Is Sports Medicine Harming Womxn?
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Is Sports Medicine Harming Womxn?
Authored by Julie Markhus
For far too long, sports medicine has been dominated by research and practices designed with the male body in mind. Historically, the field has overlooked the unique physiological and anatomical needs of female athletes, leading to a significant gender bias that persists to this day. Despite the increasing participation of womxn in sports, the specific needs of female athletes remain inadequately addressed. This oversight not only hampers performance but also increases the risk of injury, highlighting the urgent need for a more inclusive approach to sports medicine that acknowledges and accommodates the differences between male and female athletes.
The Research Gap
The gender research gap in sports medicine is a significant issue, with the majority of studies being conducted on male bodies. As a result, much of the equipment, training programs, recovery protocols, and dietary plans are predominantly tailored for men.
“In sports science and medicine, as little as 8% of research is conducted exclusively on womxn” (Paul, 2022). This disparity means that best practices are often not optimized for womxn, leading to a greater risk of injury and less effective training outcomes.
Men and womxn have different physiological and anatomical characteristics, including variations in hormone levels, body composition, and muscle mass. These differences mean that womxn may respond differently to training and recovery. To truly optimize training for women, researchers must include female participants in their studies.
A significant part of the problem stems from funding disparities. Few areas highlight the gender pay gap as starkly as in sports, and this gap extends into research funding, further perpetuating the lack of focus on female-specific needs in sports science.
Hormones and Training
“Why are most fitness plans not designed for women?” Jane Druker. 2022 www.jennis.com
Oestrogen promotes muscle repair and growth, causing faster recovery during a womxn’s follicular phase. Oestrogen also has anti-inflammatory purposes, promoting recovery. When oestrogen levels are high, glucose transporters are up-regulated causing enhanced glucose intake to the muscle. This gives a sensation of more energy during your follicular phase. Experiments on rodents have found that oestrogen gave them a desire to move, this could indicate that women have more motivation to exercise during their follicular phase. (De Jonge et al. 2019)
Progesterone is associated with less sensitivity to insulin, muscle breakdown, and a feeling of less energy, typically during your luteal phase. You might feel like you have less energy and that your muscles take longer to recover between sessions. (De Jonge et al. 2019)
Higher progesterone levels during the luteal phase also cause more peaks and crashes in blood sugar levels, impacting mood and appetite. (De Jonge et al. 2019)
Since hormone levels can severely impact recovery and energy, several womxn have had success by tailoring their training to their menstrual cycle. A study conducted by Sung et al (2014), found that having eight strength-training sessions in the follicular phase and only two in the luteal phase showed a higher increase in muscle strength compared to training equally throughout the cycle.
How birth control can influence training
As hormonal birth control impacts a womxn’s hormones, this can also impact their training. This is highly individualized, depending on the womxn’s baseline hormone levels and which contraceptive she is using.
For example, oral contraceptives stabilize oestrogen and occasionally progesterone levels, causing fewer spikes and dips in their hormones. This might soften the downfall of less energy and sore muscle, but several womxn also lose the “high” of energy during ovulation.
Some birth control pills act as anti-androgens, thus lowering testosterone levels which can impair muscle growth and muscle recovery. (Sung et al. 2022)
Injury Risks and Gender-Specific Concerns
In sports medicine, the gender gap remains significant, particularly in injury susceptibility and prevention. Due to anatomical and physiological differences, womxn face a higher risk of certain injuries, yet current prevention and treatment protocols often overlook these factors, leading to increased vulnerability.
Joint injuries
Womxn are four to six times more likely to suffer ACL tears than men, largely due to anatomical differences like a wider pelvis and a greater Q-angle, which place more strain on the knees. Additionally, hormonal fluctuations, especially increased oestrogen, can affect ligament stability. Despite these differences, injury prevention and treatment protocols remain largely designed for male physiology, often leading to suboptimal outcomes for female athletes. (Herzberg et al. 2017)
Bone Fractures and Iron
Womxn are more prone to stress fractures due to lower bone density and hormonal influences. Oestrogen is key in maintaining bone health, and its fluctuations can increase fracture risk, particularly in high-impact sports. Additionally, active womxn are at a greater risk of iron deficiency, often due to foot-strike haemolysis during running, which can severely impact performance. (Petkus et al. 2017)
Concussions: A Gendered Disparity
Girls in school and team sports experience more frequent and severe concussions than boys. This may be due to differences in neck strength, head mass, and hormonal factors, yet concussion protocols rarely account for these gender-specific risks. (Prien et al. 2018)
Leveraging Strengths in Training
Despite these challenges, womxn have unique physiological strengths that can be leveraged in training. Womxn tend to gain strength through nervous-system adaptations rather than muscle mass increases and can sustain endurance activities significantly longer than men. Understanding these differences allows for more effective, gender-specific training programs that enhance performance and reduce injury risks. (Hicks et al. 2001)
The Pelvic Floor: An Overlooked Area
Many womxn are aware of the importance of pelvic floor exercises before and after childbirth, but did you know that weak pelvic floors are a significant issue for many athletes, regardless of whether they have given birth?
