Jaime Lewis (Host): Here's a question you parents might be asking. Is my female athlete at high risk of injury if she plays sports year round? Well, with the rise of sports specialization for young athletes and the popularity of travel leagues, research finds that women athletes tend to experience more overuse injuries and severe injuries requiring surgery than their male counterparts.

We'll dive into the details and learn how to prevent and treat young female athlete injuries with Dr. Joanne Baird, a Board Certified and Fellowship Trained Orthopedic Surgeon specializing in sports medicine and women's athletic wellness with Gulf Orthopedics. This is LifeCast, a podcast from Infirmary Health.

I'm Jaime Lewis. So, Dr. Baird, my kids are at the age when sports specialization really begins to take off, and a lot of their friends are very wrapped up in it right now, which is great, but I know it can be really taxing on young bodies. For our listeners, can you explain what sports specialization is?

Joanne Baird, MD: Sure, so sports specialization is actually training in a single sport on a year round basis. It has become very much more popularized and there are multiple factors that contribute to this. So pure enjoyment of the sport, the kids like it, they want to do it year round, scholarship and professional aspirations, further advancing their competitive edge against their fellow competitors, and then always the parent and coach pressures.

Unfortunately, it's actually more detrimental to the athlete by specializing in a single sport and it increases their risk of injury and burnout.

Host: Well, that makes a lot of sense, first of all, but then also some folks may wonder if their daughter is even ready to specialize in one sport, which, what would you say to them?

Joanne Baird, MD: So females do tend to specialize at a younger age in athletic careers than their male counterparts. Now, some sports, this is kind of mandatory, such as gymnastics, figure skating, and even swimming, where if you wait until you're mature, the athletes have already surpassed when their most beneficial competitive edge is. In general, though, we recognize and recommend that we should only specialize when we're mature, both emotionally, and physically, which typically occurs around age 16. Now, I will readily admit that I specialized in a single sport at a much younger age than 16, I was a soccer player and played year round.

Now, I also did multiple sports in addition to soccer, but definitely played soccer year round because of that pure enjoyment. We recommend more sports sampling, however, for our younger athletes that are still growing. And this is where they participate in multiple sports, which allows better motor and social development.

Host: Okay. According to recent research, female athletes suffer more overuse injuries than male athletes. Can you talk a little bit about that?

Joanne Baird, MD: Yeah. So we definitely see overuse injuries being more prominent in our female athletes compared to our males. The male athletes tend to be more traumatic injuries. Women in general also tend to have more severe injuries and require surgery when comparing directly comparable sports to our male athletes.

There's several differences and potential reasons for why this may occur, which we'll delve into in a little bit. In general, females sustained more lower extremity injuries, that tended to be overuse such as stress fractures, tendonitis, to name a few, and were very common in endurance athletes, such as our swimmers, track and field, long distance runners, cyclists. But we also see it in our competitive athletes like soccer, basketball, and whatnot, that they tend to be more overuse injuries than males.

Host: You hinted at this earlier, but what are the physiological differences between males and females that contribute to these kinds of injuries?

Joanne Baird, MD: So the exact mechanisms are poorly understood at this time as to the direct interplay. Females tend to reach skeletal maturity at a younger age. They also tend to have less upper body strength. They have higher percent body fat and a smaller cross sectional area of muscle. There's additional physiologic differences with smaller thoracic cages. Their heart size is smaller. They have a lower lung capacity, decreased cardiac output. They have lower blood volume, less iron stores, and increased risk of anemia. In addition to that, there's multiple skeletal differences. They have a wider pelvis, their lower extremity alignment tends to be a little different than our male athletes, and there's differences in bone morphology.

Their ligaments tend to be smaller in size, and they're also more ligamentously lax, which may put them at increased risk. And then the hormonal influences. We know that our women and males have different hormone balances. We just don't know the extent of how this plays in at this point. We do know that they have different landing mechanisms.

And so the biomechanical differences with decreased strength, increased stiff landing puts them at increased risk. And nothing has been more studied than this with the ACL injuries in our female athletes.

Host: I know that those are very common and that's fascinating, all of that information you just shared. I didn't realize actually how much difference there is between the two genders in terms of physiological composition. Well, let me ask, Dr. Baird, what are some of the ways families can prevent overuse injury in young athletes?

Joanne Baird, MD: Yes, we definitely recommend sport sampling, where athletes will participate in multiple sports, which will help their motor and social development. The diversification of movement improves their muscular and skeletal development. In general, we recommend the two to one rule, where their recreational play and practice is twice as long as their deliberate practice and play.

Additionally, the hours of training in a week should not exceed the athlete's current age and then every athlete should rest at least one day a week, free of all sport and then at least three months out of the year with one month of that being immediately after a competitive season.

Additionally, in general, you know, proper technique, training, and a well rounded diet, and then allowing that recovery and rest period as overuse injuries accumulate from repetitive overuse and loads. You want them to listen to their body. If they're complaining of a pain, they need to rest. Their body's trying to tell them something. And then proper neuromuscular training is super important, particularly for our female athletes. As we mentioned earlier with the ACL injuries, we know that their landing mechanics are different. Additionally, the females tend to have an increased risk of concussions potentially relating to their muscular neck strength as well as the stiffness in their neck.

And so working on good proper technique and neuromuscular training can help prevent overuse injuries as well as using proper safety and equipment. And then we're learning more and more about what used to be the female athlete triad, which was amenorrhea, stress injuries, and an eating disorder. We recognize now that this is not unique to our female athletes, and there's actually a more common concept that has been developed called (RED-S) in which there's a reduction in energy being taken in compared to what is being expended. And this results in multiple overuse injuries in addition to multiple system issues. And it's not unique to female athletes, but that's kind of a newer way of looking at it. And so anytime we're looking at preventing overuse injuries, we want to make sure that we're taking in enough energy and calories for what we're burning off, in order to allow our bodies to rest and recover and repair themselves so that we're at our highest level of competition. There was a study in 2019 that compared female athletes that specialized in one single sport compared to females that participated in multiple sports.

They looked at pre and post puberty lower extremity biomechanics, in athletes that participated in soccer, basketball, and volleyball. Compared to the multiple sport athletes; the athletes that specialized in a single sport had significant biomechanical and neuromuscular deficits during landing compared to the multiple sport athlete, which increased their risk of injury.

Host: Well, thank you so much for sharing your expertise on this subject, Dr. Baird. I appreciate it.

Joanne Baird, MD: You're welcome. Thank you for having me.

Host: I'm Jaime Lewis, and this has been LifeCast from Infirmary Health. If you want to know more, Gulf Orthopaedics sports medicine specialists provide exceptional patient care to treat sports injuries. The team at Gulf Orthopaedics are experts at using the most cutting edge surgical and non surgical techniques to create common sports injuries through ligament reconstruction, tendon repair, and cartilage restoration. Learn more about the physician team and services offered at gulfortho.com.