A Guide to Injuries for Female Athletes

By Chris Centeno, MD /

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injuries in female athletes

We see a lot of pain and injuries in female athletes, from triathlon and CrossFit competitors to volleyball and soccer stars and everything in between. The pain and injuries we tend to see most in our female athletes involve the knees, back, ankles, and feet. We’ve covered many studies over the years that show higher percentages of injuries in female athletes than in male athletes, so why does this happen, and what can be done about it?

In this article, we’re going to discuss some of the more common pain and injuries in female athletes we see in clinic and share some of their stories. We’ll also discuss how they were able to get back in the game following treatments using their own stem cells or platelet rich plasma.

Knee Pain

It seems like every day we hear about another female soccer player with knee pain, and, by far, the most common reason is an anterior cruciate ligament (ACL) injury. And it’s not just in our pro players. Fifteen years ago, it was relatively uncommon to see a teenage girl come in with an ACL tear; now it seems like it’s commonplace. Much of this seems to be due to the rise in popularity of US women’s soccer, inspiring more young girls to play the sport. But why so many ACL injuries?

The reason female athletes seem to have more ACL injuries than men seems to lie in the way female athletes tend to let their knees adduct (or draw inward) as they land. This makes sense, as women have generally wider pelvis bones, and it would, therefore, take more force from the hip abductor muscles to keep the knee from moving inward during landing. Compare this to dancers, in which ACL injuries are rare. Dancers go through extensive core-conditioning protocols with rigorous routines like Pilates, so it’s not surprising that they have better control over the hip and knee. In addition, they practice how to land in a controlled way, and develop what I call “CORE knee control,” a key element to preventing ACL injuries.

Test Your Landing to Determine ACL Injury Risk

Perform this quick test in front of a mirror, or video yourself. Stand against a wall without touching it. Jump straight up and down, landing in the same spot. Watch your knees closely as you land. Do they stay apart and in-line with the hip? Do they come inward or touch? If the latter is the case, there’s likely a higher risk for ACL injury and patellofemoral pain syndrome.

Here are the tests performed by my soccer-athlete daughter and my athletic son. Watch my son’s knees when he lands. Note how they stay apart and generally in-line with his hips.

Now take a look at my daughter’s knees. Note how they come together uncontrollably as she lands.

The test result? My daughter is at greater risk for an ACL injury as she can’t control her knees when she lands and they draw inward.

The solution? Female athletes with poor knee control on landing are 15 times more likely to injure their ACL, so it’s important for females to work on strengthening their abductor muscles and CORE knee control. They should also be evaluated in landing to see if they can control the knee and if they can’t, pursue specific strengthening and conditioning programs until they have that control.

In addition, hormones released during ovulation can impact ACL laxity, likely making it more prone to injury. Increasing your warm-up time during ovulation seems to improve ligament properties during this time.

Stem Cell Treatments for ACL Injuries

Regrettably, about two-thirds of athletes with an ACL injury who undergo surgical reconstruction of the ACL don’t get back to playing sports by one year after the surgery. In addition, women are more prone to knee arthritis after ACL reconstruction surgery, and more female athletes suffer from reinjuries after ACL surgery. So for many females athletes who injure their ACL and get it “fixed” with surgery, this is a career-ending injury, or one that will eventually lead to the early onset of knee arthritis.

Stem cell injections provide a less invasive way to treat ACL injuries, but don’t take it from us. Watch a brief video below of one of our female-athlete patients performing a standing vertical jump to a counter top. Rather than an invasive surgery where her loose ACL ligament would have been cut out and surgically replaced, she underwent ultrasound-guided specific injections of stem cells and platelets into her ACL and patellar tendon. Four weeks after the procedure, she reported 100% relief of pain.