The pelvic floor is a frequently overlooked area in sports and training, not just for athletes but for all womxn. Approximately 25% of women experience pelvic floor disorders (Carls, 2007). If the pelvic floor muscles are not adequately trained and strengthened, it can lead to incontinence and difficulties in controlling the bladder and bowel. This is especially true in high-impact sports like running and jumping, where it is common for athletes to experience urinary leakage during training. A systematic review found that 36% of female athletes suffer from urinary incontinence while training, with this figure rising to 45.1% among elite female athletes (Teixeira et al., 2018; Rodriguez-Lopez, 2020).
For this reason, it is crucial that female athletes incorporate pelvic floor exercises into their strength training programs. A strong and balanced pelvic floor contributes significantly to core stability, helping to reduce the risk of lower back and extremity injuries (Nygaard and Shaw, 2016). While there is still a stigma surrounding pelvic floor issues, opening up the conversation could greatly improve the health and well-being of womxn.
Female Athletes and the Equipment Gap
In sports, the disparity in equipment design between male and female athletes, often referred to as the "equipment gap," remains a critical issue. Many sports equipment and protective gear designs are optimized for male athletes, leaving female athletes with ill-fitting gear that not only hampers performance but also increases the risk of injury. Here are some key examples highlighting the need for gender-specific design and development.
Ice Hockey Equipment:
A study by Wörner et al. 2024 revealed that ice hockey gear designed for men often fits poorly on female athletes. This mismatch in design can lead to increased injuries, as the equipment does not provide the necessary protection or mobility tailored to female anatomy. Poorly fitting gear can shift during play, exposing vulnerable areas and increasing the likelihood of impact injuries.
Footwear and Performance:
Shoes designed specifically for men can negatively affect the performance of female athletes. Luftglass et al. (2023) found that women using footwear designed for male feet experienced lower performance levels, as these shoes do not account for the generally narrower female foot shape. This can lead to discomfort, poor support, and an increased risk of foot and ankle injuries.
Combat Sports Protective Gear:
Female athletes in combat sports, such as martial arts and mixed martial arts (MMA), face higher rates of upper limb injuries due to ill-fitting protective gear. Disselhorst et al. (2013) highlighted that gloves and wrist guards designed for men often fail to provide adequate support for womxn, resulting in hand and wrist injuries. Similarly, Jansen et al. (2021) noted that headgear designed for men does not fit womxn properly, increasing the risk of concussions due to inadequate protection.
Conclusion
The persistent gender bias in sports medicine and equipment design has left female athletes at a disadvantage, increasing their risk of injury and compromising their performance. From ill-fitting gear to injury prevention protocols rooted in male physiology, the gaps are clear and pressing. However, by recognizing and addressing these disparities, the field can evolve to better support female athletes, enhancing their safety, performance, and overall experience in sports. It’s time for sports medicine to catch up with the realities of today’s diverse athletic landscape, ensuring that every athlete, regardless of gender, has the tools and support needed to excel.
References
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Herzberg, S.D., Motu’apuaka, M.L., Lambert, W., Fu, R., Brady, J. and Guise, J.-M. (2017). The Effect of Menstrual Cycle and Contraceptives on ACL Injuries and Laxity: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine, [online] 5(7), p.232596711771878. doi:https://doi.org/10.1177/2325967117718781.
Hicks, A.L., Kent-Braun, J. and Ditor, D.S. (2001). Sex Differences in Human Skeletal Muscle Fatigue. Exercise and Sport Sciences Reviews, 29(3), pp.109–112. doi:https://doi.org/10.1097/00003677-200107000-00004.
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Jansen, A.E., McGrath, M., Samorezov, S., Johnston, J., Bartsch, A. and Alberts, J. (2021). Characterizing Head Impact Exposure in Men and Women During Boxing and Mixed Martial Arts. Orthopaedic Journal of Sports Medicine, [online] 9(12), p.23259671211059815. doi:https://doi.org/10.1177/23259671211059815.
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