Why are women more prone to sports injury?

There may be a gender gap in pay, with men receiving more prize money in 30% of sports, but there is also inequality when it comes to sports injuries.

There is no one sole reason why women are more susceptible to sports injury than their male counterparts, as there are a number of factors. We take a look at the five most common injuries among female athletes and what might be the cause.

1. Anterior cruciate ligament tears

The anterior cruciate ligament, known as the ACL, is one of the four ligaments that supports the knee joint and provides much of its stability. The ACL is vulnerable to damage when landing from a jump or a sudden change in direction so it is a high risk injury in a wide range of sports, including football, netball, basketball, volleyball, skiing and snowboarding.

Although the roll call of male sporting stars that have torn their ACL is extensive, ACL tears are actually four to six times more likely to occur in female athletes than male. The International Olympic Committee has reacted to the high degree of ACL injuries affecting female athletes competing at both the Winter and Summer Games by convening a panel of medical practitioners, physiotherapists, biomechanists and other specialists to address the problem, with a particular focus on injury prevention.

It is thought that poor knee alignment is a major factor in ACL tears and women have a wider pelvis that affects alignment between knee and ankle. In female athletes this causes the knee to fall inwards when landing, bending and pivoting. Women also tend to land more upright putting pressure on the knee. Addressing this from a biomechnical point at an early point could help prevent ACL injury.

There are also anatomical differences between men and women that contribute; women have less muscle mass than men to support the knee and a narrower knee joint for the ACL to pass through. Hormones could also play a role as it seems there may be an increased risk during the menstrual cycle although this has not been fully proven.

2. Ankle sprain

This is a very common sports injury that affects both men and women, but a study in 2013 found that women were more susceptible than men. The ankle is a complex mechanism, made up of two joints, the subtalar joint and the true ankle joint, and supported by a framework of ligaments. Ankle instability is a key factor in ankle sprains and women’s ligaments tend to be more lax than men’s – also female muscle tissue is more elastic which could be a contributing factor to a higher rate of ankle sprains in female athletes.

3. Patellofemoral syndrome

Another knee problem that is more common in women is patellofemoral syndrome, with women more than two times more likely to suffer from this condition. Pain is caused by the patella or kneecap rubbing against the femur when the knee is flexed or extended. One theory is the Q angle, or quadriceps angle where the upper leg bone meets the lower leg bone, is greater in women causing the quadriceps to pull on the kneecap.

4. Stress fractures

Women are more susceptible to stress fractures, particularly in the foot or lower leg and this can be the result of a syndrome known as the female athlete triad. These are three separate health concerns; the first is ‘disordered eating’ where the female athlete may try to lose weight to improve athletic performance leading to eating disorders. The second is amenorrhea, where nutritional deficiencies and excessive training result in a decrease in hormones that affect the menstrual cycle and, finally, bone loss or osteoporosis caused by low oestrogen levels and poor nutrition.

5. Plantar fasciitis

Alignment issues in the foot increase the risk of developing tears in the supporting tissues in the heel and the arch of the foot.

Is there anything women can do to prevent sports injury?

Strength conditioning can be key to strengthening the supporting muscles and, if done properly, to correct any muscle imbalance. A 2012 study published in the Journal of Bone & Joint Surgery reviewed ACL injury prevention progammes and found that they could reduce risk of ACL injury in female athletes by 52%.

Professor Cathy Speed offers a holistic approach to fitness and is highly experienced in treating female athletes, particularly endurance runners. Every aspect of performance is reviewed including nutrition and preparation to ensure optimal efficacy. For more information or to arrange a consultation at her Cambridge Sports Medicine Clinic, call 01223 200 595.

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Vitamin D & the athlete: is the sunshine vitamin invaluable for improved athletic performance?

Could a deficiency in vitamin D be undermining your athletic performance, affecting both muscle function and levels of fitness? Vitamin D insufficiency is on the rise and, in the USA, up to 80% of the adult population have suboptimal levels. Athletes that have a very low body fat or mainly train indoors are at risk also of developing a deficiency in this invaluable vitamin. Although they are not at greater risk than the general population, athletes may be more sensitive due to the nature of intense training.

One study into vitamin D and athletic performance looked at Caucasian football players, testing them at the commencement of the study and another at the end of their ‘off season’ period. At the start of the study, which commenced just after their intensive training and playing season their vitamin D levels were lower than the second test, indicating that physical exertion depleted their levels of vitamin D.

