The New York Times has a preview up today of a long article coming out on Sunday in their magazine: The Uneven Playing Field. It’s by Michael Sokolove, and based on his forthcoming book Warrior Girls: Protecting our Daughters Against the Injury Epidemic in Women’s Sports. (I’ve pre-ordered the book, and will review it this summer when it comes out.)
In this lengthy adaptation on the Times website, Sokolove writes about what he sees as the extraordinary number of knee (ACL) injuries that are being sustained by female athletes, soccer players in particular. His thesis:
(the epidemic is) part of a national trend in the wake of Title IX and the explosion of sports participation among girls and young women. From travel teams up through some of the signature programs in women’s college sports, women are suffering injuries that take them off the field for weeks or seasons at a time, or sometimes forever.
Girls and boys diverge in their physical abilities as they enter puberty and move through adolescence. Higher levels of testosterone allow boys to add muscle and, even without much effort on their part, get stronger. In turn, they become less flexible. Girls, as their estrogen levels increase, tend to add fat rather than muscle. They must train rigorously to get significantly stronger. The influence of estrogen makes girls’ ligaments lax, and they outperform boys in tests of overall body flexibility — a performance advantage in many sports, but also an injury risk when not accompanied by sufficient muscle to keep joints in stable, safe positions. Girls tend to run differently than boys — in a less-flexed, more-upright posture — which may put them at greater risk when changing directions and landing from jumps. Because of their wider hips, they are more likely to be knock-kneed — yet another suspected risk factor.
The rate (of ACL injury) 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.
At this point, my heart was sinking. Was this going to be anti-feminist ideology dressed up as professed concern for the health of young women? Was Sokolove trying to scare parents into pulling their daughters out of competitive sports? I even wondered if Sokolove was some sort of shill for the anti-Title IX crowd, trying a new tactic in their never-ending crusade to roll back a policy of equal funding for women’s sports. As a passionate sports fan, married to a former club soccer star, I have a deep and abiding commitment to women’s athletics — particularly the “beautiful game” of what the rest of the world calls football.
Happily, reading the article to the end (it is ten pages long) makes it at least fairly apparent that Sokolove is committed to women’s sports. Rather than imploring parents to pull their daughters off soccer teams, he writes sensibly and knowledgeably about the causes of what is undeniably a common problem: catastrophic ACL injuries among young female soccer players. The chief culprits have nothing to do with inherent feminine weakness. Rather, they are two-fold: poor bio-mechanics and the exhausting “club” system in high school and college that leaves many talented girls playing a demanding sport literally year-round.
The bio-mechanics bit is fascinating. Perhaps because of the wideness of the hips, and perhaps because of the way we teach girls to run (or more accurately, don’t teach girls to run):
“Women tend to be more erect and upright when they land, and they land harder,” he (Steve Marshall, lead researcher in a major national study on ACL injuries) said. “They bend less through the knees and hips and the rest of their bodies, and they don’t absorb the impact of the landing in the same way that males do. I don’t want to sound horrible about it, but we can make a woman athlete run and jump more like a man.”
A program called “PEP”, which emphasizes stretching and balancing as well as muscle-building exercises, has proved demonstrably helpful in reducing incidences of catastrophic knee injuries among young women. Indeed, since strong leg muscles are a key factor in protecting the knee from injury, this insight suggests that we need to do a better job of encouraging lower-body weight-training among female athletes, something that is all too rarely done at the junior high school level. Though Sokolove doesn’t say it, it may well be that a fear of becoming “bulky” may prevent some girls from doing sufficient strength training to protect their knees; few young male athletes have that same fear. In other words, the solution to the higher incidence of serious injury among female soccer players is not to pull girls off teams, but to do a better job of preparing their bodies to handle the stresses of games that require a great deal of running, leaping, and sudden lateral movements.
