From the Editor

From the Editor, Dr. Miho J. Tanaka Journal of Women's Sports Medicine

Return to Sport Following Anterior Cruciate Ligament Reconstruction: Women's Lacrosse

Participation in women’s lacrosse has increased in popularity over the last 20 years with a subsequent rise in sports-related injuries. Despite this increase, there is a paucity of research examining this population, particularly regarding guidelines for safe return to lacrosse after anterior cruciate ligament (ACL) reconstruction. A lacrosse-specific functional rehabilitation program is critical to the success of the athlete. The athlete must be prepared and demonstrate the ability to cut, pivot, jump, pass, and shoot with the incidental contact required for sport clearance. A criterion-based program delineating a progression of range of motion, mobility, strength, neuromuscular control, agility, and cardiovascular training is an essential part of ACL rehabilitation. Early incorporation of lacrosse-specific skills emphasizing multiplanar neuromuscular control should gradually progress to more challenging field-based tasks as the athlete transitions through their rehabilitation program. A multidisciplinary team of physicians, physical therapists, athletic trainers, strength and conditioning specialists, coaches, and parents must collaborate effectively to reduce the athlete’s risk for reinjury, meet the demands of the sport, and facilitate returning to the field without complications. Associated video content

Sex-Specific Differences in Perceived Injury Management and Prevention in High School Student-Athletes

BACKGROUND: Sport-related injuries are common among high school student-athletes with specific sex disparities in injury risk. Many of these injuries may be avoidable with the use of injury prevention programs (IPPs). Sex differences in injury management and return to sport are not well understood. PURPOSE: To determine sex-specific differences in self-reported injury management and prevention strategies in high school student-athletes. DESIGN: Cross-sectional, survey-based study. METHODS: An anonymous 13-item electronic survey was distributed to all students in a private high school in December 2019 with responses recorded over a one-month study period. Primary outcomes were sex-specific differences in self-reported outcome measures assessing student-athlete experience during injury recovery and familiarity with IPPs. Groups were evaluated via descriptive statistics and differences between groups were compared. RESULTS: From a total of 190 responses, 106 were included in the analysis (63F, 43M, mean age 16.7 years). Female athletes reported decreased exposure to injury prevention training (44.4% vs 69.8%, p=0.01) and practice-based utilization of IPPs (23.8% vs 55.8%, p=0.001) compared to male athletes. Overall, reported utilization of IPPs was low regardless of sex at less than 40% for all athletes. Nearly 85% of female athletes compared to 51% of male athletes felt they could benefit from IPPs (p=0.001), yet fewer than half of female athletes reported ever having training in injury prevention. There were no statistically significant differences in measures of injury management or return to sport between sexes. Females reported similar major impact of injury on life and future plans compared to male athletes. CONCLUSIONS: Male athletes were 1.6x more likely to report injury prevention training and 2.4x more likely to report practice-based utilization of IPPs compared to female athletes. Sex-specific differences in injury management and return to sport were not identified. Better incorporation of IPPs, specifically at the high-school level, may help to address sex disparities in preventable sport-related injuries and allow student-athletes to maximize the myriad benefits of sport participation.

History of Women's Sports Medicine

This editorial reviews the rationale for development of Women’s Sports Medicine Programs in the United States. Current issues surrounding the lack of sex-specific analysis in the published literature are reviewed. There is an ongoing need for basic, translational, and clinical research in optimizing care of female athletes and active women of all ages. The importance of the newly established Journal of Women’s Sports Medicine in fulfilling that need is discussed.

Hamstrung: Do Sex Differences in Hamstring Injury Profile Necessitate a Different Approach to Rehabilitation and Prevention Programs in Female Athletes?

Hamstring strain injury (HSI) is one of the most common injuries encountered in running sports and can lead to significant morbidity, with time lost from participation and high rates of recurrence. Though the incidence is high in both sexes, male athletes appear to have a two to four-fold greater risk of HSI compared to female athletes, with a longer recovery. Multiple potential risk factors have been studied and age, history of hamstring injury, ACL injury and calf injury appear to be the most significant factors in predicting index injury and recurrence. Female athletes may be relatively protected by less hamstring unit stiffness and greater muscle endurance. Other potential sex-influenced risk factors including differences in pelvic, hip and knee structural morphology and limb alignment, musculotendinous flexibility and joint mobility, and kinetic chain (primary posterior) strength imbalances require further investigation. Further research focusing both exclusively on female athlete as well as more robust comparative studies with male athletes will help us to better understand differences in HSI profile. Future investigation is necessary to determine whether a sex-specific approach to HSI rehabilitation and prevention programs will optimize clinical care for both male and female athletes.

Sex-based Differences in Hamstring Injury Risk Factors

Hamstring injuries (HSI) are common in a number of different sports and can confer a significant burden to both male and female athletes. Though research on HSIs in the female athlete population is lacking, current literature suggests male athletes are between two to four times more likely than female athletes to sustain an HSI. Despite this discrepancy, the role of intrinsic sex differences in HSI risk factors has not been previously explored. This review aims to summarize these sex-based differences in HSI risk factors and their influence on the lower rate of HSIs seen in female athletes as compared to male athletes. Women exhibit increased hamstring flexibility and decreased hamstring musculotendinous stiffness as compared to men; women are also shown to be more resistant to skeletal muscle fatigue. Sex differences in the hamstring to quadriceps ratio and certain lower limb morphologies may also contribute to the sex discrepancy in HSI rates. This remains an area for future research in order to understand the multifaceted nature of HSI injury risk factors and optimize HSI rehabilitation and prevention programs for both male and female athletes.