Vitamin D and our health and athletic performance

Vitamin D is a fat soluble vitamin that exists in two main forms; vitamin D2 and vitamin D2. We gain vitamin D3 through synthesising ultraviolet rays in our skin when it is exposed to the sun. We also obtain small amounts from a number of animal sources, particularly oily fish, liver and egg yolks. Vitamin D2 is obtained from plant sources such as mushrooms, but we also typically find both types of vitamin D in fortified foods.

Our general health is reliant on having optimal levels of this vitamin; its ability to promote healthy bones through the absorption of calcium is well known, but there is also mounting evidence that deficiencies in vitamin D can lead to an increased risk of diabetes, muscle and bone pain and various cancers.

In terms of athletic performance, its benefits can be evaluated in the following ways:

  1. Impact on musculoskeletal structures; its benefits for bone strength is the biggest argument for vitamin D supplementation, as a deficiency can lead to stress fractures. There is less clear evidence for how it assists muscle recovery.
  2. Vitamin D is proven to have a powerful impact on immunity and allergies and athletes that have higher vitamin D levels have fewer upper respiratory tract infections.
  3. Other benefits; vitamin D deficiency has been linked to depression and cognitive impairments, but the benefits for promoting a positive mental attitude in the athlete has not been investigated.

The top-flight athlete and vitamin D supplementation

The stress of intensive training, the need to ‘bounce back’ quickly and the importance that even the smallest improvement can bring to performance indicates that vitamin D levels should be evaluated. Professor Cathy Speed is a Sport & Exercise Medicine Specialist who provides a holistic approach to health and fitness; her advice is to screen for vitamin D deficiency at a pre-season screening and also be aware that some athletes are particularly at risk, including those with limited sun exposure, female and/or older athletes and those that are seeing a poor recovery from training or recurrent injury.

For more information on Cathy’s Cambridge Sport & Exercise Medicine Clinic call 01223 200 595 to make a consultation.

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New study shows obesity and smoking likely to undermine rheumatoid arthritis treatment

Rheumatoid arthritis (RA) is an autoimmune condition that causes inflammation in the joints, resulting in joint pain and swelling. There are estimated to be approximately 20,000 cases of rheumatoid arthritisdiagnosed in the UK every year, affecting 700,000 adults in all. The first few weeks and months after the onset of rheumatoid arthritis is commonly known as the ‘window of opportunity’, as treatment at an early stage can prevent some of the damage that is inflicted on the joints, meaning a greater chance of achieving remission or avoiding many of the long-term problems associated with rheumatoid arthritis.

However, a new study presented at the recent European League Against Rheumatism Annual Congress indicated that the chance of achieving remission in early rheumatoid arthritis is greatly reduced in those that smoke or who are obese.

How does rheumatoid arthritis affect the joints?

Our joints are where two bones meet. The ends of our bones are covered with the flexible connective tissue called cartilage that allows our joints to move easily against each other without friction. The joint is surrounded by the synovium membrane, another type of connective tissue, that produces synovial fluid which lubricates the cartilage and joint.

Rheumatoid arthritis causes an inflammation of the synovium membrane, so it swells, produces extra synovial fluid and goes red as there is increased blood flow which accounts for the feeling of heat in an affected joint. Pain and stiffness is the result of the nerve ending becoming irritated by the inflammation and the capsule that surrounds the joint becoming stretched by swelling.

Treatment for rheumatoid arthritis

The aim of rheumatoid arthritis treatment is to achieve remission, where the disease is not affecting your ability to perform normal everyday activities or continue in employment. Yet it is estimated that, within ten years of onset of the disease, half of all sufferers are unable to maintain a full-time job. In the UK, in a survey carried out by the National Rheumatoid Arthritis Society in 2010, only 17.8% of respondents felt that the condition had not affected their employment.

The study’s lead investigator Dr Susan Barlett of McGill University, Canada, found that a non-smoking male with a healthy BMI would have a 41% chance of achieving sustained remission compared to 15% for an obese male smoker. For women, the probability is 27% compared to 10%. Dr Bartlett commented: “Our findings show that not smoking and a healthy body weight – lifestyle factors which can be modified by patients – can have a significant impact on becoming symptom-free.”

Cambridge-based Rheumatologist Professor Cathy Speed believes in a holistic approach to healthcare which in practical terms means addressing your general health, nutrition and lifestyle factors to produce optimal results. For a consultation with Professor Speed call 01223 200 595.

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Professor Cathy Speed discusses Rio commitment in Cambridge News

This August Professor Speed will be joining our Olympic athletes in Rio as the chief medical officer for the GB badminton team. She talked to the Cambridge News recently about what her job in Rio will entail. She also explained how her experience of the Olympics, which has now encompassed three Games, has informed her Cambridge practice where she treats everyone from top-flight athletes to those Cambridge residents struggling with the demands of arthritis.