Other Causes of Knee Pain

Meniscus injuries or arthritis are also common injuries in female athletes. Again, avoiding surgery, if at all possible, should be the goal for any athlete. First, meniscus surgery seems to work no better than a placebo operation. Second, removing parts of the meniscus likely leads to more knee arthritis. As a result, many athletes are avoiding meniscus surgery by having their own blood platelets or stem cells precisely injected into the meniscus tears. Below is an excerpt of a letter from the father of a female high-school basketball athlete who underwent an ultrasound-guided injection of her own super-concentrated platelets a couple of years ago:

 Kristen was treated about 6 weeks ago, and I have to admit, although I was truly hoping this would work, it was hard to not be skeptical. However, since it was fairly affordable, we figured we had nothing to lose, as we could always pursue surgery. Well, let me tell you, I am a believer. After her 30 days of rest, we slowly worked her back into shape. She just played in a basketball tournament this last weekend, and for the first time in nearly a year, was able to play 100% pain free.   

Triathlete knee pain can sideline the best of them, especially in the running or cycling portions of the event. All too often, triathletes opt for invasive surgical quick fixes that leave them with more knee arthritis in the long run. We’ve been treating triathletes for many years, and one of our female triathletes who we treated with a stem cell procedure for her bad knee arthritis a couple of years ago sent us this letter:

Thank you for the new knee! I finished my first triathlon in 2 hours, 2 minutes 3 seconds! I promised you a picture at the finish. It is so amazing to know that in February I couldn’t walk around my classroom and on June 21st I was able to complete a triathlon! Thank you!

Back Pain

Back pain and spinal injuries can also hit female athletes hard and cause their performance to suffer. Causes of back pain that are common in our female athletes include disc bulges or tears, arthritis in the facet joints, collapsed or ruptured discs, and pinched nerves. You might notice stabbing low back pain with exercise or numbness anywhere from the back all the way down through the foot. Traditional orthopedic surgeons might recommend anything from disc surgeries to back fusions, but these invasive procedures will at best limit your performance, and at worst take you out of the game altogether.

Regenerative spine procedures, including low back stem cell treatments, have helped our female athletes get back in the game. We recently treated Eileen, an International Federation of BodyBuilding and Fitness (IFBB) athlete whose back injuries and arthritis had taken her away from her sport for 17 months. Her amazing acrobatics, following her treatments, can be viewed on her videos at this link: Eileen’s Hip Hop Low Back Stem Cell Recovery. Eileen summed up her experience with stem cell treatments in one simple sentence:

I owe you guys big time!!! I couldn’t be happier with my results; my stem cells, my plasma—no scars, no hardware!

Foot and Ankle Pain

Foot and ankle pain and injuries in female athletes can be very frustrating. Waiting for sprains to heal can take a very long time, and even then, the injury may not fully heal, leaving you with more problems down the road. One female track star had torn plantar-plates and severely degenerated cartilage. Another female track star had chronic ligament sprains, swelling, and ankle arthritis, and she had failed traditional care. Both achieved success with stem cell injections. Patients with foot or ankle joint arthritis tend do well with PRP or stem cell treatments as these joints are small and easy to access via an imaging-guided injection.

More Stem Cell Success Stories of Injuries in Female Athletes

Nobody can describe their PRP or stem cell success stories better than our female-athlete patients themselves. Link to their fascinating stories of hope and recovery below:

Musculoskeletal pain and injuries in female athletes take countless women out of the game every year. The surgery to fix those problems keep them out out of the game even longer and often result in biomechanical issues that affect their performance going forward. Women are injured at a higher rate than men and their knees are at particular risk. Take the time to do the self tests above to proactively prevent injury, and consider nonsurgical biologic treatments, like your own stem cells and platelets, which don’t create the permanent biomechanical problems of surgery and get you back in the game much faster!

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4 thoughts on “A Guide to Injuries for Female Athletes

  1. DaveT.

    i know this post is geared toward female athletes, but do the general principles and outcomes (e.g., stem cell treatment working well for foot and ankle smaller joint arthritis) also apply to male and older athletes? Thanks.

  2. Sue Shellenberger

    Oops… wrong video provided after this statement!
    “Watch a brief video below of one of our female-athlete patients performing a standing vertical jump to a counter top.”

    1. Regenexx Team Post author

      Sue,
      You’re right! Fixed now. Thanks!

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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