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An athlete’s sex matters in sports-related injuries and treatment outcomes

The U.S. Centers for Disease Control (CDC) estimates an annual average occurrence of 8.6 million sports- and recreation-related injury episodes. Understanding how to avoid these injuries and how best to treat them is critical for optimizing safer sports participation.

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A new review article published in the July issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) examines the role that sex plays in common sports-related injuries (SRIs) and a patient’s treatment outcome.

The U.S. Centers for Disease Control (CDC) estimates an annual average occurrence of 8.6 million sports- and recreation-related injury episodes. Understanding how to avoid these injuries and how best to treat them is critical for optimizing safer sports participation.

Study authors looked at five common sports-related injuries: stress fracture; anterior cruciate ligament (ACL) tear; shoulder instability; concussion; and femoroacetabular impingement, a condition in which extra bone grows along one or both bones that form the hip joint.

“Males and females have different risk factors for experiencing SRIs,” said lead study author and orthopaedic surgeon Cordelia Carter, MD. “Anatomic and physiologic characteristics such as skeletal structure, muscle mass, ligament laxity, and hormone levels differ between the sexes and may contribute to disparate injury risk. The best ways to avoid or treat a sports-related injury in a male may be different for a female. Understanding the sex-based differences can help orthopaedic surgeons be better equipped to care for patients with these injuries and improve their treatment outcomes.”

According to one study referenced in the review article that looked at SRIs in Canadian children and adolescents, males are more frequently injured during sports participation than females. Males also comprised 71 percent of SRIs in 11 of the 13 sports investigated.

Another study of children aged 5 to 17 years in the United States described the type and the frequency of SRIs to be a function of sex and highlighted the following findings:

  • Females are more likely than males to sustain overuse injuries such as anterior knee pain, while males are at an increased risk of sustaining acute traumatic injuries such as fractures.
  • While some risk factors are a part of one’s nature, others can be modified.  For example, females demonstrate patterns of landing after a jump that are different from male landing patterns and are associated with ACL tears.
  • For both sexes, training programs can be used to teach at-risk athletes to modify landing patterns to help prevent ACL injury.

Other reviewed literature highlighted in the article reported that females have a higher incidence of concussion, most commonly in sports such as soccer, basketball, volleyball, and lacrosse.  Some studies have linked this to females having more slender necks and smaller heads compared with those of males, which can render females more vulnerable to concussion when head trauma is sustained.  Others have suggested this higher rate can be linked to females’ being more likely to communicate symptoms after an injury than males, which could lead to higher reported rates and severity of such injuries as concussions.

The review article authors also noted that while the relative risk of getting an ACL tear is higher in females by a rate of two to one, the number of injuries is higher in males due to greater exposure to high-risk activities.

Study authors concluded that there is a continued need for focused efforts at studying the role of sex in SRIs.

“We are still learning about how sex plays a role in an athlete’s experience of sports injury,” explained Dr. Carter. “This paper paves the way for future researchers to begin to investigate how we can improve medical care for all athletes by recognizing that male and female athletes with the same injury may have better outcomes if their treatments are not the same but rather are sex-specific.”

The full study is available HERE.

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Fitness

Study finds moderate-vigorous physical activity is the most efficient at improving fitness

Dedicated exercise (moderate-vigorous physical activity) was the most efficient at improving fitness. Specifically, exercise was three times more efficient than walking alone and more than 14 times more efficient than reducing the time spent sedentary. Additionally, they found that the greater time spent exercising and higher steps/day could partially offset the negative effects of being sedentary in terms of physical fitness.

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In the largest study performed to date to understand the relationship between habitual physical activity and physical fitness, researchers from Boston University School of Medicine (BUSM) have found that higher amount of time spent performing exercise (moderate-vigorous physical activity) and low-moderate level activity (steps) and less time spent sedentary, translated to greater physical fitness.

“By establishing the relationship between different forms of habitual physical activity and detailed fitness measures, we hope that our study will provide important information that can ultimately be used to improve physical fitness and overall health across the life course,” explained corresponding author Matthew Nayor, MD, MPH, assistant professor of medicine at BUSM.

He and his team studied approximately 2,000 participants from the community-based Framingham Heart Study who underwent comprehensive cardiopulmonary exercise tests (CPET) for the “gold standard” measurement of physical fitness. Physical fitness measurements were associated with physical activity data obtained through accelerometers (device that measures frequency and intensity of human movement) that were worn for one week around the time of CPET and approximately eight years earlier.

They found dedicated exercise (moderate-vigorous physical activity) was the most efficient at improving fitness. Specifically, exercise was three times more efficient than walking alone and more than 14 times more efficient than reducing the time spent sedentary. Additionally, they found that the greater time spent exercising and higher steps/day could partially offset the negative effects of being sedentary in terms of physical fitness.