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Are you just not built to run?

The latest figures released last week by Sport England show a marked upswing in those taking part in sporting activities, with more women than ever getting involved. Running remains ever popular, with a staggering one million more men and women running regularly compared to just ten years ago.

As organisations like Parkrun make running accessible to all, more and more of us are getting into this low-cost and highly beneficial form of exercise, but many of us struggle to take their running to the next level. Is it possible that we’re just not built to run?

Running and your genes

Your suitability to marathon running is dictated by a genetic element as proved by a study performed at Loughborough University two years ago. Researchers discovered a group of 30 genes that govern how the body responds to stamina training and its ability to run long distances. The study estimated that about 20 per cent of people will just not be able to increase their endurance, whatever the extent of their training, because their muscles just do not extract the same amount of oxygen.

Cambridge-based Sport & Exercise Medicine Specialist Professor Cathy Speed works with athletes at every level and from a wide range of sports, including top flight runners, and explains that understanding what makes an athlete ‘resilient’ is the main focus of anyone that works with and manages the health of our top sports men and women. Genetics do play a role, governing our cartilage strength, our adaption to training, our fitness and strength levels and bone, muscle and joint composition, but nature can be as much of a factor as nurture, particularly in terms of injury.

Running injury

Injury is a key factor in our running performance and it’s certainly true that some of us are more susceptible to injury than others. Joint laxity, also known as hypermobility, those with pre-existing or congenital joint abnormalities and those who are overweight are all at a higher risk of incurring injuries.

However, as Professor Speed explains, “Most injuries occur because much as someone might be built to run, they are not fit to run! When people pick up a new sport or activity they tend to do it partly because it will make them fitter. Overall that is true, but it also is the case that we need to get fit to do a sport.”

We lead increasingly sedentary lives and trying to cram a run into a spare hour is the biggest mistake that new runners can make. Invest the time in building your fitness levels even before you begin pounding the streets and focus on strengthening your core. When you start running you should mix it up with other forms of exercise. Trying to do too much too soon is also a common running injury problem so set yourself realistic goals.

If you do incur a running injury then turn it into a positive. “Being a ‘runner’ means gaining experience in how to recognise the warning signs of injuries,” Professor Speed often tells new runners she sees at her Cambridge sports injury clinic. “That first injury, however unpleasant it is, is an opportunity to learn from the experience and to return fitter and stronger than before.”

To arrange a consultation at Professor Speed’s Cambridge sports injury clinic, please call 01223 200 595.

 
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Inflammation and tendon disorders

Tendons are the bands of fibres that attach muscles to bones, producing the movement of our joints. They are a common injury that can cause great discomfort and lack of mobility for the sufferer and, over the last few decades, doctors have debated whether they are due to ‘degeneration’ or inflammation. For many years, the bias has been to the former and as Professor Cathy Speed explains in a new book due to be published by Springer, this may have led to patients missing out on effective early treatment of these conditions.

Due to be published in June, ‘Metabolic Influences on Risk for Tendon Disorders’ brings together contributors from across the world who are specialists in tendon injuries. Cathy’s chapter entitled ‘Inflammation in tendon disorders’ focuses on the role that inflammation plays.

The tendons can become stressed due to a number of causes, including repetitive activities, force, vibration and awkward postures and this causes an inflammatory response. The tendons can then become thickened, bumpy and greatly weakened if early intervention is not made.

The link between inflammation and degeneration has been a source of great debate, as tendons can sometimes become damaged without inflammation and yet other scientific studies have indicated that inflammation should be viewed as an early warning sign for tendon injury.

What are the most common areas for tendon injury?

Any area of the body can be affected, but tendon injuries are common in the shoulder, particularly the rotator cuff. The elbow is also particularly prone for tendon problems and tennis elbow is an inflammation of the tendon that attaches the forearm muscles to just above the elbow. There are also a number of specific tendon disorders and conditions that affect the hand and wrist.

What are the treatment options for tendon injuries?

Tendon disorders usually present as pain at the site of injury, often accompanied with tenderness when touched. There is often swelling and redness and movement in the afflicted body part is restricted.

Prevention is the best option for treatment and this requires addressing the possible cause, whether it is due to the work environment or choice of sporting activity. Other treatment options include the use of NSAIDs or non-steroidal anti-inflammatory drugs for pain relief, corticosteroid injections, application of ice or heat and physical therapy that covers stretching and strengthening exercises.

