Chapter 14
Prevention and Management of
Common Musculoskeletal Injuries in
the Adult Female Athlete
Mimi Zumwalt, MD
Learning Objectives
• Understand 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 system
• Know 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 athletes
Introduction
• Female body undergoes morphologic,
structural, hormonal, metabolic changes
from young to adulthood
• Musculoskeletal & neurological alterations
• Bring about unique orthopaedic trauma
while playing sports or performing
athletic activities
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 growing
• Body composition changes ~ mid 20’s –
bone loss starts, muscle mass declines, fat
rises dependent on nutrition, mechanical
loading/physical activity & hormonal milieu
Musculoskeletal Anatomy, Body
Composition, & Biomechanics of
Adult Males vs. Females
• Testosterone vs. estrogen
•
• Essential fat percentage
higher in females vs. storage •
fat similar to males
• Advantage in water sports
• XS endurance exercise
opposite effect
• Fat distribution around upper
body in males vs. hips &
•
lower body in females
• Females 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
Orthopaedic Injuries/Conditions In
Adult Female Athletes
• Olympic female athletic participation
finally in 1912
• Education Amendments Act in 1972
• Tremendous rise in female involvement
& sports injuries esp. ACL tears
• Risky landing positions among others
• Intrinsic &/or extrinsic factors
Orthopaedic Injuries/Conditions In
Adult Female Athletes
• “Miserable malalignment syndrome”
• PFPS, etc
• Foot problems – Achilles tendinitis, bunion,
lesser toes
• Shoulder conditions – laxity, impingement,
rotator cuff tendinosis/bursitis
• Elbow tendinosis
• Stress fractures
• Female athlete triad
Prevention of Musculoskeletal
Trauma in Adult Female Athletes
• Maximize physical fitness & optimize
extrinsic factors beyond equipment/gear
• Modify landing techniques thru training
• Strengthen/balance key muscle groups for
limb support
• Core conditioning, plyometrics, flexibility,
proprioception, agility drills
• Avoid xs impact activity
Management of Orthopaedic Injuries
in Adult Female Athletes
• PRICE – prevent/Protect, relative Rest, Ice,
Compression, Elevation
• NSAIDs, E-stim devices, orthotics, taping,
(braces)
• Bone bruise, stress reaction/fxxray
• Therapy rehab exercises
• Strength & conditioning
• Sports specific drills
Conclusion
• Morphologic & hormonal changes from
adolescence to adulthood in female athletes
• Intrinsic & extrinsic factors dictate type &
frequency of musculoskeletal trauma assoc
w/different sports
• Conditioning programs help to maximize
physical fitness & lower injury rates
• If not responsive to Rx, seek ortho care
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.