Special Considerations in Female Athletics
By R. C. Schafer, DC, PhD, FICC
Manuscript Prepublication Copyright 1997
Copied with permission from ACAPress
Growth, Development, and Function
Strenuous Activity During Menstruation
The Breasts and Genital Organs
Temperature Responses in Sportswomen
References and Bibliography
Girls and women are now taking an increasing role in sports as various
taboos and culturally imposed restrictions give way. While women
have long been active in such sports as tennis and golf, they
have recently increased their participation in such violent
activities as wrestling, boxing, football, and demolition
To ensure optimal endurance and performance, adequate iron is
necessary in he diet to carry oxygen to the cells. Iron
deficiency is the most common nutritional fault in American
females. A female loses from 5 to 45 mg of iron per day during
menstruation. Thus, most female athletes require diet supplements
and frequent monitoring of blood-iron content.
few studies dealing specifically with women in the training
environment have been done. Gender differences in heart size,
muscle mass, relative hemoglobin content of blood, oxygen
consumption, anthropometric measurements, and body composition
have been noted.
Pollock/Wilmore list some studies that conclude that the
performance of postpuberty female runners is similar to that of
males when males ran with trunk weights equal to the percent fat
of weight-matched women. We must keep in mind that the essential
fat of the female cannot be eliminated by diet or training; thus,
it becomes a biologic justification for separate standards and
GROWTH, DEVELOPMENT, AND FUNCTION
capacity for physical activity during childhood is equal for both
sexes. Strength, cardiovascular endurance, and motor skills
exhibit few differences between the sexes to the age of 12 years.
After adolescence, however, males develop faster physically,
which allows for greater power and potential, but the capacity to
develop motor skills remains about equal. Contrary to common
opinion, women have achieved much greater muscle strength without
an appreciable change in muscle bulk. Weight-lifting, with proper
technique, will not necessarily cause undue hypertrophy.
The ratio of lean body mass to fat is one of the most obvious
physical differences. Males typically have greater bone strength
and density, greater muscle bulk and broadness in the shoulder
area, and greater subcutaneous fat in the upper half of the body.
At maturity, females are generally shorter in height, have more
flexibility in their joints, have more delicate ligaments and
tendons, have more subcutaneous fat in the hips and lower body
regions, have less erythrocyte and hemoglobin mass, and exhibit a
greater degree of pelvic tilt and obliquity.
The female elbow offers a greater carrying angle and tendency
toward cubitus valgus, and the female has smaller lungs, heart,
liver, and kidneys than the male. Schroeder reports that female
joints are more subject to injury in sports requiring an
expulsive effort, sudden stopping, sudden checking of speed and
turns, and landing in jumps.
compared basic strength abilities of men and women and reported
that (1) lower extremity strength measurements in females range
57%-86% of males, averaging 71.9%; (2) upper extremity strength
measurements in females range 35%-79% of that of males, averaging
55.8%; and (3) trunk strength measurements for females range from
37%-70% of males, averaging 63.8%).
Pollock/Wilmore report that females average only 36.9% of
bench-press strength and 73.4% of leg-press strength of that of
males. But when expressed relative to fat-free body weight by
removing the influence of body fat, females have only 53.4% of
bench-press strength but 106.0% of leg-press strength of males.
Such statistics are of general interest but are of minor concern
clinically where we are dealing with unique individuals who are
determined not to be "average."
is more delicate than that of the male. Many dermatologic
problems can be prevented if conditioning and participation
progresses slowly enough to allow the skin to accommodate to the
acquired demands of excessive exposure to perspiration, dirt, and
bumps. During menstruation, large and bulky external sanitary
napkins may irritate inner thighs during prolonged vigorous
competition to the extent that a severe dermatitis develops.
Hair and fingernails also present special consideration. In
many sports, hair must be either cut short or pulled out of the
way of vision through tight braiding pulled into buns or
ponytails. This traction, however, has occasionally caused some
degree of hair loss and balding. Traumatized fingernails may
result in nail breaking and splitting leading to secondary
patterns occur in the menstruating female reflecting the effects
of ovulation. There is a fall in morning temperature just before
menstruation that continues at this level until the midpoint
between adjacent periods. In about 24-36 hours before ovulation,
the morning temperature rises and stays at a somewhat higher
level until just before the next menses.
NOTE: You may find this article of interest:
“Link Found Between Menstrual Cycle And Knee Injuries” as it states:
Researchers at the University of Michigan and the Cincinnati Sports Medicine Clinic have discovered that female athletes are more likely to suffer a common type of knee injury when their estrogen levels are highest.
Knee injuries, especially damage to the anterior cruciate ligament (ACL), have been characterized as an epidemic among women. Studies have shown that women are two to eight times more likely than men to suffer ACL tears. Such injuries often require surgery and up to a year of rehabilitation.
Theories abound over why women suffer more knee injuries, but there has been little objective proof. The U-M research team, led by orthopaedic surgeon Edward M. Wojtys, M.D., evaluated 40 young females with acute ACL injuries and discovered a disproportionately high number of the injuries occurred during the ovulatory phase of the athlete’s menstrual cycle. The ovulatory phase typically occurs during days 10-14 of the cycle and is marked by a significant rise in estrogen levels as well as high levels of a hormone called relaxin.
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STRENUOUS ACTIVITY DURING MENSTRUATION
exception of an athlete experiencing unusual discomfort or
excessive flow, there is no physiologic reason why training or
competition should be avoided during menstruation. Most Olympic
sportswomen do not interrupt training during menstruation,
although the type of training and the intensity of training may
be modified. About one out of four women sometimes interrupt
training, and only one out of 20 does not train during
menstruation. Although the majority of females prefer tampon
protection during some phase of menstrual bleeding, the
controversy about "toxic shock syndrome" deserves caution and
suggests frequent changes. Caution must also be given with
diaphragms continually worn and to intrauterine devices that
might complicate an abdominal blow.
