Monograph 10

Special Considerations in Female Athletics

By R. C. Schafer, DC, PhD, FICC
Manuscript Prepublication Copyright 1997

Copied with permission from  ACAPress


General Objectives
Growth, Development, and Function
Strength Training
Dermatologic Problems
Ovulatory Patterns
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 derbies.

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.


Relatively 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 expectations.


The 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.


Laubach 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."


Female skin 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 infection.


Temperature 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.


With 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 menstrual cycle.

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 cycle alteration.


A metal 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.


Because a 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.


Except with 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 breast feeding.

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.


Corwin JM: personal correspondence. Oakland, California, 1981.

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, 1972.

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 Economics, 1980.

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 & Wilkins, 1982.

Schafer RC: Clinical Biomechanics: Musculoskeletal Actions and Reactions, ed 1. Baltimore, Williams & Wilkins, 1983.

Shierman G: Conditioning the Athlete. Sports Medicine for the Athletic Female. Oradell, New Jersey, Medical Economics, 1980.

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