The other great contributor to catastrophic knee injuries is the tendency for girls, particularly talented and dedicated ones, to specialize in one single sport from adolescence onward. Driven by parents hungry for college scholarships and by coaches eager for trophies, girls in sports like softball or soccer or basketball compete year round. Ask any high school girl who plays any of these sports at a highly competitive level when her seasons “ends” and she’ll likely laugh grimly. The high school season may end, but club sports (often very expensive and demanding) can go year round with special “showcases” and clinics and tournaments, tournaments, tournaments. Girls are playing soccer in January and July, April and October — particularly in those parts of the country where sports can be played outdoors year ’round.
Not so long ago, star athletes in high school played many different sports. It was a mark of honor to “letter” in three or more sports. Male high school jocks in this country traditionally lettered in football in the fall, basketball in the winter, and baseball (or track) in the spring. That kind of athletic breadth is becoming an increasingly dated phenomenon, particularly among middle-class kids who can afford to play for private clubs as well as on high school teams. If you’ve got the talent to get a scholarship, your coaches will encourage you to play that sport year-round. This is potentially disastrous for several reasons. One, the risk of psychological burn-out increases enormously. (I’ve known a lot of girls, especially in cross-country and soccer, who were excited as 10th grade phenoms and miserable as 12th graders with scholarship potential.) Doing the same thing, year after year, day after day, loses its luster fast. Two, playing one sport tends to place heavy stress on the same parts of the body without any opportunity to give other parts a chance to get stronger; transitioning between soccer and track each spring, for example, allows for a certain amount of recovery that isn’t possible playing the former year round.
Coaching girls and boys requires acknowledging difference. No, I’m not suggesting girls are weaker: they’re not. In my limited athletic coaching experience, buttressed by my years in youth work, I’ve noticed that highly athletic girls are actually less likely than male counterparts to complain about injury or to “push back” against the demands of coaches and parents. This makes sense in a culture where we inculcate “people pleasing” in our daughters to a far greater degree than we do in our sons. We also teach girls, starting with the onset of menstruation, to expect pain as part of what it means to be a woman. How often do we hear older women saying to younger ones: “Men are just big babies; women are the really strong ones in this world.”? A girl raised with the message that she can “do anything”, raised with the message to be pleasing, raised with an exaggerated sense of her own capacity to endure — she’s a prime candidate for burnout or injury.
In my experience, coaching girls sometimes involves kicking their butts (not literally, of course). More often, however, it involves teaching them the difference between putting forth maximum effort and pushing themselves past the threshold of what their bodies can tolerate. As I’ve written before, young girls in contemporary society are extraordinarily hard on themselves, much more so than their brothers. As Courtney Martin famously has said: We are the daughters of feminists who said, “You can be anything” and we heard “You have to be everything.” The Sokolove article and the forthcoming book suggest that there are tangible consequences, often located in the vicinity of the anterior cruciate ligament, to this relentless pursuit of perfection.
It would be a huge mistake if the publicity around this article (it was featured on the front page of the Times website today, complete with photo) distorts Sokolove’s message. The last thing we want to suggest is that teen girls are too fragile to play demanding, competitive sports; anyone who comes away from this article with that message didn’t read closely. But we do need to take practical, sensible steps — ranging from a greater emphasis on strength training and plyometrics to a commitment to reduce the awful internalized pressure girls place on themselves — to protect the spirits and the bodies of our little sisters. Sokolove’s forthcoming book is encouragingly titled “Warrior Girls”, and I applaud that. But too often, the bodies of these young women bear scars that are due in no small part to the fact that the war they fight is, in the end, directed inward.
UPDATE: I’m bumping up something Amanda said in the comments, because I think it’s so right:
Maybe it would help if girls had a lot more free form rough and tumble play time in their childhoods, so they learn to run like boys do in a more natural, less stiff way?
That sounds like “bingo” to me.
Interesting comments on the article. Given your views on animal rights I was expecting a tie-in to the tragic Eight Belles situation.
Since high school athletes are MINORS, it is my belief that parents are responsible for insisting on proper strength and conditioning and helping to preventing overuse injuries. This might mean saying “no” when a child wants to play a sport year-round.
