Scott Webb (Host): Welcome to Health Dose, your go-to source for quick and reliable health and wellness news. I'm Scott Webb, and today we're discussing female athletes and the challenges they face with physical therapist, certified strength and conditioning specialist and triathlon coach Laura Crower from MyMichigan Health.

Laura, welcome to the podcast.

Laura Crower, DPT, CSCS: Hi. Thanks for having me.

Host: It's nice to have you here. I was telling you that my daughter is going to be a division one basketball player next year, and my wife and I have been on this mental and physical health journey with her over the years, so it's great to have you here. She also wants to be a physical therapist, so it's great to have you here and I want to start here. I want to get a sense from you, how do cultural and societal attitudes impact the participation and performance of female athletes, and what strategies exist to combat those challenges?

Laura Crower, DPT, CSCS: There are a lot of cultural impacts. There are many reasons. Two times more girls than boys drop out of sports by the time they're 14. Some of these barriers are fear of judgment, lack of confidence, school pressures, unsafe environment, social stigma and lack of equity. So some of those socio-cultural backgrounds, understanding those, understanding that some cultures, have greater gender stereotyping than other cultures.

And it likely starts at an early age. So this could be something as simple and easy as pink for girls in blue for boys, but it might be something more meaningful and lasting. Like, boys can play tough, but girls have to be nice. Being able to remove those stigmas, watching your language, don't say things like girl pushups, but modified pushups to an incline or on your knees.

And, I modify these every day in the clinic and teaching group fitness classes for both genders. So being able to modify those pushups is not, it's a girl thing. It is just something to modify for where each athlete is at that particular time. Be positive about your language, be empowering, build them up, focus on the positive. And then one thing that you can include with your conversations is focusing on health over performance.

Performance will be a piece of it at some level, but when we're talking about our young female athletes, a lot of it is instilling that love of exercise that hopefully they'll hold onto for life. So making it a discussion about their health and not just performance. And, a piece of that is normalizing talking about menstrual health. Because there's a huge stigma around that and, it has a big effect on our young athletes' health and their performance as well.

Host: Yeah. It's so interesting, Laura to hearyou mention about the labels. I've been fighting this battle mostly internally over the years, but the putting the lady with team names, right? So the boys are the Mustangs. Well, why do the girls have to be the lady Mustangs? I've seen my daughter play multiple sports, flag football, basketball, softball.

There's nothing quote unquote ladylike about the way she and her teammates play. They are athletes. And I have been fighting this battle for so long. Stop calling them ladies. Because it implies right Laura, that somehow they need to be ladies, when they play, they need to conduct themselves. How come we don't, we, we don't hold boys to that standard. We don't expect them to act like gentlemen. Right?

Laura Crower, DPT, CSCS: It's great to hear you say that.

Host: Yeah. I'm going to keep fighting the good fight. I'm sure you are as well. And let's dig in here a little bit. Roll up our sleeves, even though I'm wearing short sleeves. What are some of the specific challenges faced by adolescent female athletes, and how can they be addressed?

Laura Crower, DPT, CSCS: So we talked a little bit about that previously, the fear of judgment, the confidence, the social stigmas, the lack of equity. So some of these are a little outside of our wheelhouse. Like, if you live in an unsafe neighborhood, that's not something you and I are going to fix. That might be something that we can advocate for, but that's not something that you and I can fix as coaches, as parents, as healthcare professionals. There are a few things we can do. We can create a fun, welcoming environment for them to learn a new skill. I think guiding them to find the fun in sport early on can instill that love of exercise and sport and things that they can engage in through their entire life because we know how important it is for them to stay active forever.

Specifically we can use that empowering language, avoid using the stereotypes like lady Mustangs and we can provide uniform options that allow girls to play comfortably. And sometimes this might be more of a comfort thing, but it also might be a cultural thing because there may be some cultures that requires certain dress. I've played ball with and against, a teammate for 25 years and her religion requires that women wear dresses. So she is one of the fiercest volleyball and softball players I've ever played with and against, but she had to wear a dress while she was in high school, So that was something that her programs would accommodate for her. Some of these barriers, like I said, like the equity and the safe environment, they need to be recognized and addressed at a much broader level. And we can only be advocates for those.

Host: As you say, there are some things that are within our control, obviously, and some things are broader societal cultural type of things that may be beyond the scope of what we're doing today. And I mentioned to you that my daughter also wants to be a physical therapist and years ago to try to get out in front of a potential ACL injury, because I know that girls tend to suffer ACL injuries more so than young male athletes. So to get out in front of that, we really proactively went and saw a physical therapist. She gave her exercises and it helped of course, that the physical therapist been a athlete too, right? So I that they really connected, they, she played high school basketball, so they really connected and gave her these exercises and knock on fake wood, she's been able to avoid any, you know, ACL, MCL, those types of common injuries.

But let's talk through that. What are some of those most common injuries and can they be prevented?

Laura Crower, DPT, CSCS: So you're right. Girls are six to eight times more likely than boys to tear their ACLs. They also have different risks for other injuries just based on their gender physiology. They have a higher risk of concussion with prolonged recovery from that, they're more likely to sustain both knee and ankle injuries, because of differences in bone mineral density relative to their cycles.

