For our first article on female athletes ages 4-10, click here.
As boys and girls enter adolescence, a variety of changes occur with the onset of puberty. Puberty for girls can begin anywhere from ages 8-13; for boys, it usually starts somewhere between 9-15. The beginning of menstruation marks the beginning of puberty for females and it is during this time that increased estrogen leads to increased body fat, breast development, and widening of the hips. During this period of development, injuries to tendons and ligaments become more prevalent than the bone injuries more common in younger children.
Increased Injury Risks These ages are a crucial time for female athletes because they are at an increased risk for injuries, especially during their largest growth spurts. Injuries can occur due to changes in their body’s center of mass, with muscles and tendons lengthening over rapidly growing bones, also making growth plates vulnerable. Injury may also be due to muscle imbalances that occur through these changes, since peak strength gains don’t occur until after the peak growth spurt. As they grow females tend to have greater difficulty controlling their increased height than their male counterparts due to the effects of hormones. Many key strength deficits can be seen in the body mechanics of female athletes. One of the most common signs is what we call knee valgus, or the knees caving inward with activities such as squatting, lunges, stepping down stairs, and jump landings (see Fig. 1). These same mechanics and developmental differences are one of the reasons females are six times more likely to sustain an ACL injury compared to males. In addition, overuse injuries are common, such as patellofemoral pain (pain in the front of the knee), stress fractures, and tendonopathies (injury to the muscle tendons often from repetitive stress).
Look out for these Signs As girls go through puberty, we need to be aware of more than just musculoskeletal injury risks. Some athletes may be participating in sports and related activities for extended periods of time. While single sport specialization is discouraged until later in development, many still do specialize. In addition to increased injury risk, this may lead to “overtraining” and burnout. Common signs to watch for: lingering muscle soreness for several days, decreased performance, and lack of desire to train. Another important topic to be aware of is the female triad: disordered eating, menstrual dysfunction, and loss of bone mineral density. Athletes and active girls need to be sure they eat enough calories to sustain the amount of activity in which they are involved. Many times the pressure to perform or to be a certain body size can play a role.
Prevention and PT While injuries are bound to happen in sports, many issues and injuries discussed above can potentially be prevented by continuing to change the culture of female sports. While teams of adolescent girls often don’t participate in strength training in conjunction with their sport–they should be! And much of this strengthening should be focused on hip, core, scapular strength, body mechanics, proprioceptive and agility training. These athletes should also be getting adequate rest and a proper warm-up prior to sport or strengthening activities.
If you, your child, or someone else you know has pain with activity; or if you just notice the poor body mechanics (such as knee valgus mentioned above), physical therapy can help! You don’t have to be in pain to receive physical therapy. PT can help teach proper mechanics and appropriately strengthen based on abilities; can educate the patient to ensure success after therapy, improve muscle imbalances, and, of course, treat any pain or overuse injuries the patient may experience. Think you or your child may benefit from PT? Call our office at (815) 758-5508 to schedule a free consult to talk with one of our physical therapists.