Transcript Staying Active Across the Female Lifespan

Staying Active Across the Female Lifespan
Ellen Casey, MD
Assistant Professor
Associate Director Sports Medicine
Fellowship
Disclosures
 NIH K-12HD001907-15
Why focus on females?
• Sex differences in anatomy, biomechanics and
physiology
Different injury profile
• Risks and types of injuries change throughout
the lifespan
• Knowledge of these factors is essential for
providing comprehensive care
Impact of Title IX
1972
• 1 out of every 27 females participated in
athletics
2002
• 1 in every 2.5 females participated in
athletics
Benefits of Sports Participation
•
•
•
•
•
Higher graduation rates
Decreased risky behaviors
Increased self-esteem
Decreased depression
Decreased risk of:
– Obesity, DM, CAD,
Osteoporosis, Cancer
Coe 2006
MSK problems more common in
female athletes
• ACL injury
• SIJ Pain/Dysfunction
• Stress Fracture
• Pelvic Floor Dysfunction
• PFPS
• SUI
• FAI (pincer-type)
• Chronic ankle instability
• Hip Labral tear
• Lateral Epicondylosis
• Hip and knee osteoarthritis
• Concussion
Sallis 2001; Taunton 2002; Schaffer 2006; Burnett 2006; Boles 2010
Puberty
Menopause
Pregnancy
The Adolescent Female:
Focus on ACL injury
Why focus on ACL injuries?
Granan 2008
REFERENCE
SPORTS
LEVEL
ACL INJURY RATE
(above that of males)
Renstrom et al
Soccer
Collegiate
2.5
Lindenfeld et al
Soccer
Youth
3.0
Arendt et al
Basketball
Collegiate
4.1
Mykelbust et al
Handball
All
5.0
Gwinn et al
Military
Collegiate
9.7
Risk of OA is 40-80% greater after ACL injury3
Gender Gap in ACL Injury
• Females are less likely to return to sport
after ACL injury
ACL Injury is Multi-factorial
Risk Factors for ACL Injury
Biomechanics
Hormonal milieu
Female vs. Male Landing
• Inadequate shock
absorption
• Poor hip dynamic
stability
• Poor lumbopelvic
stability
Increased valgus load on knee
Hewett 2005, Boden 2009,
Sigward 2012
Risk Factors for ACL Injury
How might sex hormones affect
ACL injury?
• Receptors throughout the
neuromusculoskeletal system
• Relationship between menstrual cycle
phase and:
– Ligamentous laxity
– ACL injury
– Neuromuscular control
Review of the Menstrual Cycle
Casey 2014
Fluctuations Across the
Menstrual
Reese & Casey
2014
(unpublished)
Sex Hormone Receptors
Progesterone13
Testosterone
14
Relaxin
Estrogen13
Ligament
15
Sex Hormone Receptors
Testosterone
Estrogen
14
Relaxin
16
Muscle
Tendon
15
Modulatory Role in Collagen
Synthesis Relaxin
Estrogen13
Progesterone13
Testosterone17
18
ACL LAXITY & menstrual phase
Adapted from
Zazulak 2006
ACL INJURY & menstrual phase
Adapted from
Zazulak 2006
Vescovi 2011
Sex Hormones Modulate Nm
Control
• Friden et al. 2006:
– Better performance on square hop test
Sex Hormones Modulate Nm
Control
• Dedrick et al. 2008
– Shift in motor control across the cycle
– Different co-contractive behavior between
gluteals and hamstrings
Sex Hormones Modulate Nm
Control
• Park et al. 2009
– Incr knee laxity  incr knee loading
(ovulatory phase)
Muscle Stretch Reflex
• Basic unit of Nm control
Muscle Stretch Reflex
31
Rectus Femoris
Casey 2014
4x
1.5x
Origin of the change?
How can we intervene?
Neuromuscular
Re-education
Modify the hormonal
milieu
Neuromuscular Training is
Effective
Hewett 1999
Nm retraining + hormones?
• Is there an optimal time during maturation
or within the menstrual cycle to conduct
Nm re-education?
Summary
• ACL injury is multi-factorial
• Modifiable factors
– Biomechanics/Nm control
– Sex hormones?
• A more complete understanding can inform
injury prevention strategies
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