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. al.: Anterior cruciate ligament injuries in young females playing soccer at senior levels. Scan J Med Sci Sports 12(2):68-68, 2002. Hormonal Changes During the Menstrual Cycle
52 48 LH Progesterone Estradiol 44 nmol/L pmol/L 40 63 917 36 57 826 32 Progesterone 50 734 Estradiol LH & FSH 28 44 642 IU/L 24 38 550 20 32 458 16 25 367 12 FSH 19 275 8 12 183 4 6 91 0 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 Day of Cycle Body Locations and Level of Concern
CRITICAL (at risk, may require surgical intervention) • Anterior tibial cortex • Medial malleolus • Navicular • Proximal 5th MT diaphysis (Jones Fracture)
High Risk Tensile Side Low Risk Compression Side 18 YO Freshman Div. I basketball athlete
• C/O mid-foot pain, L > R • Started when she was running, playing in shoes mandated by her school • History of “normal” periods
Eating Disorders: The Female Triad
Osteoporosis
Amenorrhea
Disordered Eating Eating Disorders: The Female Triad
Three related factors Prevalence Disordered eating 15-62% Amenorrhea 3.4-66% Osteoporosis Unknown
High recurrence rate in anorexia, 30% relapse - 10-18% mortality rate Most likely you have seen a female athlete with this triad.
Short Preview of the New Video: “Eating Disorders: More Common Than You Think”
DVD or VHS Available
Sponsored by the James E. Ireland Foundation Supported by the Women’s Sports Foundation
Body image is important to all ages
Thin is still in
Young females are doing anabolic steroids to look “cut” Did you know that Marilyn Monroe was. . .
5’4”, 140 lbs. and ...... that she pumped iron! Joan Ryan, Little Girls in Pretty Boxes Warner Books (New York), © 1995 A WOMAN IS OFTEN MEASURED ...... by the things she cannot control. She is measured by the way her body curves or doesn’t curve. By where she is flat or straight or round. She is measured by 36-24-36 and inches and ages and numbers, by all the outside things that don’t ever add up to who she is on the inside. And so if a woman is to be measured, let her be measured by the things she can control. By who she is and who she is trying to become. Because as every woman knows, measurements are only statistics and STATISTICS LIE.
― Nike: “Helping Athletes with Eating Disorders” 1992 US Olympic Gymnastics Team eating hamburgers at the White House Injury Patterns
• Cheerleading Injuries • Who gets hurt? • How? • How bad? • No NCAA tracking of injuries in cheerleading • Studies on cheerleading injuries are needed Cheerleading Fatalities and Catastrophic Injuries
• At high school level: • Incidence is 18/39 (46%) • At college level: • Incidence is 16/21 (76%)
– from Cantu RC, Mueller FO, “Fatalities and catastrophic injuries in high school and college sports, 1982-1997,” in The Physician and Sportsmedicine 1999;27(8): 35-48. Fatalities and Catastrophic Injuries
Direct Fatalities & Catastrophic Injuries Indirect Fatalities
HIGH SCHOOL HIGH SCHOOL Cheerleading 18 Basketball 8 Gymnastics 9 Swimming 5 Track 3 Track 4 Swimming 2 Cheerleading 3 Basketball 2 Soccer 1 Softball 2 Cross country 1 Field Hockey 2 Volleyball 1 Volleyball 1 TOTAL 39 TOTAL 23 Women’s Professional Leagues BASKETBALL • The American Basketball League (ABL) 1996-1999 • Women’s National Basketball League (WNBA) 1997-Present • 16 teams
•SOCCERWomen’s United Soccer Association (WUSA) 2001-2003 • Women’s Professional Soccer League 2009 – Present • 8 teams
Billie Jean King and Mary Lloyd Ireland at first WUSA Game
4/15/2001 “Ever since that day when I was eleven years old and I wasn’t allowed in the (tennis team) photo because I wasn’t wearing a tennis skirt, I knew I wanted to change the sport.”
-- Billie Jean King, quoted in Marshall and Sue Burchard, Sports Hero: Billie Jean King Women’s Professional Leagues GOLF • Womens’ Top-Level Tours • LPGA (Ladies Professional Golf Assn., United States) • LPGA of Japan Tour • Ladies European Tour • LPGA of Korea Tour (South Korea)
TENNIS
• Numerous Levels
Women’s Professional Leagues FOOTBALL • Womens’ Professional Football League (WPFL) • Began in 1999 with two Teams (Lake Michigan Minx, Minnesota Vixens) • Now 15 Teams Ireland ML & Nattiv A, eds. The Female Athlete (W.B. Saunders, 2003) Available from Amazon.com
Psychology of Coaching
• Coaching • Manhood: “Be the Man” • Boys/men humiliation tactics by their coaches if performing poorly • Do not work on female athletes – Kathy DeBoer, “Optimizing performance in team sports for female athletes.” In Ireland & Nattiv, eds. The Female Athlete, 2002. • The female athlete is very competitive – must use methods to motivate and match world view Psychology of Coaching
• Sex differences in upbringing • Dolls vs. army • Work advancement • Men (win promotions) • Women (contribute communication) • Breaking the glass ceiling – Pat Heim, PhD, CEO of The Heim Group Win Contribute Promotion Communicate Rearing Children
Play Dolls Balls Sports Participation Win or Lose Grades Athletics Rewards Social Behavior Winning Feminine Masculine Acts Not Tomboy Not Janegirl There are only a few females ...... breaking the Glass Ceiling.
• Business • Wall Street • Executives • University-based / Academic chairs - Physician - Physical therapist - Athletic trainer • Others Pat Heim www.heimgroup.com
Give little girls dolls and balls if you want them to be competitive athletes. 9th grader has won small division cross-country state titles for the past 3 years.
The phrase “Be the Man” is commonly used during the action of a competition. Also included should be “Be the Woman.” “A man’s reach should exceed his grasp.”* — Robert Browning
* But also a woman’s. Encourage athletic participation regardless of gender . . .
. . . and reward them with your support.
Ireland, ML. “Problems facing the female athlete,” in: Pearl, AJ. The athletic female. 1993, 11-18.
“ ‘Catch a rising star . . . Catch it if you can.’ These lines from a children’s song should encourage limitless but achievable goals for youngsters. As a child I was encouraged to play as hard and run as fast as I could. If I beat the boys, that was okay.”
The End . . . Thank You!
The Female Athlete
Mary Lloyd Ireland, M.D. University of Kentucky Dept. of Orthopaedic Surgery & Sports Medicine
Orthopaedic Guild Williamsburg, VA• October 1, 2011