The Uneven Playing Field

Tuesday, May 13th, 2008

I must admit that I’m shocked that the New York Times is willing to address The Uneven Playing Field of scholastic sports — that is, the fact that girls and boys are different:

Title IX, the federal law enacted in 1972 mandating equal opportunity in sports, has helped to shape a couple of generations of girls who believe they are as capable and as tough as any boy.

For instance:

By Janelle’s and her mother’s count, her club team, with 18 players, had suffered eight A.C.L. tears — eight — during her high-school years: Janelle’s two, another player’s two and four other girls with one each. A high-school teammate one class above Janelle endured chronic ankle problems and, according to a Miami Herald article, six ankle operations — three in each leg — over the course of her four years on the varsity soccer team.

This casualty rate was not due to some random spike in South Florida. It is part of a national trend in the wake of Title IX and the explosion of sports participation among girls and young women. From travel teams up through some of the signature programs in women’s college sports, women are suffering injuries that take them off the field for weeks or seasons at a time, or sometimes forever.

Girls and boys diverge in their physical abilities as they enter puberty and move through adolescence. Higher levels of testosterone allow boys to add muscle and, even without much effort on their part, get stronger. In turn, they become less flexible. Girls, as their estrogen levels increase, tend to add fat rather than muscle. They must train rigorously to get significantly stronger. The influence of estrogen makes girls’ ligaments lax, and they outperform boys in tests of overall body flexibility — a performance advantage in many sports, but also an injury risk when not accompanied by sufficient muscle to keep joints in stable, safe positions. Girls tend to run differently than boys — in a less-flexed, more-upright posture — which may put them at greater risk when changing directions and landing from jumps. Because of their wider hips, they are more likely to be knock-kneed — yet another suspected risk factor.

This divergence between the sexes occurs just at the moment when we increasingly ask more of young athletes, especially if they show talent: play longer, play harder, play faster, play for higher stakes. And we ask this of boys and girls equally — unmindful of physical differences. The pressure to concentrate on a “best” sport before even entering middle school — and to play it year-round — is bad for all kids. They wear down the same muscle groups day after day. They have no time to rejuvenate, let alone get stronger. By playing constantly, they multiply their risks and simply give themselves too many opportunities to get hurt.


Girls are more likely to suffer chronic knee pain as well as shinsplints and stress fractures. Some research indicates that they are more prone to ankle sprains, as well as hip and back pain. And for all the justifiable attention paid to concussions among football players, females appear to be more prone to them in sports that the sexes play in common. A study last year by researchers at Ohio State University and Nationwide Children’s Hospital in Columbus, Ohio, reported that high-school girls who play basketball suffer concussions at three times the rate of boys, and that the rate for high-school girls who play soccer is about 1.5 times the rate for boys. According to the N.C.A.A. statistics, women who play soccer suffer concussions at nearly identical rates as male football players. (The research indicates that it takes less force to cause a concussion in girls and young women, perhaps because they have smaller heads and weaker necks.)
If girls and young women ruptured their A.C.L.’s at just twice the rate of boys and young men, it would be notable. Three times the rate would be astounding. But some researchers believe that in sports that both sexes play, and with similar rules — soccer, basketball, volleyball — female athletes rupture their A.C.L.’s at rates as high as five times that of males.
Men also tear their A.C.L.’s, most frequently in football and from direct blows to the leg. But even football players, according to N.C.A.A. statistics, do not rupture their A.C.L.’s during their fall seasons at the rates of women in soccer, basketball and gymnastics. The N.C.A.A.’s Injury Surveillance System tracks injuries suffered by athletes at its member schools, calculating the frequency of certain injuries by the number of occurrences per 1,000 “athletic exposures” — practices and games. The rate for women’s soccer is 0.25 per 1,000, or 1 in 4,000, compared with 0.10 for male soccer players. The rate for women’s basketball is 0.24, more than three times the rate of 0.07 for the men. The A.C.L. injury rate for girls may be higher — perhaps much higher — than it is for college-age women because of a spike that seems to occur as girls hit puberty.

Boys seem to learn athletic movement patterns simply by being boys. Girls seem to need explicit training to avoid “running like a girl”:

“Women tend to be more erect and upright when they land, and they land harder,” he said. “They bend less through the knees and hips and the rest of their bodies, and they don’t absorb the impact of the landing in the same way that males do. I don’t want to sound horrible about it, but we can make a woman athlete run and jump more like a man.”
Silvers, along with a Santa Monica orthopedic surgeon, Bert Mandelbaum, designed an A.C.L.-injury-prevention program that has been instituted and studied in the vast Coast Soccer League, a youth program in Southern California. Teams in a control group did their usual warm-ups before practices and games, usually light running and some stretching, if that. The others were enrolled in the foundation’s “PEP program,” a customized warm-up of stretching, strengthening and balancing exercises. An entire team can complete its 19 exercises — including side-to-side shuttle runs, backward runs and walking lunges — in 20 minutes. One goal is to strengthen abdominal muscles, which help set the whole body in protective athletic positions, and to improve balance through a series of plyometric exercises — forward, backward and lateral hops over a cone. Girls are instructed to “land softly,” or “like a spring.”
The subjects were all between 14 and 18. In the 2000 soccer season, researchers calculated 37,476 athletic exposures [practices or games] for the PEP-trained players and 68,580 for the control group. Two girls in the trained group suffered A.C.L. ruptures that season, a rate of 0.05 per 1,000 exposures. Thirty-two girls in the control group suffered the injury — a rate of 0.47. (That was almost twice the rate for women playing N.C.A.A. soccer.) The foundation compiled numbers in the same league the following season and came up with similar results — a 74 percent reduction in A.C.L. tears among girls doing the PEP exercises.

The PEP program:

1. Warm-up
A. Jog line to line (cone to cone):
B. Shuttle Run (side to side)
C. Backward Running

2. Stretching
A. Calf stretch (30 seconds x 2 reps)
B. Quadricep stretch (30 seconds x 2 reps)
C. Figure Four Hamstring stretch (30 sec x 2 reps)
D. Inner Thigh Stretch (20 sec x 3 reps)
E. Hip Flexor Stretch (30 sec x 2 reps)

3. Strengthening
A. Walking Lunges (3 sets x 10 reps)
B. Russian Hamstring (3 sets x 10 reps)
C. Single Toe Raises (30 reps x 2 reps)

4. Plyometrics
A. Lateral Hops over Cone (20 reps)
B. Forward/Backward Hops over cone (20 reps)
C. Single Leg hops over cone (20 reps)
D. Vertical Jumps with headers (20 reps)
E. Scissors Jump (20 reps)

5. Agilities
A. Shuttle run with forward/backward running
B. Diagonal runs (3 passes)
C. Bounding run (44 yds)

6. Alternative Exercises-Warm Down and Cool Down
A. Bridging with Alternating Hip Flexion (30 reps)
B. Abdominal Crunches (30 reps x 2 reps)
C. Single and Double Knee to Chest (30 sec x 2 reps)
D. Figure Four Piriformis stretch (30 sec x 2 reps)
E. Seated Butterfly stretch

If the goal is to get teenage girls to perform more like teenage boys, they probably don’t need stretching (step 2) or a cool-down (step 6). They need strength and power training (steps 3, 4, and 5). And they can warm up (step 1) with skill training.

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