Physiological variations between men and women can be considered as predictive factors for the risk of lower limb pathologies; a number of studies have been published to determine the extent to which women are more susceptible to certain injuries than their male counterparts.
With young female athletes more likely to suffer from anterior cruciate ligament (ACL) injury than men, the increased incidences of such lower extremity pathologies in women require an in-depth understanding of anatomical, neuromuscular and hormonal differences between the sexes to develop successful intervention and treatment strategies.
Bruce D. Beynnon, of the Department of Orthopaedics and Rehabilitation at the University of Vermont, reviewed two categories of intrinsic risk factors – an athlete’s anatomy and the menstrual cycle phase.
It was established that irregularities in lower extremity alignment can contribute to significant increases in ACL strain values, with females possessing a narrower notch, higher-than-average body mass index, and general joint laxity at a higher risk of incurring an ACL injury.
An interesting fact to emerge from the literature was the risk of an ACL disruption being at its peak during the pre-ovulatory phase of the menstrual cycle than the post-ovulatory phase, most likely because of the increase in estradiol and the decreased concentration of progesterone influencing the composition of the ligament in this phase.
Neuromuscular control differences in 205 female adolescent soccer, basketball and volleyball players were analysed by Hewett et al. to support the hypothesis that decreased neuromuscular control and increased valgus joint loading are indicative of ACL risk.
Using 3-dimensional kinematics and joint moments during a jump-landing task, the nine athletes with a confirmed ACL rupture were determined to have high abduction loads and increased dynamic valgus; this necessitates the implementation of improved neuromuscular training as a preventative measure for female athletes participating in high-risk sports.
Biomechanical components such as an increased Q-angle prevalent in women can also contribute to the development of knee-specific conditions such as chondromalacia patellae and patellar tracking dysfunction.
This stems from the higher lateralisation force on the patella by the quadriceps which leads to increased retropatellar pressure between the lateral facet of the patella and the femoral condyle. This can cause a gradual degeneration of the joint cartilage in the patella, leading to pain and discomfort.
Structural modifications albeit difficult can be accomplished through the use of supportive foot devices which help to decrease the stress on the patella by reducing excessive internal tibial and femoral rotation, in turn, significantly improving the Q-angle.
This helps in the prevention of a number of overuse injuries whilst restoring the Q-angle to a more normal level and correcting any excessive pronation which could potentially cause more dysfunctions in the patellofemoral complex and the lower extremity in general.
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