As Cathy explains, the scientific evidence now supports the strong role of inflammation in tendon injuries and so newer treatments should be orientated towards this. She believes that there are definitely subsets of patients who have a lot of inflammation and these are often overlooked in sorts clinics. So detection – particularly early – and meticulous clinical assessment is vital.

For more information on how Cathy treats tendon disorders, please call 01223 200 595 and speak to one of the Cambridge clinic team.

 
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The Road to Rio: Vika and vaccinations

As our GB athletes learn whether they have qualified for this summer’s Rio Olympics, Professor Cathy Speed, Chief Medical Officer to the GB Badminton team, explains how they will be preparing for the Games in the following weeks and months.

The Rio experience

Obviously, climate and culture will be vastly different in Brazil to the UK, so some of the preparation will be dedicated to informing the athletes as to what they can expect in Rio, covering the environment, facilities, timetables and even Zika.

The Zika virus presents as a fever and a rash, often accompanied with joint pain and conjunctivitis, and it can last several weeks, but most sufferers do not require hospital treatment. The panic over Zika stems from its link to birth defects when pregnant women are exposed to the virus.

Zika and the Olympics

Since the World Health Organisation declared the Zika virus a global public emergency, there has obviously been much apprehension about how it will affect our athletes and the support staff that will be travelling with them.

There is no vaccination for the Zika virus, so advice is based on prevention. Athletes are encouraged to use mosquito repellent liberally as soon as they land in Rio and mosquito nets will be provided. The International Olympic Committee are inspecting venues now and will continue to do so through the Games to ensure that there are no stagnant pools of water present, which are the breeding ground of mosquitos.

August is also midway through Brazil’s winter season so the climate will be dryer and cooler, than in recent months, which will hopefully ease the problem.

Other countries are tackling the Zika problem in different ways. The use of condoms to minimise the spread of Zika through sexual activity has been advised by the World Health Organisation and there will be free dispensing machines throughout the Olympic village. The Australian Olympic Committee has taken it one stage further and is providing its athletes with ‘dual protection’ condoms which claim to be Zika virus-proof.

South Korea, on the other hand, has issued its national team with uniforms featuring long trousers and long-sleeved shirts, all of which have been infused with insect repellent

Zika is not the only mosquito-borne disease that athletes have to protect against. Although there is no vaccination for Zika, there is one for Yellow Fever, which is prevalent in many parts of Brazil. Our athletes will have their vaccinations pre-Games for travelling to Brazil by the end of June, and these are timetabled so that any minor side effects do not interfere with preparations. Many will get anxious about this but adverse effects are very rare.

However, it’s not just the athletes that are worrying about the Zika virus, as it is estimated that more than 600,000 people will travel to Brazil this August to watch the Rio Olympics. Advice from the Centre for Disease Control and Prevention includes avoiding mosquito bites by covering up arms and legs and using insect repellants. At night, it is important to use a mosquito net and screen and crank up the air conditioning.

 
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Osteoarthritis sufferers are twice as likely to need time off sick

The impact of osteoarthritis, the most common form of arthritis affecting men and women in the UK, should not be underestimated as a new study published in Rheumatology finds.

Researchers at the University of Calgary and Statistics Canada found that osteoarthritis sufferers are almost twice as likely to need time off work and are three times as liable to become unemployed.

Culling their data from the National Population Health Survey, the researchers selected 659 osteoarthritis sufferers and compared them with over 2,000 adults of the same age and sex who didn’t display osteoarthritis symptoms. They then focused on work time loss recorded between 2000 and 2010. The research team discovered that work time loss was 90 per cent higher and that unemployment as a result of illness and disability tripled in osteoarthritis sufferers.

Why does osteoarthritis pose such a growing problem to the UK population?

Osteoarthritis is typically a progressive disease which gradually becomes worse over time, particularly if the sufferer does not seek treatment. Every joint in the body is cushioned with cartilage, a firm, flexible lining that protects the joints, allowing free range of movement. As the cartilage wears down, it thins and can disappear altogether, causing the joints to become stiff and painful.

Each year, a fifth of the population seeks medical help for a musculoskeletal condition and it is estimated that those figures will continue to rise as we face a growing obesity epidemic and the associated lack of physical activity, both key factors in the development of osteoarthritis.

Osteoarthritis is not just a condition that affects the elderly. According to Arthritis Research UK, almost a third of people aged over 45 have sought treatment for osteoarthritis, including over half a million women of working age seeking treatment for osteoarthritis of the hand or wrist. This rapidly increasing problem will only become more of an issue for the UK government and individuals.