Dave, I thought about that, particularly about the comments that Eight Belles pushed herself so hard to please that she broke down. But I was afraid that that would prove a distraction.
Part of the problem is that very few parents want to interfere with a kid’s dream — particularly when it seems like such a positive dream (which it generally is). We want kids who are ambitious, hard-working, passionate. We just have to find a way to make sure that passion is safely channeled. And when one top kid is playing 12 months a year, it’s hard to tell your daughter (who also wants a scholarship) that she can’t.
Maybe it would help if girls had a lot more free form rough and tumble play time in their childhoods, so they learn to run like boys do in a more natural, less stiff way?
The myth of bulkiness makes me crazy. Women are not built to bulk up. The more muscular my legs get from biking, the thinner they get, every single time. Women’s bulk, unless they’re on steroids or something like that, is mainly from fat. We build muscle differently from men. If women were taught this from the get-go, they’d be a lot more willing to do muscle-strengthening exercises.
Natalie Angier has a great section in her book Woman about the biology of women’s bodies, and why women do not and can not “bulk up” like men do. Her discussion of it carries a lot of weight for purely physical reasons—she brags about how much she can lift, and then you turn to look at her picture, and she’s scrawny. She looks birdlike. Clearly, if she lifts weights and looks like that, it’s a myth that women bulk up from weight training.
I coached AYSO for five years. The only knee injuries my kids had were the year I had a girls’ team, 12-13 y.o.
I had asked a physical therapist for advice and she told me about stretching and strength exercises, but we had only about three hours a week of practice, which wouldn’t have been enough if it were all devoted to defensive conditioning.
Fortunately, these days, the knee can be repaired without leaving the big scars we used to call “railroad tracks”.
My DIL and her two sisters were 12-month jocks, including, in DIL’s case, barrel racing. The worst injury was the younger sister getting a broken collar bone in a riding accident.
The increasing popularity of lacrosse is increasing the number of sports in which open-field, max-speed changing direction is required (soccer and football have the same requirements) and thus threatening knees.
IMO, women need additional defensive conditioning to protect the knees.
So they should do it.
I don’t see the issue here.
Amanda,
I respect that for you, and for Ms. Angier, no-bulking-up is the case, but it’s also NOT the case for all women. My younger sister was a versatile high school athlete who played hockey, rugby, and soccer at the varsity level as well as training horses and being a nationally-competitive speedskater. (Now in her late 20s, she still does a lot of those things on a more laid-back level.) Her lower body was *very* bulky and she weighed enough that the BMI declared her obese at a time when her body-fat percentage was hovering around 8 percent. “Women are not built to bulk up … Women’s bulk, unless they’re on steroids or something like that, is mainly from fat.” may be generally true - I haven’t seen the studies - but it sure wasn’t true for her.
From a less athletic perspective, my own experience has been that when I was most in shape, I also had larger glutes, fuller thigh muscles, and more prominent calves than when I wasn’t getting much exercise. I’ve never ever seen my upper body get much bulk, and I’ve not seen many other women do that either, but there are lots of women of my acquaintance whose “thunder thighs” are pretty darn muscular.
I get your larger point, but I’m not sure couching it in such general terms will help.
Thanks for the reference, Amanda; you’re absolutely right about “bulk” and it’s a real reminder that this irrational fear of size may have very real and disastrous consequences. But the real issue, as Marianne’s comment makes clear, is that the problem isn’t bulk — it’s the fear of it. We need an aesthetic shift as much as we need good training in bio-mechanics and plyometrics.
Hugo,
How is this news? It’s been known for decades that women experience knee problems at a far greater rate than men. At first glance, it sounds like they might have a better handle on why, although looking at the article a second time makes me wonder if it’s just “conventional wisdom.” C.f. vacuuming and dust mites.
