In 1971, more than 7% of high school sports participants were girls. By 2018, they accounted for nearly 43%. At the 1984 Summer Olympics, roughly a quarter of the competitors were women, and nearly half of the Olympians at the 2016 games were female. 

Much of the credit for fostering female athletic participation is due to Title IX, a 1972 law that outlaws discrimination based on sex in any activity that receives federal funding, including school sports programs. Today, 37% of women, from recreational participants to elite competitors, exercise or play sports at least once a week. 

While athletic activity yields clear physical, emotional and social benefits, it also increases both the need to emphasize proper conditioning and the potential for injury.  

"Female athletes face different medical conditions and are more susceptible to certain injuries than their male counterparts," says Eileen Crawford, M.D., assistant professor of Orthopaedic Surgery and Sports Medicine and part of the MedSport team, Michigan Medicine's multidisciplinary sports medicine program. "One size fits all sports medicine isn't good enough."

MedSport physical therapist Kristen Schuyten, PT, DPT, SCS, MS, CSCS, agrees. "We need a more targeted approach for female athletes – and more female providers involved in their care – to help offer the most effective, holistic care possible."

Crawford and Schuyten are leading the effort at MedSport to tailor diagnostic, treatment and rehabilitation services to the needs of female patients, and to educate athletes, parents and their colleagues in sports medicine.

Equal, not identical

Women are making great strides in their quest for equality on the field of sport. But for medical providers, it is important to distinguish between offering everyone equal access to care regardless of gender, which is essential, and providing everyone the exact same care, which is an outdated approach.

Here are a few of the ways female sports medicine patients differ from their male counterparts:

Some injuries are more common in predominantly female sports. Shoulder injuries resulting from 'windmill pitching' in softball are one example. Similarly, certain injuries and conditioning challenges are common in sports like gymnastics, cheerleading and figure skating, and in physically demanding performing arts like dance, and these activities tend to skew female. Schuyten, a member of the International Association of Dance Medicine and Science and the U.S. Figure Skating Association medical team, specializes in treating these patients.

Women have different anatomical, musculoskeletal and reproductive physiology. Tears in the knee's anterior cruciate ligament (ACL) are common sports injuries for both men and women. "But many people are surprised to learn that factors including hormonal changes, muscle activation patterns and limb alignment in relation to the pelvis put women at greater risk of ACL injury than men," explains Schuyten. 

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"We also know that hormones impact musculoskeletal health," adds Crawford. "Both the hormonal changes expected during puberty, and hormone disruptions from overtraining or overly restrictive eating can make a young female athlete more prone to injury."    

Sports like distance running require disciplined cycles of training and recovery for optimal performance. Here too, Schuyten cautions, one size does not fit all. "A traditional three-weeks-on, one-week-off schedule might work well for a male, but we suspect that for a female runner, aligning training with her menstrual cycle could be more beneficial.  "Females have the physiological foundation for amazing endurance, but their hormones need to be addressed in their training programming."

"Of course, since women currently make up only about three percent of subjects in sports medicine research, there is an overall gender data gap," she adds. "Research is another aspect of sports medicine that needs greater female representation."

Women experience pain and setbacks differently

Crawford and Schuyten are also helping their Michigan Medicine and MedSport colleagues recognize and address the physical and emotional effects sports injuries have on their female patients. 

One rare and severe example is complex regional pain syndrome, or CRPS, a difficult to diagnose condition that can develop following a musculoskeletal injury or surgical procedure. More prevalent in younger women, CRPS triggers a cluster of symptoms at the site of the injury, including hypersensitivity to touch, changes in temperature, and discoloration or blotchy skin.

"These strange localized physical symptoms can be worsened by a psychosomatic reaction, often out of proportion with the extent of the injury," Schuyten explains. "For example, a young woman recovering from a sprained ankle may have a longer or more complicated recovery due to limitations from CRPS."

Female athletes may also be more prone to post-injury depression. "We see this often with adolescent girls who sustain injuries that require surgical management," Crawford explains. "Being sidelined for several months can be devastating when so much of their identity is wrapped up in excelling in their sport."   

Building a deeper bench

Just as more women are stepping onto the field of sport, many more women are stepping into the field of medicine. According to a report from the Association of American Medical Colleges, 2019 marked the first year that women made up a majority of U.S. medical school students (at 50.5%).

More women are becoming doctors, and sports medicine is the fastest growing specialty for women. The percentage of women in the separate specialty of orthopaedic surgery within sports medicine has also experienced significant growth, the AAMC notes.

Along with more female providers in the clinical setting, more are also serving on the sidelines as team physicians in professional and collegiate sports, although they still occupy fewer than one in five such positions.

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"We have a long way to go, but we're on our way," Crawford says. She and Schuyten cite several reasons why female representation is so important in sports medicine:

Honoring religious or cultural doctrines

Some faith traditions prohibit women from uncovering their bodies in the presence of men. The availability of a female provider ensures these patients can receive thorough examinations.

Providing a more approachable, relatable patient experience

 "Many sports medicine providers are athletes themselves, and know firsthand the ups and downs of conditioning, competition and injury," says Crawford, a former national champion in women's rowing. "It's important to establish trust and build a rapport with female athletes, especially adolescents, and shared experience can really help build that bridge."

Handling sensitive topics

Similarly, female patients may feel more at ease discussing intimate concerns with a female provider.

"For instance, female athletes can develop problems with the pelvic floor muscles that control urinary and fecal continence," Schuyten explains. "They may not realize that this an issue that is treated with physical therapy."

Showcasing female leaders, sharing best practices

In March 2021, Crawford and Schuyten hosted Women in Sports Medicine and Rehabilitation: Caring for the Female Athlete, a day-long symposium with a dual objective: providing a platform to educate providers on female-specific concerns and issues in sports medicine, while addressing the lack of diversity among sports medicine providers.

Nearly 200 medical providers, coaches and strengthening and conditioning specialists attended the event (despite being held virtually). While both male and female providers attended, the panel of presenters was all women, sharing information and best practices on topics including the treatment and rehabilitation of musculoskeletal injuries, mental health and pain management, concussion, sports nutrition, sleep, pelvic floor dysfunction, menstrual cycles and exercise during pregnancy. 

"There's so much actionable information to share, and such a hunger for it," says Schuyten. "Those who support and care for female athletes need and want to understand how gender differences affect the physiological and psychological aspects of injury, treatment and rehabilitation, and how they can use that knowledge to up their game for their female patients."

"I was impressed by the breadth and depth of expertise within Michigan Medicine's community of female providers," Crawford adds. "It was a great opportunity to celebrate the contributions of these sports medicine leaders. They inspire all of us to continue to advocate for female athletes."