SPORTS INJURIES
ACL Injury and Hormones
Though
males and females have the same musculoskeletal structures,
there are some unique differences that actually make female
athletes more prone to injury. In regard to skeletal differences,
males usually have wide shoulders and narrow hips, whereas
a female generally has a wide pelvis in relation to the width
of her shoulders. This wider pelvis is necessary for childbirth.
This wider pelvis is stabilized by the sacroiliac ligaments
in the back and the pubic symphysis and pubic ligaments in
the front. It is these ligament structures that are stressed
and account for the significant back pain that occurs in
50 percent of women who are pregnant.
This wider pelvis in females leads to an increased inward slant of the thigh
and, therefore, an increased Q-angle of the knee. The Q-angle, a measurement
of the angle created by the line from the anterior superior iliac spine and the
patella, and the line from the patella to the tibial tubercle, is normally less
than 12 degrees. An increased Q-angle produces excessive lateral forces on the
quadricep's mechanism and abnormal tracking of the patella. This is one of the
reasons why chondromalacia patella or patellofemoral syndrome is more common
in women. (Hutchinson, M. Knee injuries in female athletes. Sports Medicine.
1995; 19:288-302.)
As stated above, a female's thighs tend to slant inward towards the knees more
than a male's. This puts additional strain on a woman's hips and their ligamentous
support. This is one of the reasons that the majority of the 120,000 hip replacements
done each year are in women. Females also have a wider carrying angle of the
elbows. This is similar to the Q-angle of the knee. This wider angle places additional
stress on the medial elbow stabilizers, namely the ulnar collateral ligaments,
which are usually the culprits when a female athlete has medial elbow pain.
Body composition is also different between males and females. The average body
fat content of the female is approximately 26 per-cent, compared with that of
the male at 14 percent. The female has a lower lean body mass indicating less
muscle mass. The greater muscle mass in males is due to the predominant effect
of the androgen hormones, whereas estrogen, predominant in females, results in
increased body fat. As it turns out, this difference in hormones is key to understanding
why female athletes are more easily injured and repair more slowly than their
male counterparts. Testosterone stimulates fibroblastic proliferation, whereas
estrogen, especially estradiol, inhibits it.(Liu, S. Estrogen affects the cellular
metabolism of the anterior cruciate ligament. A potential explanation for female
athletic injury. American Journal of Sports Medicine. 1997; 25:704-709.)
It is for this primary reason that female athletes can benefit from Prolotherapy
for their sports injuries. Estrogen makes a woman a woman, but they have a definite
negative effect when it comes to healing sports injuries.
Females also have a smaller proportion of muscle in relation to body size because
of the hormonal differences. Having less muscle tissue means there is less muscle
to stabilize the joints if the ligaments are injured. This causes more stress
to be placed on injured ligaments in women than in men, because women do not
have as much muscle back-up. This is another reason for female athletes to become
familiar with the local Prolotherapist.
Females, compared to males, have a lower metabolic rate, the rate of conversion
of food to energy under conditions of total rest. This appears to be related
to the greater lean body mass of the male and the greater proportion of adipose
tissue in the female. This could be one explanation why females heal sports injuries
slower than men and why more of them develop chronic pain, and need operations
such as hip replacements.
The Hormone Factors
Walk into any chronic pain clinic and who do you see? You see women. Caring Medical
and Rehabilitation Services in Oak Park is no different. About three out of every
four patients coming for Prolotherapy are woman. Why are the women getting most
of the arthritis and needing the majority of the artificial joint replacements?
It is easy to explain when you take into account the hormone factor.
The dominant hormone in males is testosterone. Testosterone is very anabolic,
which means that it stimulates the growth or repair of tissues. Men have about
10 times the amount of testosterone as women. This is why they have a sex drive
that is about 10 times as strong as women do. It is also the reason why, on average,
men are 33 percent stronger than women. Males are stronger because of their increased
muscle mass due to testosterone. When males perform strength training, they develop
increased strength and increased muscle size due to hypertrophy of the muscles.
