What women need to know about sports injuries

Anatomy, nutrition and other factors can make female athletes — and all active women — more prone to injury and orthopaedic aches and pains.

Whether you are a triathlete or just trying to get fit, minimize your risk for injury with these tips from Farah Hussain, MD, and Caroline Vonck, MD, sports medicine specialists at the University of Chicago Medicine.

Why women are at risk

Anatomy: Women have greater flexibility than men, thanks to looser ligaments. The downside of greater flexibility is less stable joints, which can lead to injury. Women also have wider pelvises, which alters the alignment of the knee and ankle and puts more pressure on surrounding joints. Similarly, women have narrower shoulders, which can result in less upper body strength.

Nutrition: Many women, including athletes, don’t get enough calcium and vitamin D. Because of menstruation and difficulty absorbing iron, women face a higher risk of iron-deficiency anemia.

Hormones: Higher estrogen and lower testosterone levels in women are associated with less muscle mass, weaker ligaments and more body fat. Estrogen also helps maintain joint health; therefore, postmenopausal women are at increased risk for joint pain and cartilage loss due to decreased estrogen.

Biomechanics: When jumping, women tend to land more upright with their knees closer together. Also, in sports such as soccer, women often cut from side to side on one foot, creating torque — and additional strain and pressure — on the knee and ankle.

Muscle imbalance: Women are more likely to have stronger quads relative to core, hamstring and hip muscles, predisposing to injury.

Relative energy deficiency in sport (RED-S): Highly athletic women may be susceptible to RED-S, or the “female athlete triad”— a combination of inadequate calorie and nutrient intake, irregular menstrual periods and low bone density. Inadequate calorie consumption can lead to overuse injuries, including sprains, strains, tendonitis and stress fractures. Eating disorders, including anorexia nervosa, can contribute to this triad.

Sports injuries common in women

Ankle sprains: Looser ligaments mean weaker ankles and instability when pivoting in sports like basketball and soccer.

Rotator cuff tendonitis: This results from looser shoulder joints, weaker muscles and improper form with overhead movements in sports such as tennis and volleyball.

Knee injuries: Weak hip and knee muscles can put too much pressure on the kneecap and cause chronic pain and inflammation around the knee joint (patellofemoral pain), because the kneecap is not properly aligned and tracking with movement. Women are also at an increased risk for ACL tears when pivoting in sports like basketball and soccer, because of their different anatomy and biomechanics.

What women can do to prevent sports injuries

Conditioning: Identify weaker muscles or areas that need more flexibility, and target those in your training. Weightlifting can be very beneficial for women who want to prevent overtraining injuries. Women should also make core strengthening a priority. Lastly, proper warm ups and cross-training are important.

Neuromuscular training: Sport-specific training is important to learn proper jumping, landing, cutting and pivoting techniques. Focusing on strength, muscular control and agility can reduce injuries.

Nutrition: Women need to eat enough calories to fuel their activity levels. Know your risk factors for nutritional deficits and have your iron, calcium, vitamin D and bone density checked for a baseline measurement and then as often as recommended by your healthcare provider. In addition to the short-term risk for injury, chronic calcium and vitamin D deficiency can lead to low bone density and a much higher risk of osteoporosis later in life.

Recovery: Rest and recovery days are an important part of training. If you are injured, be sure you recover completely to avoid further damage and the long-term risks of inadequate rehabilitation.

Consult your care team: Counseling from nutritionists, primary care physicians, coaches and psychologists can help address RED-S (female athlete triad) injuries and other challenges facing female athletes.