According to the researchers, while the study was focused on the relationship of physical activity and fitness specifically (rather than any health-related outcomes), fitness has a powerful influence on health and is associated with lower risk of cardiovascular disease, diabetes, cancer and premature death. “Therefore, improved understanding of methods to improve fitness would be expected to have broad implications for improved health,” said Nayor, a cardiologist at Boston Medical Center.

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Fitness

Tips to avoid common running injuries

Injuries are very common among runners. Recent research estimates that 82% of runners will become injured during their running career and up to 90% will experience injury while training for a marathon. Some of the most common include a stress fracture, plantar fasciitis, hamstring tendinitis, ankle sprain, runners’ knee, and Achilles’ tendonitis.

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Whether training for a marathon or preparing for your first community race, being knocked off course with pain can be hard to handle mentally and physically.

Injuries are very common among runners. Recent research estimates that 82% of runners will become injured during their running career and up to 90% will experience injury while training for a marathon. Some of the most common include a stress fracture, plantar fasciitis, hamstring tendinitis, ankle sprain, runners’ knee, and Achilles’ tendonitis.

Injury prevention is critical. Here are some safety tips from Dr. Joshua Blomgren, a 15-time Chicago Marathon team physician and sports medicine physician, Midwest Orthopaedics at Rush:

Don’t over-train

Don’t increase weekly mileage or intensity by more than 10 percent each week. Build up slowly and let a good training schedule determine how much you run.

Invest in good shoes

Go to a specialty running shop to be properly fitted for running shoes and/or orthotics. Replace them every 350-500 miles. Incorrect shoes can affect your gait, leading to injuries in your feet, legs, knees, or hips.

Choose the best running surface

Look for running surfaces that absorb shock. Opt for asphalt over concrete. Find grass or dirt trails, especially for higher mileage. Avoid uneven surfaces and seek paths with slow curves.

Stretch!

Training causes tight muscles, leading to strain and changes in your gait. Commit to a stretching program. Just 5 -10 minutes after each workout can make a big difference.

Strengthen muscles

Runners have tight hip flexors because their quads are overtrained. Strengthen your hamstrings and glutes to reduce chance of injury and abductors, adductors, and core to create stability.

Watch out for heel striking

Heel striking occurs when your feet land in front of you and your heel hits the ground first. This is common among new runners but can lead to injuries such as shin splints, stress fractures, and joint pain. Land mid-sole with your foot directly underneath your body.

Prioritize posture

Good form means staying upright and keeping your shoulders back and relaxed. Work core exercises into your training and do posture checks every so often. Hold your head right above your shoulders and hips.

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Fitness

Postmenopausal women can dance their way to better health

After menopause, women are more likely to experience weight gain, overall/central body adiposity increases, and metabolic disturbances, such as increases in triglycerides and bad cholesterol. Together, these changes ultimately increase cardiovascular risk. Around this same time, women often are less physically active, which translates into reductions in lean mass and an increased risk of falls and fractures.

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Women often struggle with managing their weight and other health risk factors, such as high cholesterol, once they transition through menopause. A new study suggests that dancing may effectively lower cholesterol levels, improve fitness and body composition and in the process, improve self-esteem. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

After menopause, women are more likely to experience weight gain, overall/central body adiposity increases, and metabolic disturbances, such as increases in triglycerides and bad cholesterol. Together, these changes ultimately increase cardiovascular risk. Around this same time, women often are less physically active, which translates into reductions in lean mass and an increased risk of falls and fractures. As a result of all these changes, postmenopausal women often suffer from decreased self-image and self-esteem, which are directly related to overall mental health.

Physical activity has been shown to minimize some of the many health problems associated with menopause. The effect of dancing, specifically, has already been investigated with regard to how it improves body composition and functional fitness. Few studies, however, have investigated the effects of dance on body image, self-esteem, and physical fitness together in postmenopausal women.

This new study was designed to analyze the effects of dance practice on body composition, metabolic profile, functional fitness, and self-image/self-esteem in postmenopausal women. Although the sample size was small, the study suggested some credible benefits of a three-times-weekly dance regimen in improving not only the lipid profile and functional fitness of postmenopausal women but also self-image and self-esteem.

Dance therapy is seen as an attractive option because it is a pleasant activity with low associated costs and low risk of injury for its practitioners. Additional confirmed benefits of regular dancing include improvement in balance, postural control, gait, strength, and overall physical performance. All of these benefits may contribute to a woman’s ability to maintain an independent, high-quality lifestyle throughout her lifespan.

Study results are published in the article “Dance practice modifies functional fitness, lipid profile, and self-image in postmenopausal women.”

“This study highlights the feasibility of a simple intervention, such as a dance class three times weekly, for improving not only fitness and metabolic profile but also self-image and self-esteem in postmenopausal women. In addition to these benefits, women also probably enjoyed a sense of camaraderie from the shared experience of learning something new,” says Dr. Stephanie Faubion, NAMS medical director.

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