This hypertrophy is due to the effect of testosterone. Females performing strength
training gain increased strength with relatively less muscle hypertrophy. This
is because females have significantly less testosterone. If a woman shows up
at the Olympics looking like a man, the other athletes will accuse her of using
anabolic hormones like testosterone. The complaint is justified. When a woman
does weight strength training, she will get stronger, but she cannot turn herself
into a body shaped like a man because the hormones are just not there.
Recent epidemiological studies have recognized a significantly higher anterior
cruciate ligament (ACL) injury rate in female athletes as compared with male
athletes in sports such as basketball, hand-ball, gymnastics, and soccer. (Gray,
J. A survey of injuries to the anterior cruciate ligament of the knee in female
basketball players. International Journal of Sports Medicine. 1985; 6:314-316.;
Nilsson, S. Soccer injuries in adolescents. American Journal of Sports Medicine.
1978; 6:358-361.; Slauterbeck, J. The incidence of anterior cruciate ligament
tears in men and women collegiate soccer players Orthop. Trans. 1996; 20:259.;
Whiteside, P. MenÆs and women's injuries in comparable sports. Physician
and Sports Medicine. 1980; 8:130-136.) Although various causes of this phenomenon
have been postulated, including differences in ligament or muscle strength, conditioning,
endurance, anatomy, and training techniques, the most plausible appears to be
the hormone factor.
Unique to the female athlete is her exposure to a constantly changing hormonal
milieu throughout her reproductive years. For most of her life, the female athlete
is exposed to rhythmic variation in either endogenous hormones during a regular
menstrual cycle or exogenous hormones via oral contraceptives.
It has been only recently that it was discovered that there are estrogen receptors
on the fibro-blasts of the human ACL, suggesting that female sex hormones may
have an effect on the structure and composition of this ligament. Dr. Stephen
Liu and associates, at the UCLA School of Medicine, made this discovery and went
the next step to find out exactly how estrogen affects ligament growth. They
investigated the effects of 17B-estradiol on the cellular proliferation and collagen
synthesis of fibroblasts derived from the rabbit anterior cruciate ligament.
Measuring 3H-thymidine and 14C-hydroxyproline incorporation assessed fibroblast
proliferation and collagen synthesis, respectively. They found that collagen
synthesis was significantly reduced with increasing local estradiol concentration.
Declining collagen synthesis was first noted at a 17B-estradiol concentration
of 0.025 ng/ml. Within physiologic levels of estrogen (0.025 to 0.25 ng/ml),
collagen synthesis was reduced by more than 40 percent of control, and at pharmacological
levels of 2.5 and 25 ng/ml, as typically occurs in female atheletes taking birth
control pills or estrogen replacement therapy, by more than 50 percent of control.
A significant reduction of fibroblast proliferation was also observed with increasing
estradiol concentrations.
These results are startling. Estrogen, the female hormone, dramatically inhibits
fibroblasts. These fibroblasts are what make the collagen that makes up the ligaments
and tendons, which are injured during sports. Estrogen was shown in the above
study to inhibit the fibroblastic growth and thus collagen formation in a dose-dependent
manner.
The more estrogen a woman has, the more inhibition will occur. This has direct
effects for all women taking birth control pills. Birth control pills have pharmacological
levels of estrogen, which are far in excess of a woman's normal production. The
simplest way for a female athlete, who is on artificial estrogen, to overcome
sports injuries, is to stop taking them. Inevitably, women are placed on birth
control pills because of menstrual irregularities, which are easily treated with
natural medicine techniques including diet manipulation and nutritional supplements.
At Caring Medical and Rehabilitation Services in Oak Park, we perform Diet
Typing and hormonal testing on our patients. The female athletes inevitably come
up essential fatty acids deficient. This means they need to injest more good
fats in their diets in the form of omega-3 fatty acids as is found in fish oils.
They are encouraged to drink cod liver oil and eat more fish. Better kinds of
fats are also found in nuts and seeds, flaxseed oil, and olive oil. Just this
mild change in diet is typically all that is needed to get rid of menstrual cramps
and other menstrual irregularities. Sometimes, however, more sophisticated dietary
manipulation, herbal supplementation, or other natural medicine techniques may
be needed.
Would you like information of how to be our patient? Click Here
Want to talk to us first? Click
Here
< Back to Sports Injuries |
