North Carolina has welcomed its first professional women’s soccer team to Charlotte this fall in the Carolina Ascent FC, putting female athletes in the spotlight.
One of the team doctors, Dr. Elizabeth Ichite of Novant Health SouthPark Family Physicians, is a former athlete herself. She was a first team All-American 400-meter runner for the Florida State women’s track team. As a senior in 2015, her 4 X 400-meter relay team finished third in the NCAA Outdoor Track & Field Championships.
Serving as the team orthopedist is Dr. Kaitlyn Hurst also of Novant Health Orthopedics & Sports Medicine - Ballantyne. Dr. Jacquelyne Murray and Dr. Pulak Patel also provide sideline coverage and help see athletes in their clinics when needed.
Here, Ichite (pronounced E CHEE TAY) shares insights into how injuries to female athletes can differ from those of males and what can be done to prevent them.
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Q. Do you see different injuries with female soccer players than with male players?
Yes. In general, there are certain injuries females are set up for just by our anatomy. One of those can be anterior cruciate ligament (knee) injuries. The rate can be in higher in females due to our body alignment, body composition and even different hormonal factors. Another thing we see is a higher rate of concussions in female soccer athletes. We believe this to be due to decreased neck size and strength, as well as increased head acceleration in comparison to their male counterparts.
Q. Does the prevalence of ACL injuries have to do with angle of women’s hips?
Yes, the quadriceps angle (Q-angle), which is the angle between the upper and lower leg, is greater in women due to having a wider pelvis. We do know that a greater Q angle is associated with an increased risk of an ACL injury.
Q. Might concussion risks have to do with a difference in muscle mass for girls?
In younger athletes, we think about high concussion rates due to neck muscles not being fully developed and maybe some technique issues. We also believe there to be decreased neck strength at play, even in fully developed female athletes. There are also hormonal differences are at play, although not well understood.
Q. How do you teach injury prevention to coaches, parents and patients?
It starts from youth sports. It’s important for youth athletes to get a period of rest from a single sport. These days we have several youth athletes playing for their school, a local club and their travel team; essentially competing year-round. That increases the risk for not only overuse injuries, but sometimes they're burning out, so it has psychological impacts. They need that break.
Q. How should parents ensure their students get those breaks?
We recommend against early sports specialization. We don't think athletes who are youth should be just sticking to one sport and doing that sport year-round. They need to make sure they are balancing out different muscle groups by diversifying the sports they do and learning different techniques from those different sports as well. This helps prevent injuries and actually improves their athleticism.
Q. How much rest is ideal?
Youth athletes should not play a single sport for more than eight months a year.
Q. What about short-term rest?
Recovery is very important. Ideally, our young athletes should have a minimum of two days off per week from training and competition. Sleep is really important, too. There’s a lot of correlation with performance in sport and injury prevention and the amount of sleep you're getting. Then nutrition, obviously, keeping well-balanced there and making sure your intake is matching the demands that are required of you as an athlete, with an emphasis on high protein consumption and healthy carbohydrates.
Q. Why is sleep so important for athletes?
A big part about sleep is all the recovery that happens overnight. You have muscles you have put through high demands. A part of your recovery beyond just the nutrition and the stretching and taking days off is making sure that overnight, active recovery is happening too.
Q. How can female athletes walk the line of keeping a healthy weight?
I don’t think there’s a certain number we should be chasing as female athletes. The focus should be on accepting our constantly evolving bodies and talking to our athletic staff and doctors about specific health concerns.
Q. What are some warning signs that you’re not getting proper nutrition?
One of the major signs is abnormal menstruation patterns. It used to be accepted that if you're a female athlete, you only have two or three periods a year, and that's fine. Even during my time as a college athlete, we thought fewer periods just meant we were super fit and well-trained. We now know that is a sign that our intake is not matching our demands. We should be shooting for normal periods, with a goal of 12 periods a year. Another sign of inadequate nutrition is recurrent injuries, particularly stress fractures.
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Q. What are some other areas athletes should emphasize to prevent injuries?
Core strength is imperative for athletes of all ages and levels. It is also important to make sure that if you're working out one muscle group, the opposite muscle group is also being activated to balance things out. Another thing is warming up and cooling down in a specialized way, depending on your sport. For soccer, specifically, dynamic warmups are important to promote blood flow to the muscles and prepare the body for the intensity of the sport’s demands. We do have data to suggest that dynamic activity before putting your body through more explosive activities is preferred and improves performance.
Q. Are girls doing too much weight training too soon? Not enough?
I think weight training is very beneficial, but the issue with young folks is a lot of them aren't being properly supervised and getting set up for injuries. For most sports, I see how resistance training can be very beneficial in improving strength and coordination. We do know that supervised resistance training is safe and does not increase risk of growth plate injuries. But if they’re doing resistance training without supervision, then it's not really worth it. The risk of injury probably outweighs any benefit.
Q. What are some other areas athletes should emphasize to prevent injuries?
Core strength is imperative for athletes of all ages and levels. It is also important to make sure that if you're working out one muscle group, the opposite muscle group is also being activated to balance things out. Another thing is warming up and cooling down in a specialized way, depending on your sport. For soccer, specifically, dynamic warmups are important to promote blood flow to the muscles and prepare the body for the intensity of the sport’s demands. We do have data to suggest that dynamic activity before putting your body through more explosive activities is preferred and improves performance.
Q. Is there anything to be done to prevent concussions?
The biggest thing with concussions is recognizing when they happen, knowing the symptoms so you can immediately be removed from play, knowing that if we don't recognize it and treat it early, it can contribute to a prolonged recovery, and maybe even some chronic traumatic encephalopathy (a brain disorder known as CTE that has been widely covered in pro football) or second impact syndrome. We have to empower coaches and athletes to know the signs and symptoms. Ensuring proper sport-specific technique and equipment can help with prevention.
Q. What are some of the symptoms of concussion?
Of course, we think of headache as a hallmark symptom. There might even be some initial difficulty with balance, some disorientation. Some other symptoms beyond a headache are visual symptoms, a little bit of double vision or things look blurrier. Maybe light or noise bothers them. There can be nausea. There can also be cognitive symptoms: difficulty focusing, or maybe thinking makes your head hurt worse. There can be emotional symptoms, feeling more sad or irritable and not really knowing why. Trouble sleeping or feeling sleepier can also be a part of it.
Q. How do you know when it’s time to go to the doctor, not just for a concussion, but any sports injury?
If you're not training, maybe on a rest day, and something is bothering you pretty significantly, or if you’re getting woken up from sleep because of pain, or it's impacting your performance, you can't push it as much because you’re scared that the pain is going to worsen — those are all signs it's something you should tell somebody about. It’s really important to always communicate with your coaches, the athletic trainer and your parents, even if you feel like maybe it's nothing.
