging (MRI) scans or both. Once the diagnosis is confirmed, most athletes will need surgery to permit them to return to activities that require jumping, cutting or pivoting movements.
Because most ACL tears can't be repaired with stitching, surgeons have to reconstruct the ligament with tissue grafts. ACL reconstruction is generally performed using an arthroscopic procedure, which is minimally invasive and results in less pain and faster recovery time. Young people who are still actively growing have special considerations and can benefit from a consultation with an orthopedic surgeon who's experienced with pediatric ACL reconstruction.
The good news? Studies have found that after having ACL surgery, women say their knees feel stable and they can return to sports and high-impact activities.
- Wear a brace or use crutches to keep weight off the injured knee.
- Use ice packs as directed by the doctor to relieve pain and swelling.
- After the surgery, a set of exercises can help strengthen the leg muscles and restore function to the knee. These exercises should be tailored to the specific sport. It usually takes about nine months to return to the previous level of activity.
High-impact sports such as running, tennis, gymnastics, volleyball and basketball can be hard on the legs and feet. When muscles get overused and fatigued they sometimes transfer the stress to the bones, causing small cracks or severe stress overload within a bone. These injuries, called stress fractures, typically occur in the lower leg or foot.
Adolescent girls, particularly those on the female athlete triad spectrum, are especially susceptible to stress fractures because they usually have thinner and more-fragile bones. Not getting enough vitamin D and calcium also can increase the risk of a stress fracture. The main symptom is a specific area of pain that improves with rest and worsens with running, jumping or walking.
Health care professionals typically recommend avoiding any kind of impact activity for six to eight weeks while the injury heals. Rushing back into the activity that caused the stress fracture can cause more-serious stress fractures to develop or even lead to chronic problems. A health care professional might recommend the use of crutches to unload the injured leg, followed by a walking boot or brace as the stress fracture heals.
- Rest the injured area from bearing weight as much as possible. If there is swelling, then lie down with the foot raised higher than the heart.
- Apply ice packs for 20 minutes, several times a day, to relieve swelling and pain.
- Once a health care professional gives the OK, start exercising with low-impact activities such as swimming or stationary cycling.
- Maintain a healthy diet, making sure to get plenty of calcium and vitamin D.
"Shoulder instability" actually refers to a spectrum of disorders. These include:
- Dislocation. The head of the upper arm bone has slipped all the way out of its socket in the shoulder joint.
- Partial dislocation (subluxation). The upper arm bone is partially out of the socket, or the bone partially goes out of the socket and then goes back in.
- Laxity. The joint is loose.
When a shoulder dislocates, either fully or partially, a doctor will determine which direction the upper arm bone has slipped — most commonly toward the front of the shoulder and downward. Multidirectional instability (MDI) is a general looseness of the joint in all directions, which can cause the upper arm bone to dislocate or partially dislocate (sublux) more frequently. MDI tends to be more common than single-direction dislocations in female athletes. Shoulder instability is increasingly seen in girls and young women who play overhead and throwing sports, such as volleyball, swimming and tennis.
Shoulder dislocations are painful, noticeable events that need immediate treatment. The joint should be immobilized immediately and ice applied, even while waiting to see a doctor. Girls experiencing shoulder pain, muscle spasms or weakness should also seek help. Other signs and symptoms can include swelling, numbness and bruising.
Doctors treat dislocations with a closed-reduction procedure, in which the upper arm bone is gently repositioned back into the shoulder socket. This typically stops the severe pain. The procedure is done as an outpatient procedure. If a qualified medical professional is on hand when the injury occurs, the procedure can often be performed on-site, although follow-up medical care is essential to ensure the joint is properly positioned. A doctor might also recommend a sling for a short period of time for comfort.
Although most shoulder instability injuries are treated nonsurgically, doctors recommend surgery when the instability becomes a chronic condition. Among girls younger than 19 who have had a dislocated shoulder, the re-dislocation rate is very high. With surgery, doctors can repair and tighten the ligaments that hold the joint in place.
Nov. 04, 2016
- Rest the injured shoulder by keeping it immobile.
- Use ice packs for 15 to 20 minutes every couple of hours for the first few days after the injury.
- After three days, consider using a hot pad for no more than 20 minutes at a time, which can help relax the shoulder's stressed muscles.
- Follow the health care professional's guidelines for pain management.
- A physical therapist can recommend a series of gentle range-of-motion and strength exercises to be completed at home.