They'll have higher risks of stress fractures with overuse injuries. And plantar fasciitis is another kind of random one we throw in there that they have higher risk factors for. So, the ACL is always that big scary one. But what a lot of people don't realize is that incomplete recovery from a much smaller injury, say an ankle sprain, will increase your likelihood of tearing that ACL down the road.

So getting your athletes into PT after, oh, it's just a piddly little sprain, but getting them into PT, even though they can play almost like normal, but making sure that they're not compensating and creating bigger risk factors for those bigger injuries. Like you said, getting in either with a physical therapist or a good strength and conditioning coach, creating those prehab programs can really be valid for your athletes.

It's not just about the strength, although that's a big piece of it, but also that neuromuscular control and learning how to control the body.

Host: Yeah, as you say, a seemingly minor ankle injury causes them to you know, start to compensate a little bit and then they maybe land funny because they're trying to avoid that ankle and then the ACL goes, right? Good stuff today. Prehab, that was the word. I couldn't think of the word before, but we did some prehab to avoid the knee injuries.

So, this is a tricky one because I played sports and I don't remember coaches really caring about my feelings, talking to me about my feelings, or anything like that, but maybe that's the culture of football, more so than maybe some of these other sports or for female athletes now. But how should coaches and trainers address body image issues?

Because we want to foster a healthy and supportive environment for female athletes. So how do they do that?

Laura Crower, DPT, CSCS: One, stress of what the body can do, not what it looks like. Embracing appearance diversity, promoting appearance diversity. Not every athlete is going to look the same, and that's good because we're not all short stops. We're not all catchers, we're not all left fielders. So. embracing that appearance diversity and celebrating what each body can do.

Focus on empowerment, and we've talked about this before, but keeping that positive, empowering language. Use positive reinforcement at a young age. Promote the fun of your sport. Because ultimately that's what it is. And if your sport isn't fun, find a different one. There's lots of them out there.

One interesting thing has stood out to me, through the continuing education I've done; understand the impact of your language. Some seemingly innocuous comments could have really long lasting effects. For example, one parent said to me, when you go to college, these college coaches are not going to want to see any fat over your muscles.

Well, that is a hard thing to take as a high school kid. So the high school kid who's already not the smallest kid in the room. And then we had previously talked about discussing openly the menstrual health. So making it a normal thing to talk about, realizing that not everybody's the same, promoting that diversity, I think those can go a long way to improving body image.

Host: Good stuff today. I appreciate your time and your expertise. Just want to find out you as a physical therapist and all the other things that you do, how do you guys work together to optimize rehab programs and tailor them specifically for female athletes?

Laura Crower, DPT, CSCS: So in the past year-ish, we have developed a system-wide return to sport program. We were kind of all over the board at our different locations. So we really developed a robust return to sport program with all of the testing battery. We recognized that some norms are gendered and some are not.

In researching for this battery of tests, I came across this test. ee you were worried about the strength and conditioning specialist as a bunch of words, but here's a bunch of words for you. Closed kinetic chain, upper extremity stability test. Yeah.

Host: That is a lot of words.

Laura Crower, DPT, CSCS: Exactly. So in this test they, there are tapes on the ground that are 36 inches apart and you start in a plank and then you tap each hand and you have to do as many taps as you can in 15 seconds.

So this test was developed in 2000 and they developed norms. Well, the tapes are 36 inches apart. And let me tell you, I am not a little athlete and that is really wide. So, thankfully down the road, more researchers used more brain cells and they decided, Hey, what if we do this at shoulder width instead of this 36 inches?

And oh my gosh, almost all of the gender disparity disappeared. There was also one person who redid this study, they just decided that the girls were going to do all of their planks on their knees. There was no reason for it. And I would like to tell that to my group fitness classes and my athletes because virtually none of them do them on their knees. They're all pretty strong. So that kind of burned my buttons when I came across that. The other things that we're doing where some therapists are working one-to-one at a clinic level, we have other therapists working out there in those prehab, providing clinics out at the field level. So athletic trainers, strength and conditioning coach, therapists, we are all out there at the field level offering these prehab things as well.

At a nitty gritty girls versus boys level; at the younger ages, we want to work to develop aerobic capacity first and anaerobic second. Just the way the female body develops, and then always, always, always, whatever gender, but particularly with females, work coordination and motor control before you start adding weight when we are doing those lifts.

And as we've been saying all along, that positive reinforcement, all the things we've mentioned about empowerment, building strong athletes with strong self-efficacy and self-image.

Host: Great stuff from an expert today. I told you my daughter's a basketball player. She wants to be a physical therapist. Like this has been such good stuff for me. I'm sure it is for the audience as well. Thanks so much for being here. Appreciate your time.

Laura Crower, DPT, CSCS: Thanks for having me, it was fun.  

Host: And those who would like more information about MyMichigan Health's comprehensive musculoskeletal care can visit mymichigan.org/msk. And if you enjoyed this podcast, please share it on your social channels and explore our podcast library for more health related topics. And this is Health Dose.

Thanks for watching and listening.