Girls, Sports, and Knee Injuries

by Lou Schuler on May 12, 2008 8:45 AM EDT in News

If you have a daughter who plays sports, and haven't yet seen Michael Sokolove's feature about girls and knee injuries in the New York Times Magazine, you should drop what you're doing and read it now.

Here's how Sokolove describes the crux of the problem (and I do mean "crux," since we're talking about injuries to the anterior cruciate ligament):

Girls and boys diverge in their physical abilities as they enter puberty and move through adolescence. Higher levels of testosterone allow boys to add muscle and, even without much effort on their part, get stronger. In turn, they become less flexible. Girls, as their estrogen levels increase, tend to add fat rather than muscle. They must train rigorously to get significantly stronger. The influence of estrogen makes girls' ligaments lax, and they outperform boys in tests of overall body flexibility -- a performance advantage in many sports, but also an injury risk when not accompanied by sufficient muscle to keep joints in stable, safe positions. Girls tend to run differently than boys -- in a less-flexed, more-upright posture -- which may put them at greater risk when changing directions and landing from jumps. Because of their wider hips, they are more likely to be knock-kneed -- yet another suspected risk factor.

This divergence between the sexes occurs just at the moment when we increasingly ask more of young athletes, especially if they show talent: play longer, play harder, play faster, play for higher stakes. And we ask this of boys and girls equally -- unmindful of physical differences. The pressure to concentrate on a "best" sport before even entering middle school -- and to play it year-round -- is bad for all kids. They wear down the same muscle groups day after day. They have no time to rejuvenate, let alone get stronger. By playing constantly, they multiply their risks and simply give themselves too many opportunities to get hurt.

Here's how serious the injury risk is for young female athletes:

The N.C.A.A.'s Injury Surveillance System tracks injuries suffered by athletes at its member schools, calculating the frequency of certain injuries by the number of occurrences per 1,000 "athletic exposures" -- practices and games. The rate for women's soccer is 0.25 per 1,000, or 1 in 4,000, compared with 0.10 for male soccer players. The rate for women's basketball is 0.24, more than three times the rate of 0.07 for the men. The A.C.L. injury rate for girls may be higher -- perhaps much higher -- than it is for college-age women because of a spike that seems to occur as girls hit puberty.

One part that will probably catch a lot of readers by surprise is the assertion that parents aren't the ones pushing girls to play more and play harder:

Rich and Maria Pierson never had to push Janelle into soccer or to reach for higher-level teams, and they certainly never berated her after bad games. These types do exist, stereotypical "Little League parents," but it is far more difficult than some imagine to push a reluctant child into sports, especially at a level that demands great commitment. Children may acquiesce for a while, but all but the most passive or abused will eventually rebel and shut down.

I found a different syndrome: parents of highly motivated, athletic children who are supportive of their kids' sports but bewildered by the culture. The children, often as not, are the ones leading the way, and the whole family gets pulled along in ways it never anticipated.

I can vouch for this. My older daughter is the athletic adventurer in our family. She taught herself to ride a two-wheeler at 5, and when she was 7 was the first kid in her league to head the ball in a soccer game. (It went out of bounds. I think it took her two more years before she successfully headed a ball in the right direction.) Out of the blue, she'll try to do one-arm push-ups, or announce that she wants to take up fencing. It's always a surprise. Her team had a really bad game on Saturday morning, but in the last five minutes of the first half she played the best soccer of her life so far. Her coach once compared her to Rudy: She's small for her age, and not nearly as fast or skilled as the best players in her league. But when she's on, she competes as hard as anybody.

By contrast, my younger daughter has almost no competitive instincts at all. She's regressed as a soccer player this year, and has already said she doesn't want to play next year. She wants to take an extra ballet class instead, which is fine with me. There are plenty of injury risks with ballet, but since the whole point is to move with full control over the body, the risk of catastrophic injury to knee ligaments is a lot lower.

No matter what, with kids and sports it's always an adventure, and there's always something to worry about. But it beats the hell out of the alternative, doesn't it?

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