If osteoarthritis is limiting your ability to perform your job effectively or even perform normal everyday tasks, then call 01223 200 595 to book a consultation at Professor Cathy Speed’s Cambridge arthritis clinic.

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If paracetamol won’t help with joint pain, what will?

New research published in The Lancet has suggested that paracetmol, commonly prescribed to help with the discomfort and joint pain associated with osteoarthritis, is largely ineffective, even in large doses which are then accompanied by potential side effects.

Osteoarthritis is the most common musculoskeletal condition affecting older people – it’s estimated that one in ten men and one in five women over age of 60 are suffering from this type of arthritis. Here in the East of England, Arthritis Research UK has collated figures for hip and knee osteoarthritis and 17.8 per cent of the Cambridgeshire population aged 45 years and over are suffering from knee inflammation and 10.7 per cent are estimated to have arthritis of the hip.

With a high percentage of those men and women categorised with severe osteoarthritis and paracetamol determined as ineffective, what can be done to manage the pain and stiffness that can limit the sufferer’s ability to perform even simple tasks:

# 1 Other medications

Researchers at the University of Bern, Switzerland, that carried out the study into paracetamol found that non-steroid anti-inflammatory drugs, specifically diclofenac, was the most effective osteoarthritis treatment. However, long-term use of this drug is discouraged and it is only suitable for occasional joint pain relief.

# 2 Muscle strengthening exercise

According to the latest guidelines from the National Institute for Health and Care Excellence (NICE), exercise should be the ‘core treatment for managing osteoarthritis’, both to relieve joint pain and also to improve function and mobility.

Stronger muscles can take stress off our joints, but there may be initial resistance, stiffness and pain, and your natural response might be to give up. Seek expert advice from a Sports & Exercise Medicine specialist who can prescribe a programme that will ensure your joints become more flexible and better protected by the supporting muscles.

# 3 Lifestyle changes

Also included in NICE’s recently updated guidelines was the importance of the osteoarthritis sufferer making fundamental lifestyle changes, particularly losing weight if overweight or obese.

If osteoarthritis is impacting on your quality of life then Professor Cathy Speed can provide advice and treatment for the management of this serious condition. To book a consultation at her Cambridge clinic call 01223 200 595.

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The history of sports medicine

Sports and exercise medicine, often known as SEM, is the most recently recognised medical specialty in the UK, becoming established as a faculty by the Royal College of Physicians just ten years ago. Yet the history of sports medicine is a lengthy one and SEM’s reach in the general public is extensive, from the very highest level of athletic endeavour to those leading a purely sedentary life.

The aim of sports and exercise medicine is to deliver expert care in injury management and illness, physical activity and sport. Sports medicine can be applied to an individual or team’s performance at any level, both in the prevention and rehabilitation of injury. Exercise as a tool for health is now heavily promoted as physical inactivity is one of the leading problems affecting public health in the UK.

Sports medicine in ancient times

Hippocrates (469-399 BC) is described as the ‘Father of Medicine’ and is probably the most famous of the Greek physicians. He was thought to be an army physician at one point, but the works of medical literature attributed to him seem to be devoted more to the description of athletic injuries.

Wrestling was very popular in Greek times and most young men would join the palaestra or wrestling school. Another popular sport was pankration, a mixture of boxing, judo and wrestling, and the diagnosis and treatment of injury that Hippocrates described relates closely to injury types common to these sports.

Hippocrates learned his art from Herodocus, who was a physician, but was also known as a ‘trainer of athletes’. Herodocus is credited with the use of therapeutic exercise as a way to help with the healing of injury.

However, the link between medicine and sport in ancient times is best exemplified by Galen, a doctor in the second century AD, who could claim the title of father of sports medicine. His first post was as doctor and surgeon to the gladiators in Pergamum before moving to Rome where he became the personal physician to the emperor Marcus Aurelius.

The establishment of sports medicine

In modern times, the establishment of sports medicine can be traced back to the 1928 Winter Olympics, held in St Moritz. A committee was formed to organise an International Congress of Sports Medicine. Not just for the treatment of sports-related injuries, but also to develop the concept of preventing its occurrence.

The Olympics were key to the development of sports medicine in modern times and in 1968, Dr J.C. Kennedy organised a team of doctors to accompany the Canadian athletic team to the 1968 Summer Olympics and in 1972 he was made the Chief Medical Office for the Olympics that were held in Munich.

The future of sports medicine

Scientific advances, in the form of developing more advanced sports equipment that lessens the chance of injury, new technology to more accurately diagnose and, from there, more specialised care and innovative therapies to treat and rehabilitate, are the future of sports medicine.

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