Social Plus Biological Factors Increase Knee Injuries Among Female Athletes

Writing in the British Medical Journal, scientists have argued that the study of knee injuries in female athletes is too focused on biological factors and not enough on social factors.

It is said that female athletes experience anterior cruciate ligament (ACL) injury, at a rate three to six times higher than their male counterparts.The ACL is one of the key ligaments that helps to stabilise the knee joint. This can be a career-ending injury, and occurs most often in sports involving sudden changes of direction such as basketball.

The authors of the paper argued that much of the focus still falls on biological and hormonal factors, with little attention paid to how sex-based factors are affected by the social concept of gender and how they could influence each other.

They suggested that gendered experiences are relevant in shaping female sport participation as well as disparities in injury outcomes. They demonstrated that, over a lifetime, gendered expectations of physical abilities (eg ‘throw like a girl’), to inequitable access to funding, training, and facilities for women’s sport (eg disparities in access to weight training).

Lastly, the authors suggested there may also be differences between post-injury rehabilitation for men and women recovering from an ACL injury. These social and environmental factors play a much bigger role in how sports injuries occur than once thought, they said, urging that there should be much more weight given to these issues.

Dr Sheree Bekker from the Department for Health at the University of Bath (UK) explained: “We wanted to unpack the biases and assumptions that we were seeing in research into and practice around sports injuries in girls and women. Specifically, we wanted to challenge the increasingly pervasive idea that this is simply a problem for girls/women because they are inherently prone to injury just because of their female biology. Approaching ACL injury prevention and management from a strictly biological view can propagate sexism in sport with detrimental consequences for girls and women.”

Dr Joanne Parsons from the University of Manitoba (Canada) added: “Over 20 years of research focussed on biological traits has failed to decrease the ACL injury rate in girls and women. To make a difference, we need to approach the problem in a different way. The recent challenges that the NCAA women’s teams faced with access to adequate training equipment is a perfect example of why we have to include society’s influence when talking about injury risk for girls/women.”

Paper co-author Dr Stephanie Coen of the University of Nottingham said: “By extending the focus from individual bodies and biology to the gendered environments contextualizing ACL injury, our approach identifies new opportunities to intervene and achieve better outcomes for girls and women, with implications beyond athletes. As childhood and youth physical activity levels influence those in adulthood, the sequelae of ACL injury can be lifelong and particularly concerning for girls and women who already participate in physical activity at lower rates than boys and men. There is a wider health equity issue at stake.”

Source: Medical Xpress

Journal information: Joanne L Parsons et al, Anterior cruciate ligament injury: towards a gendered environmental approach, British Journal of Sports Medicine (2021). DOI: 10.1136/bjsports-2020-103173