The Female Athlete

Orthopaedic Guild Williamsburg, VA • October 1, 2011 The Female Athlete Mary Lloyd Ireland, M.D. University of Kentucky Dept. of Orthopaedic Surgery & Sports Medicine The Female Athlete: Main Menu The Olympics Musculoskeletal Conditions The 1970s The Female Athlete Triad NCAA Psychology Professional Sports Conclusions Docs in the Olympics Women in Sport: Past, Present, Future The Past: COMPETITION FOR WOMEN Ancient Egypt and Sparta before 1500 B.C. Sports in gymnastics calisthenics, swimming and competitive games Belief: Participation in sport enhances reproductive capabilities Golden Age of Greece • 776 BC - Women were banned from competing or observing any Olympic events. They were punished by being thrown off a cliff. • 392 BC -The first female Olympic Champion was Kyniska, the daughter of the King of Sparta. She owned the horse that won the four horse chariot race. Modern Olympic Competition Baron Pierre de Coubertin • Called the Olympics an exaltation of male sport • Excluded women from the modern Olympics because: • Not athletes • Bodies controlled by nerves and muscles • Risk children left motherless USA Summer Olympic Participation 1896 – 2008 (1896: 12 Males, 0 Females) 1896 1900 1904 1908 1912 1916 1920 1924 1928 1932 1936 1940 1944 1948 1952 12 59 565 119 174 331 362 251 374 324 301 280 Males 0 6 5 0 0 16 33 39 41 51 40 45 Females 1956 1960 1964 1968 1972 1976 1980 1984 1988 1992 1996 2000 2000 2004 2008 Males 283 257 282 292 338 297 311 389 387 400 387 338 338 280 310 Females 49 51 80 96 90 128 155 196 221 218 280 266 266 257 286 USA Winter Olympic Participation 1924 – 2006 (1924: 22 Males, 2 Females) 1896 1900 1904 1908 1912 1916 1920 1924 1928 1932 1936 1940 1944 1948 1952 22 25 93 59 38 91 63 Males 2 3 13 17 7 13 12 Females 1956 1960 1964 1968 1972 1976 1980 1984 1988 1992 1994 1994 1998 2002 2006 Males 65 66 85 92 91 84 90 85 117 119 101 101 114 121 122 Females 11 18 20 22 27 31 31 31 51 62 55 55 82 90 89 Olympians Who Came Back... Condition Athlete Sport to Overcome Wilma Rudolf Track Polio Amy VanDyken Swimming Asthma Anna Curat Track Burns 60% • 1948:of Wilmabody Rudolph dominates the games. miscarriage Modern Olympic Games • 1984: Los Angeles, California - Women’s marathon and 3000m added. Marathon won by Joan Benoit, USA. Mary Lou Retton won the gold in gymnstics and the hearts of a nation. Gabriele Andersen-Scheiss 1984 Women’s Marathon Swiss participant Last portion of race – Heat Stroke Electrolyte imbalance Appeared near death Finished the race Sprinter Gwen Torrence Holly McPeak Beach Volleyball Player Gail Devers - Track Longer Nails!? Jackie Joyner-Kersee Modern Olympic Games • 1896: First modern Olympic game in Athens, Greece. The only woman participant spent 3 weeks training secretly and “unofficially” ran in the 40km race from Marathon to Athens. • 1900: Summer games in Paris. Women compete in golf and lawn tennis. Margaret Abbott becomes the first U.S. female gold medalist in golf. Babe Didriksen 1932 Olympian Los Angeles • “Don’t call me Mildred” • American or Olympic records held in five different track & field events. • Golf champion – 80 tournaments Quotes about Babe Didriksen • “Babe breaks records easier than dishes.” • Anything she doesn’t play? “Yeah, dolls.” • “The best way to the athletics is to like them. Athletics are all I care for. I sleep them, talk them, and try to do my very best to do them as they should be done.” –Babe Didriksen Extreme pressure placed on athletes by themselves and coaches Do we push our teenage athletes too hard? Florence Griffith-Joyner 1959-1998 Died of “heart seizure” on an airplane Seoul, Korea: Olympic champion World record holder, 100 and 200 m. Competed prior to when anabolic steroid testing was mandatory. Women Use Ergogenic Aids: Chinese Track & Swimming, Female Athletes Found Guilty in early 1990s Oksana Baiul Modern Olympic Games • 1998: Nagano, Japan • Women’s ice hockey and snow boarding added • USA hockey teams: females won the gold, males were eliminated and trashed their rooms • Aggressiveness of sport differences Early 1970s 1972 Title IX Gender Equity in Sports 1973 Roe vs. Wade Women’s Right to Abortion 1973 King vs. Riggs Woman Wins in Tennis 1974 Little League Girls Can Play Little League Baseball Little League Girls banned from competition. Why? • More injuries • Weaker bones • Slower reflexes • Slower running • Less muscle mass • Risk of injury to ovaries