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It's been 50 years since the passage of Title IX. This federal civil rights law has profoundly changed education by unlocking access to educational and athletic opportunities for girls around the country. But despite these tremendous advances, some key anatomical and physiological differences between boys and girls put young female athletes at a disadvantage when it comes to injuries.
Young athletes often begin their competitive sports careers as early as age seven, with some participating in organized sports activities as early as age four. With sports injuries being the second leading cause of emergency room visits for children and adolescents, could there be a difference between boys, girls, and the most common sports injuries pediatricians treat?
"I would say that for the vast majority of common injuries that we talk about in sports (ankle and ACL injuries, as well as concussions), the literature clearly indicates that girls tend to suffer more frequently from these sorts of injuries than boys," explained Arvind Balaji, MD, a Stanford Medicine Children’s Health pediatric sports medicine specialist who sees patients at their Pleasant Hill location in partnership with John Muir Health. "For both boys and girls, it's worth noting that contact sports like soccer and basketball seem to contribute the most injuries."
What's behind this difference?
It all comes down to two key factors: anatomy and physiological changes. "What causes these divergences is connected to some of the anatomic and physiologic changes that each sex goes through as they're developing during their early childhood and through puberty," noted Dr. Balaji.
More than seeing a clear difference in the type of injuries young athletes of different sexes develop, experts explain what changes are the causes and patterns behind the injuries. "As much as we would like to think that there may be significant differences in the types of injuries that boys would develop rather than girls when you get down to the specifics of the injuries in themselves, injuries are largely the same," Dr. Balaji said. "What changes are the patterns and the frequency with which they developed these injuries. That's what's really different."
For example, research consistently shows that girls are at a higher risk for knee and hip injuries, especially after going through puberty. As they develop a wider pelvis and hips, there's a wider angle between their hips and knees. When quickly pivoting, like when playing soccer, this wider angle puts more pressure on their knees. This, combined with the fact that people with female anatomy tend to have thinner ACLs, brews a perfect storm for tears and painful injuries.
Unfortunately, these injuries can also require longer healing times and more rehabilitation. "Athletes with female anatomy may require a longer rehabilitation to improve hip and core strength," Dr. Balaji explained. "We treat and rehab all athletes the same, but those with female physiology may need more time."
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The problem with head injuries
If there's one particular type of injury with a disparity between the sexes that’s causing the most concern, it’s concussions. Though researchers are still exploring the reasons, studies consistently show that young female athletes tend to suffer from more concussions than their male counterparts, even when playing the same sport. Additionally, they require more time to recover.
According to Dr. Balaji, there's no clear explanation for this problem. "It could be that girls tend to develop more slender necks as they're growing. They tend to have a little bit less control of their neck muscles and strength," he said.
But even though the cause of the disparity may still be up for debate, the path toward equal recovery times is much clearer. "All the data suggests that if you can get girls into seeing a concussion specialist or their pediatrician who's comfortable with taking care of concussions, if we can get them in at the same time that we're doing with the boys, then the chances of them recovering at the same time is actually pretty good," Dr. Balaji said.
Another piece of the puzzle may be the more subtle ways that girls might show different symptoms like mood changes, mild headaches, or concentration problems. "We need to do a better job at recognizing symptoms in girls to get them the care they need as early as possible," Dr. Balaji asserted.
What can parents do?
Despite the differences mentioned above, with sports becoming more competitive, seasons getting longer, and young athletes playing equally hard, injuries are trending in similar directions. "Depending on the specific sport they play, and as the level of competition accelerates, children's injuries are more similar than different," Dr. Balaji said.
There's no foolproof way for young athletes to avoid injuries, but there are things both kids and parents can do to minimize their risk and impact. If a parent notices that their child is athletic and is showing interest in a specific sport, they should bring it up to their pediatrician. They might feel comfortable guiding you, or they might refer you to a pediatric sports medicine specialist, like Dr. Balaji. "When we're examining young athletes in the clinic before they have an injury, we have a series of physical exam tests,” he said. “We might notice that your body isn't lining up correctly or if your core is strong enough. We can show kids some strengthening and stretching exercises that will prevent some common injuries related to the specific sport they practice."
Parents should also be mindful of kids playing too much of the same sport. With seasons lasting longer and kids being part of multiple teams, the risk of injury increases. "That level of competition and exertion on a developing body is really more of the concern," explained Dr. Balaji. To address this situation, experts are recommending that parents expose their children to multiple sports and take breaks. Ideally, kids should stop practicing their main sport for three non-consecutive months during the year, and one day of the week should be dedicated to rest and recovery from all activities. This can help their bodies avoid overuse of certain muscle groups and can also address potential burnout.
If you have a young athlete at home, there are steps you can take to avoid unwanted injuries. With a team of sports medicine doctors, physical therapists, and athletic trainers, the experts at Stanford Medicine Children's Health are ready to work with kids of all ages and help them perform at their best. Click here to learn more or call 844-416-7846 to schedule an appointment.
