Social, not just biological factors, key in increased knee injuries among girls and women
Current approaches to a common and debilitating knee injury that occurs more frequently for women than men have focused for too long on biology at the expense of understanding social factors, say the authors of a new paper in the British Journal of Sports Medicine (BJSM).
Girls and women are said to be between three to six times more likely to suffer an anterior cruciate ligament (ACL) injury, where one of the key ligaments that helps to stabilize the knee joint is damaged. The devastating injury, which in extreme cases can be career ending for professional sportspeople, commonly occurs during sports that involve sudden changes in direction (e.g. basketball, football / soccer, tennis).
The difference in injury rates for men and women has not changed for two decades, but, say the authors, this might be partly due to how injury prevention and management has been approached to date. Writing in the BJSM they argue that much of the focus still centers on biological and hormonal factors, with little attention paid to how sex-based factors are affected by gender and might influence each other.
They suggest that gendered experiences matter in shaping girls' and women's participation in sport as well as disparities in injury outcomes. They demonstrate how this could play out across the lifecourse with gendered expectations of physical abilities (e.g. 'throw like a girl'), to inequitable access to funding, training, and facilities for women's sport (e.g. disparities in access to weight training).
Finally, they suggest there may be a difference between post-injury rehabilitation for men and women recovering from an ACL injury. They say that these social and environmental factors play a much bigger role in how sports injuries occur than once thought, and urge that much more attention be given to these topics.
Dr. Sheree Bekker from the Department for Health at the University of Bath (UK) explains: "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) adds: "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."
The NCAA represents the National Collegiate Athletic Association—a non-profit that regulates student athletes from over 1,000 North American institutions whilst also organizing athletic programs reaching nearly 500,000 college student-athletes.
Co-author on the paper 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."
More 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