The female athlete usually exhibits less colic, less
premenstrual headaches and tension, and greater regularity than
the nonathlete. Physical exercise appears to be a distinct aid in
the treatment of dysmenorrhea. Neither the menarche nor
conditions for future pregnancy are disturbed by active
participation in sports, and no detrimental long-range
gynecologic effects from vigorous physical activity have been
determined. However, according to Corwin, many female athletes
report disruption or even cessation of their periods during
intensive training. This is related to lowering the percentage of
body fat, which has a direct effect on hormonal levels and the
There is no doubt that the influence of menstruation on
athletic performance is a highly individualized effect. The
female athlete who is distinctly disadvantaged by the physiologic
function of menstruation can have her menstrual cycle medically
adjusted so that competition will occur at the optimum time of
her cycle, but this is not usually advisable. Eagles cautions
against the numerous, and often serious, side effects from
hormone therapy such as the potential for emboli formation
following small foot fractures and the visual changes some
females experience while on this type of medication. Headaches
and fluid retention are other common complaints detected from
THE BREASTS AND GENITAL ORGANS
breast protector is necessary in contact sports and in some
noncontact sports such as volleyball to prevent contusions and
pain. Breast injury may lead to a localized hematoma producing a
region of fat necrosis characterized by a firm and painless lump
that develops several weeks or months after the accident. This is
unlikely differentiated from breast cancer except by biopsy.
Haycock et al have shown that lack of an adequate supportive
bra can cause discomfort as well as injury to the breast when
walking and running. Their controlled-study data suggest that
women without proper breast support experience trauma to the
breasts and supporting ligaments, especially when the breasts are
large or pendulous. Thus, the need for a properly engineered
athletic bra is obvious. A sports bra should cover the breasts,
prevent slapping or lateral shifting during activity, and offer
enough support, without undue restriction or abrasiveness, that
there are no signs of ache or tenderness after activity. Metal
parts, seams, and allergenic effects may present problems.
The activity itself and the size of the breasts, along with
the tone of the supporting muscles and ligaments, determines
whether a special athletic bra, a regular bra, or no bra is
adequate. In modern dance or swimming for instance, the no-bra
situation may occur when the participants are small breasted
because the stretch material in leotards and swim suits (plus
water support) provides adequate support.
The most common direct genital injuries of women are those
involving vulva lacerations and hematomas (eg, in vaults,
hurdles). Forceful douching occurs in inexperienced water skiers,
which can result in serious gynecologic problems. Prevention can
be had by wearing rubber pants.
TEMPERATURE RESPONSES IN SPORTSWOMEN
woman has fewer functional sweat glands, body temperature in the
female rises 2 or 3 degrees higher than that of the male before
the cooling process of perspiration becomes significant. Thus,
acute heat stress is a greater concern of female athletes.
However, studies show that during prolonged activity in normal or
hot weather women have less change in body temperature as
compared to the male.
While males sweat more, females cool quicker after physical
activity in hot weather. Women appear to adjust their
perspiration rate more efficiently to the required loss of heat.
This suggests that females present more efficiency in body
temperature regulation and have a greater cardiovascular
component of thermoregulation.
a poor obstetric history, there is no evidence that a normal
pregnancy will be threatened by cautious exercise. Of all
athletics, swimming appears to be the best physical activity for
the expectant mother. On the other hand, there is evidence that
physical fitness regimens during pregnancy contributes to ease of
labor and postpartum light exercise assists the process of
involution. Following delivery, intense competition is usually
contraindicated for several months, especially if the mother is
Corwin advises that pregnant women should avoid increasing
body temperature especially during the 1st and 2nd trimesters.
Prolonged training in environments of high humidity and heat
(along with the practice of using hot tubs, saunas, and Jacuzzi
baths) can be responsible for raising body temperature for longer
than 10 minutes. This can cause irreversible neurologic damage to
the fetus. The personnel of spas and health clubs involved with
the pregnant women should be aware of this.
REFERENCES AND BIBLIOGRAPHY:
Corwin JM: personal correspondence. Oakland,
Harris DV (ed): Women and Sports: A National Research
Congress. University Park, Pennsylvania, Pennsylvania State
University, H.P.E.R. Series No. 2, University of Pennsylvania,
Haycock CE: Sports Medicine for the Athletic Female.
Oradell, New Jersey, Medical Economics, 1980.
Kane JE: Psychological Aspects of Sport with Special Reference
to the Female. University Park, Pennsylvania, Women and Sport: A
National Research Conference, College of Health, Physical
Education, and Recreation, 1972.
Kris-Etherton PM: Nutrition and the Exercising Female.
Nutrition Today, pp 6-16, March/April 1986.
Laubach LL: Comparative Muscular Strength of Men and Women: A
Review of the Literature. Aviation Space Environment
Medicine, 47:534-542, 1976.
Levy AM: Medical Illness. Sports Medicine for the Athletic
Female (C.E. Haycock, ed). Oradell, New Jersey, Medical
Munves ED: Nutrition. Sports Medicine for the Athletic
Female. Oradell, New Jersey, Medical Economics, 1980.
Schafer RC: Chiropractic Management of Sports and
Recreational Injuries, ed 1. Baltimore, Williams &
Schafer RC: Clinical Biomechanics: Musculoskeletal Actions
and Reactions, ed 1. Baltimore, Williams & Wilkins,
Shierman G: Conditioning the Athlete. Sports Medicine for
the Athletic Female. Oradell, New Jersey, Medical Economics,
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