Why Are So Many Female Athletes Playing in a World of Hurt?

Amid the excitement of the Olympics, it's easy to forget how many athletes trained to compete in Beijing but couldn't because of injury. Soccer star Abby Wambach broke her leg, for example, and two members of the women's gymnastics team are competing in only one event because of ankle problems. And we'll neverknow the names behind the thousands of careers that were derailed by injury before even coming close to competing on the international stage. Author and journalist Michael Sokolove sees a particular problem in the women's sports arena, which he says faces an "epidemic" of injuries. (Here's a list of common sports injuries in women.) In his recent book Warrior Girls, he explores the tension between telling our daughters that they can do anything the boys can do and recognizing the reality that girls may be particularly susceptible to crippling injuries.

You talk to a lot of young women with multiple ruptures of the anterior cruciate ligament (ACL). Is it really more prevalent in women?
There's a lot of research on this, and it's ongoing. But the way it's usually said is that in the sports that girls and boys play in common and by the same rules—including soccer and basketball—girls are considered 5 to 8 times more likely to suffer an ACL injury. Just two times the rate of incidence would be significant!

Doctors have a lot of different theories as to why. What's the consensus?
In the midteens, boys get stronger and girls tend not to, at least not to the same degree. That's unfair, but it's a fact. And girls are more flexible compared with boys; they have lots of flexibility, but not enough muscle to keep their joints in stable, safe positions. That can lead to ankle, back, hip, and knee injuries. Or, in swimmers, shoulder injuries. Second, researchers say that girls tend to run in a more upright position than boys. They are more likely to decelerate with their knee locked and out in front of them, which can hurt the ACL. Ideally, everything is lined up; the feet and knees are under the hips, and the butt is down—it's what the old gym teachers used to call the athletic position. Programs that attempt to change girls' movement patterns so they run and land more safely have shown promise.

You say girls have adopted a "warrior" ideal, where withstanding pain is a sign of strength.
I think we want our kids not to be soft, which is a good goal. At its best, sports really teaches that. My own daughter is a college swimmer, and she's really, really tough; she's not easily stopped by momentary disappointment. That came from her swimming. [As a society,] we are particularly eager for our daughters to be tough. But that sometimes goes too far. We have a culture of playing children to exhaustion and demanding more difficult athletic schedules.

That kind of culture affects both genders, though.
It's bad for boys and worse for girls because of some of these physiological differences. It's child abuse to have a child play five full-length soccer games in three days and then turn around and do it the next weekend. If a [NCAA] Division I university gives a girl a soccer scholarship, they wouldn't do that—they've got a resource to protect. That is not justified on any basis. Girls are given too many chances to injure themselves. It's the "more is more" culture. You can't convince [people] that more isn't better.

You say it would help both sexes to participate in a range of sports, not just one, and to be realistic.
Lots of coaches and parents are misinformed and believe that early specialization equates to mastery of a sport. It doesn't. People are spending money to send kids to Pilates to be "cross-trained." They used to be cross-trained naturally by playing different sports. All-around athleticism is injury prevention in itself. But it's not an era in which well-rounded kids are rewarded for that. Nearly everyone gets training as if they're moving on to the next level, and we're ruining a lot of kids that way. Everyone playing on a pretty good traveling team is training like they're going to get a Division I scholarship, and most will not.

Is it admitting that women are weaker to talk about their injuries?
Many people have not wanted to squarely face the injury issue out of the fear that people will say, "See, girls shouldn't be playing." But you can go to any community and find teams of girls where a third or a half of them have had major orthopedic injuries. It's not a good tradeoff to ignore that because of how people might take it.

One of the young women you followed had multiple ACL injuries, had a promising soccer career cut short, and still has pain. Who failed her?
It sounds like a cop-out, but it was the system. It encourages and pushes kids to get through rehab really quickly and then get back to what they were doing. There's no emphasis on resting, on healing, on going slowly—and no emphasis on education about gender-specific injuries or prevention programs. [Click here to learn about a warm-up program that can prevent ACL injuries.] I was also told repeatedly that girls are more prone to rush back from injuries. They want to go back out there with their teams and teammates.

For more: That's it from Michael Sokolove. Here you can read an article he wrote for the New York Times Magazine that is adapted from Warrior Girls. U.S. News wrote a few years ago about how to fix kids' sports and how to be a coach in your community. And my colleague Lindsay Lyon recently wrote about how she was once one of those injured female athletes—in her case, gymnastics put her in the ER.