For their sports, women play hard but hurt harder

Protecting Our Daughters Against the Injury Epidemic
in Women's Sports

By Michael Sokolove

Simon & Schuster. 308 pp. $25

Reviewed by Caroline Berson

During the summer of 2007, four of the 11 rising juniors on the Yale women's rowing team underwent surgery: one for a hip, one for an ankle, one for a shoulder, and me for my back.

I am proud of my 7-inch scar. It traces the lower part of my back and symbolizes my desire to pursue athletics with determination and gusto.

But, according to Michael Sokolove, author of

Warrior Girls

, my scar represents the negative side of the hyper- competitive American sports culture - a sports culture that rewards aggressive play, and one in which girls get injured much more often than boys.

No reader can ignore Sokolove's carefully compiled statistics, especially when they show that women sustain injuries to the knee's anterior cruciate ligament at a rate "as high as eight times that of boys."

Don't get him wrong. Sokolove has seen first-hand that "athletic girls seem happier, more confident, more in control of their bodies and their destinies than girls who do not put themselves in motion, who do not compete."

What Sokolove, a former Inquirer reporter, doesn't accept, however, is what he sees as an off-kilter pain-to-gain ratio throughout female sports.

ACL injuries are complicated, and the risk factors are difficult to isolate, Sokolove writes. The most succinct explanation comes from William Garrett, a professor of orthopedic surgery at Duke University, who says ACL injuries are caused when an athlete is off balance, lands awkwardly, or reacts poorly to surprise.

The explanation behind the ominously different injury rates for men and women most likely comes from biomechanical differences between the genders. Men run closer to the ground and have stronger hamstrings. Women run more upright and tend to be quad-dominant and therefore put more strain on their knees.

The problem even extends into the apparel industry. Sneakers for women are simply smaller versions of sneakers for men; manufacturers don't take ergonomic differences between the sexes into account at the structural design level.

With inappropriately fitted support, no wonder women are off balance and tearing their ACLs. This approach needs to change, according to Sokolove.

What Sokolove does not address sufficiently is what female athletes should do while waiting for the medical world to catch up with them.

And the medical world has a ways to go.

A reconstructed knee isn't as strong as the original, and athletes frequently reinjure themselves.

The goal should be to keep the injury from happening in the first place, Sokolove argues.

Athletes should participate in an ACL prevention training program. There are several that teach athletes "to avoid vulnerable positions - ones in which the leg is extended, the foot strikes the ground flat, and a bolt of energy surges into the knees."

One study showed that a program called PEP (Prevent Injury and Enhance Performance) reduced the rate of ACL injury per athlete by 88 percent.

But such programs are not mainstream, for which Sokolove blames the American youth sports culture, insufficient research, lack of interest by coaches, and an abdication of responsibility by parents. The one group the author doesn't seem to hold responsible is the athletes themselves; he portrays them as being caught up in the sports culture.

He appropriately tells young female athletes to "keep playing sports and keep playing them hard," but advises that they train in ways that "target gender-specific vulnerabilities."

He then goes on to make an argument that I disagree with: "And they need to play fewer games. Shorter seasons. More varied sports."

Sokolove recognizes that athletes are reluctant to change how they approach their sport, but he downplays their deeply competitive nature and will to win - even at the cost of injury.

Amy Steadman, Sokolove writes, was an adolescent soccer star on her way to professional glory until repeated ACL injuries forced her to the sidelines.

"If anyone would have told me after the first [injury] that I should stop and do something different, play a different sport or whatever, or slow down my rehab, I would have said, 'You know what? The hell with you. I'm going to do this.' Nobody could have stopped me."

Now, she says, she thinks she should have rehabbed more slowly, but she also says dealing with her injuries has made her "a more complete human being."

Most of the girls Sokolove interviewed said injuries are part of sport, as are the lessons they learn while building themselves back up.

Leslie Gaston was another young soccer star beset by knee injuries. Her knees still hurt, but she tells Sokolove "if I had to do it all over again, I wouldn't change anything. I know that sounds strange. But all the injuries have shaped my character and life in a way that I never thought something as devastating as having five ACLs could. I know whatever obstacles I face, I can get through them."

A year after my surgery, my rowing future remains uncertain, but nothing could have changed the way I trained and competed.

And, the lessons I have learned through rowing can neither be learned elsewhere nor forgotten.