May 13, 2008


The Uneven Playing Field (MICHAEL SOKOLOVE, 5/11/08, NY Times Magazine)

If girls and young women ruptured their A.C.L.’s at just twice the rate of boys and young men, it would be notable. Three times the rate would be astounding. But some researchers believe that in sports that both sexes play, and with similar rules — soccer, basketball, volleyball — female athletes rupture their A.C.L.’s at rates as high as five times that of males.

Anthony Beutler, a major in the U.S. Air Force and a professor at the School of Medicine of the Uniformed Services University in Bethesda, Md., is among the cadre of doctors, scientists and researchers trying to crack the code of A.C.L. injuries. In 2001-2, he was a sports-medicine fellow at the Naval Academy, where he served as the physician for the women’s soccer team. Seven women were lost that season to A.C.L. ruptures. Beutler, already immersed in A.C.L. research, was still stunned. “I thought to myself, What in the heck is going on here?” he said. Last season, the women’s team at Navy suffered three torn A.C.L.’s. “They thought that was great, a fortunate year,” he told me. “Think about that. Just three. It’s bizarre.”

Men also tear their A.C.L.’s, most frequently in football and from direct blows to the leg. But even football players, according to N.C.A.A. statistics, do not rupture their A.C.L.’s during their fall seasons at the rates of women in soccer, basketball and gymnastics. The N.C.A.A.’s Injury Surveillance System tracks injuries suffered by athletes at its member schools, calculating the frequency of certain injuries by the number of occurrences per 1,000 “athletic exposures” — practices and games. The rate for women’s soccer is 0.25 per 1,000, or 1 in 4,000, compared with 0.10 for male soccer players. The rate for women’s basketball is 0.24, more than three times the rate of 0.07 for the men. The A.C.L. injury rate for girls may be higher — perhaps much higher — than it is for college-age women because of a spike that seems to occur as girls hit puberty.

If you are the parent of an athletic girl and live in a community that bustles with girls playing sports — especially the so-called jumping and cutting sports like soccer, basketball, volleyball and lacrosse — it may seem that every couple of weeks you see or hear about some unfortunate young woman hobbling off the field and into the operating room. The first time, you think: What a stroke of bad luck. But you figure it won’t happen to your daughter because, after all, what are the odds?

After a couple of more A.C.L. tears in the neighborhood, you get worried and think, Gosh, we must be in a really bad cluster for these injuries. Why here? But in all likelihood, what you are witnessing is not a freakish run of misfortune but the law of averages playing out.

The Injury Surveillance reports include commentary as well as data, and in 2007 the authors stated that an A.C.L. rupture is “a rare event” and advised against making too much of the tears sustained by male and female collegiate athletes across a range of sports. But a young woman playing college soccer can easily generate 200 exposures a year between her regular season in the fall, off-season training in the spring and club play in the summer. Plenty of younger players, girls in their early through late teens, will accrue well in excess of that number between their high-school seasons, their club seasons — which often run year-round — and multigame tournaments on weekends and soccer camps in the summer. (The same is true in other sports in which girls play school and club seasons, including basketball, lacrosse, volleyball and field hockey.)

So imagine a hypothetical high-school soccer team of 20 girls, a fairly typical roster size, and multiply it by the conservative estimate of 200 exposures a season. The result is 4,000 exposures. In a cohort of 20 soccer-playing girls, the statistics predict that 1 each year will experience an A.C.L. injury and go through reconstructive surgery, rehabilitation and the loss of a season — an eternity for a high schooler. Over the course of four years, 4 out of the 20 girls on that team will rupture an A.C.L.

Each of them will likely experience “a grief reaction,” says Dr. Jo Hannafin, orthopedic director of the Women’s Sports Medicine Center at the Hospital for Special Surgery in New York. “They’ve lost their sport and they’ve lost the kinship of their friends, which is almost as bad as not being able to play.”

Marshall says he feels a sense of urgency, because without a better understanding of the injury, the situation will get worse in coming years with the great numbers of girls playing sports — and the frequency and intensity of their play. In 1972, at the dawn of Title IX, about 300,000 girls participated in high-school sports. The number is now three million. Thirty thousand women played college sports pre-Title IX; about 205,000 now play.

“We’re studying an elite population at the service academies, but the big concern for me is the girl down the street who wants to play soccer on the rec team or the travel team,” Marshall told me. “They’re ripping their knees up, and they shouldn’t be. There’s got to be a way to prevent it. And we’re really on the up curve of this, because it’s still relatively recent that girls played sports in these large numbers. . . . So if you think we have a problem now, 10 years from now we’ll have a much bigger problem.”

...girls playing soccer is two of them.

Posted by Orrin Judd at May 13, 2008 3:55 PM

My 24 year-old niece has always loved to play soccer.
So far, she's has whack out both knees. And both of her wrists have been injured so much that they are now fused and immobile.

Posted by: ray at May 13, 2008 8:40 PM


I thought the whole point here was that Soccer was a girl's game. Lets get straight on the invective and sarcasm.

Posted by: Lou Gots at May 14, 2008 7:00 AM

I don't think it's because girls are weaker. I think they go all out more than boys...

Posted by: Bartman at May 14, 2008 8:52 AM

What kind of misogynist hates wymyn enough to see them hurt themselves playing such a stupid game?

Posted by: oj at May 14, 2008 11:38 AM

I didn't read the entire article, but I read a similar one several years ago that focused on the design of a woman's hips and how it changes the angle of the femur.

Posted by: Patrick H at May 14, 2008 11:45 AM