In college, our XC coach pushed the women to put in more pool time and weight lifting to strengthen their knees — and doing the exercises in a knee-safe way. He also used pool time for those of us with shin splints and other injuries — or once he knew we were prone to them. The women also tended to gravitate toward lower-impact sports.
I’ve taught a number of my female friends to race walk — it’s a LOT easier on the knees than running.
I think the news lies in the sheer numbers of young women playing sports. And it’s important for those of us who support women’s sports to get in front of this story and make sure that the answer is better conditioning, and not a lessening of support for women’s sports. I posted this because it’s vital that the right-wing not hijack this story to promote a “girls are fragile and we should rethink Title IX” agenda.
If women were taught this from the get-go, they’d be a lot more willing to do muscle-strengthening exercises.
Oh my god you cannot be serious. This is the patronizing party-line certain pro-weight training voices have been pushing for years. I know they think they’re feminist, but you must know better.
If women are afraid to be strong because they might look strong, THAT IS THE PROBLEM. Telling them not to worry because they’ll still look bird-like and delicate, and their strength will be their little secret, does not help. Why not go all the way and tell them not to worry, because even if they get big muscles, they’ll still be allowed to submit to even stronger husbands in the marriage bed? This is just like assuring boys that being sensitive won’t make them fags.
Seriously. What the hell? If you have to sell weight training to women on skinny thighs, not on strength, you’ve given up before you even begin. You are insulting us. Skinny thigh obsessions are sad and miserable, but physical power is intoxicating. Why do a bait and switch this way, when the bait is so unappealing and the real reward so straightforwardly pleasurable? What is the damn point of it?
And of course, like Marianne said, if you’re a big strong woman who lifts weights, you’ll get bigger and stronger. Women don’t have buckets of testosterone, but we don’t have magic invisible muscles either. Nor should we.
Sophonisba,
It *is* exactly like telling young men that being sensitive won’t make them gay! When a man wants to be sensitive without being ‘a fag’, you absolutely tell him it’s possible! “Oh, it’s okay to be gay” just reinforces all his fears that he can’t be who he wants to be, namely a straight man with emotions. Similarly, “female weightlifters are attractive too!” is just going to tell a woman that she can’t participate in sports or take care of her body without giving up the body she (and her friends, boyfriends, etc) consider attractive.
Now, you don’t want to go out there lecturing about how, using the right techniques, women can be strong without having to look that way, because that’s just agreeing that there’s something wrong with looking strong. But if you meet a woman who’s afraid to become strong for fear of looking “mannish”, yelling at her and ranting about how her views of attractiveness are biased and patriarchal (even if they are) and that she needs to change her life and stop relying on the fawning attention she gets from men (even if she does) is certainly going to do nothing to encourage her to get stronger. If all you do is challenge people’s fundamental beliefs and assumptions, it doesn’t matter if you’re right because they’re not going to listen.
Being sensitive and being active/fit/strong are valuable things even taken separately from the issues of homophobia and cultural standards of attractiveness. You can encourage the former even in people who aren’t yet ready to deal with the latter.
By being afraid of “bulking up” women are thinking of images of female professional weightlifters - women whose entire job is to have bulky muscles, and to have something like 5% body fat. I agree with sophonisba that we should be running around telling FEMALE ATHLETES to be afraid of muscles, for crying out loud - but it’s also true that part of the issue is that the only image of ’strong woman’ that women are presented with is the weightlifting world’s ideal. (Not too many men want to look like the cover of Muscle and Fitness either, really.)
Concur with Marianne and sophonisba about bulk. When I danced for a living I had practically square calves and thighs like tree trunks. Funnily, though, none of my customers ever sniffed at my having ‘bulk’ or thought I looked unfeminine.
Wow - I actually mostly agree with Mythago. There are lots of images in the popular media of strong, athletic women, but outside the weightlifting world, those women aren’t being promoted as athletic, they’re being promoted as visual treats. Most of the models on swimwear magazines and other magazines aimed at men are probably putting in as much physical training time as a teenager shooting for an athletic scholarship, but that story almost never gets told.