Landmark Case August, 1972 Little League, Inc. lost suit to ban young girls from participation in baseball The Present: High School Nat. Fed. Of State H.S. Associations, 2008-2009 Top Five Sports M:W Males’ Top 5 Females’ Top 5 Football 1,112,303 Track & Field 457,732 Track & Field 558,007 Basketball 444,809 Basketball 545,145 Volleyball 404,243 Baseball 473,184 Softball 368,921 Soccer 383,824 Soccer 344,534 Spirit Squads 117,793 Title IX Federally-Funded Schools Do Not Discriminate on the Basis of Gender in the Provision of Any Educational Activity Including Athletics Female Athlete Milestones • 1972: Title IX . of the 1972 Education Amendments Act. Requires high schools and colleges that receive federal funds not to discriminate on the basis of gender in the provision of any educational activity, including athletics. Title IX • Requires proportional opportunities by numbers of athletes, not numbers of teams (If a school has an enrollment of 60% women and 40% men, the athletic percentage should be the same). • Scholarship dollars must be provided to male and female athletes proportional to the numbers of athletes participating (If the participation is 50/50, the scholarship dollars must be split 50/50) The Present: Collegiate Scorecard NCAA Participants, 2007-2008 Overall Numbers and Gender Ratios M:W Ratio: Ratio: MALES MALES M/W FEMALES M/W w/o Football Division I 90,304 1.2 74,052 0.9 64,646 Division II 54,027 1.5 36,751 1.0 38,263 Division III 95,930 1.4 67,281 1.1 73,117 TOTAL 240,261 1.3 178,084 1.0 176,026 Are there gender differences? • Yes • Triad • Musculoskeletal Injuries • ACL Tears • Patellofemoral disorders • Stress Fractures • Professional opportunities • Aggressiveness and contact nature of sport Are Female Athletes Different? No. • Desire to Compete and Win • Treatment by Health Care Professionals NCAA Injury Rate by Body Part, 1999-2000 NCAA Injury Surveillance System (ISS) • Data are shown as rate/1000 athletic exposures • Tables comparing men and women, practice and games • Soccer • Basketball http://www.nata.org/jat/readers/archives/42.2/i1062-6050-42-2-toc.pdf NCAA Concussion Rates for Basketball and Soccer: 2002-2003 NCAA Injury Surveillance System Games Women Ratio W:M Men Practice Game Ratio G:P Practice Game Ratio G:P Soccer 0.19 1.57 8.3 1.64 0.17 0.96 5.6 Basketball 0.16 0.83 5.2 1.54 0.23 0.54 2.3 Rates expressed are per 1000 athlete-exposures 1. For both sports and both genders, Games resulted in much higher concussion rates than Practices 2. For Games in both sports, Women had concussions at a rate over 1½ times greater than Men. Basketball ACL Injury Rates NCAA 1989-2004 BASKETBALL ACL Injury Rates – NCAA 1989-2004* 0.4 0.37 0.35 0.35 Avg. 0.33 For Women 0.3 0.3 0.29 0.27 0.27 0.25 0.25 0.25 0.24 0.24 0.24 Ratio of 0.2 0.22 Average Rates 0.2 Women: Men 0.19 3.38 0.13 0.12 0.12 0.1 0.1 0.1 0.1 0.1 0.07 0.08 0.09 0.05 Avg. 0.07 0.07 0.07 0.06 For 0.05 0.03 Men 0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 AVG. *Rates Given are per 1000 Athlete-Exposures. Data from NCAA Injury Surveillance System, 1989-1990 season through 2004-2005 season. Soccer ACL Injury Rates NCAA 1989-2004 SOCCER ACL Injury Rates – NCAA 1989-2004* 0.4 0.38 0.36 0.36 0.36 0.35 0.33 0.33 0.33 0.35 0.34 0.32 0.3 Avg. 0.30 For 0.29 0.29 0.28 Women 0.26 Ratio of 0.2 Average Rates Women: Men 0.16 0.14 2.75 0.13 0.13 0.13 0.12 0.12 0.12 0.12 0.11 0.12 0.1 0.11 Avg. 0.11 0.10 For 0.08 Men 0.07 DATA NOT AVAILABLE 0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Avg. *Rates Given are per 1000 Athlete-Exposures. Data from NCAA Injury Surveillance System, 1989-1990 season through 2004-2005 season. U.S. Naval Academy • Relative Injury Risk, women compared to men • Intercollegiate 3.96 (Soccer, Basketball, Rugby) • Intramural 1.40 (Soccer, Basketball, Softball, Volleyball) • Military Training 9.74 Gwinn DE, Wilckens JH, McDevitt ER, Ross G, Kao TC, “The relative incidence of anterior cruciate ligament injury in men and women at the United States Naval Academy.” Am J Sports Med 2000. Jan.-Feb.; 28(1):98--102. ACL Injuries • Females are younger than males by 5 years — Ott SO, Ireland ML, et. al.: Comparison of outcomes between males and females after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 11:75-80, 2003. • Soccer athletes <16 who move up are more likely to be injured than seniors — Soderman K, et.

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