Girls and athletic injuries

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Last Sunday's NYT has a depressing article about the sports injury rate in high school and college girls/women. Most of the article is stories about injured athletes. It's a familiar story for anyone with experience with elite athletes. There's an initial injury, followed by an incomplete recovery, followed by successive injuries, followed by even less complete recovery, etc. This is a common pattern for elite athletes, who tend to be highly motivated to train and compete (this is how you get good) and therefore bad at the kind of laying off you need to recover from injuries.
Amy said that she had "a lot of complications" with the first one. But what she described in her understated way sounded more like a nightmare than complications. She briefly became addicted to her pain pills. She lost weight and became so dehydrated she had to be hospitalized and hooked up to an IV. She received a "huge lecture" from the nurses on how to take better care of herself.

But she achieved her goal and made the under-19 team, the highlight of her too-brief career. As Amy walked toward me the first time we met, her right leg was stiff and her whole gait crooked. She moved like a much older woman. If I hadn't known her history, I would never have believed she had been an athlete, let alone an elite one. She had undergone, by her count, five operations on her right knee. Her mother counted eight, and believed that Amy did not put certain minor cuttings in the category of actual operations. She was done playing. She had been told she would need a knee replacement, maybe by the time she turned 30.

Amy told me about her final operation, recalling that when she came out of anesthesia, the surgeon seemed as if he was going to cry. He looked at her in silence for what seemed like a long time, trying to compose himself. Finally, he told her, "Amy, there was nothing in there left to fix."

The implied message of the article is that female injury rates are a lot worse than that of males, but it only cites a small number of statistics and it's clear the data is a bit fuzzy. The article focuses on ACL injuries, which are truly awful but I'm not sure they're representative. For instance, this study suggests that the overall injury rate is comparable for males and females, but that women's knee injury rates are much higher:

The boys' and girls' data were compared and statistically analyzed. The rate of injury was 0.56 among the boys and 0.49 among the girls. The risk of injury per hour of exposure was not significantly different between the two groups. In both groups, the most common injuries were sprains, and the most commonly injured area was the ankle, followed by the knee. Female athletes had a significantly higher rate of knee injuries including a 3.79 times greater risk of anterior cruciate ligament injuries. For both sexes, the risk of injury during a game was significantly higher than during practice.

See also here which describes a similar pattern, as does this. (Caution, I'm working only on the abstracts here, since the actual articles are behind pay walls.) Bottom line: I'm not sure what to make of this. I haven't done a thorough literature review, but it's not clear to me that in general—as opposed to in the specific case of ACL and perhaps concussion—females are at a significantly higher rate for sports injuries than males.

One thing I was sort of surprised not to see was any discussion of the female athlete's triad: (anorexia, amenorrhea, and osteporosis). I'd be interested to know to what extent eating disorders result in increased risk of ACL-type injuries (this isn't a topic I know a lot about).

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