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Staying Active Across the Female Lifespan

Staying Active Across the Female Lifespan. Ellen Casey, MD Assistant Professor Associate Director Sports Medicine Fellowship. Disclosures. NIH K-12HD001907-15. Why focus on females?. Sex differences in anatomy, biomechanics and physiology Different injury profile

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Staying Active Across the Female Lifespan

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  1. Staying Active Across the Female Lifespan Ellen Casey, MD Assistant Professor Associate Director Sports Medicine Fellowship

  2. Disclosures • NIH K-12HD001907-15

  3. Why focus on females? Sex differences in anatomy, biomechanics and physiology Different injury profile Risks and types of injuries change throughout the lifespan Knowledge of these factors is essential for providing comprehensive care

  4. Impact of Title IX 1972 • 1 out of every 27 females participated in athletics 2002 • 1 in every 2.5 females participated in athletics

  5. Benefits of Sports Participation Coe2006 • Higher graduation rates • Decreased risky behaviors • Increased self-esteem • Decreased depression • Decreased risk of: • Obesity, DM, CAD, Osteoporosis, Cancer

  6. MSK problems more common in female athletes • ACL injury • Stress Fracture • PFPS • FAI (pincer-type) • Hip Labral tear • Hip and knee osteoarthritis • SIJ Pain/Dysfunction • Pelvic Floor Dysfunction • SUI • Chronic ankle instability • Lateral Epicondylosis • Concussion Sallis 2001; Taunton 2002; Schaffer 2006; Burnett 2006; Boles 2010

  7. The Adolescent Female: Focus on ACL injury

  8. Why focus on ACL injuries? Granan 2008

  9. Risk of OA is 40-80% greater after ACL injury3

  10. Gender Gap in ACL Injury • Females are less likely to return to sport after ACL injury

  11. ACL Injury is Multi-factorial Biomechanics Anatomy Multi-factorial Hormonal milieu Genetics

  12. Risk Factors for ACL Injury Biomechanics Anatomy Hormonal milieu Multi-factorial Genetics

  13. Female vs. Male Landing • Inadequate shock absorption • Poor hip dynamic stability • Poor lumbopelvic stability Increased valgus load on knee Hewett 2005, Boden 2009,

  14. Sigward 2012

  15. Risk Factors for ACL Injury Biomechanics Anatomy Hormonal milieu Multi-factorial Environment

  16. How might sex hormones affect ACL injury? • Receptors throughout the neuromusculoskeletal system • Relationship between menstrual cycle phase and: • Ligamentous laxity • ACL injury • Neuromuscular control

  17. Review of the Menstrual Cycle Casey 2014

  18. Fluctuations Across the Menstrual Reese & Casey 2014 (unpublished)

  19. Sex Hormone Receptors

  20. Sex Hormone Receptors

  21. Modulatory Role in Collagen Synthesis Relaxin18 Estrogen13 Progesterone13 Testosterone17

  22. ACL LAXITY & menstrual phase Adapted from Zazulak 2006

  23. ACL INJURY & menstrual phase Adapted from Zazulak 2006

  24. Vescovi 2011

  25. Sex Hormones Modulate Nm Control • Friden et al. 2006: • Better performance on square hop test

  26. Sex Hormones Modulate Nm Control • Dedrick et al. 2008 • Shift in motor control across the cycle • Different co-contractive behavior between gluteals and hamstrings

  27. Sex Hormones Modulate Nm Control • Park et al. 2009 • Incr knee laxity  incr knee loading (ovulatory phase)

  28. Muscle Stretch Reflex • Basic unit of Nm control

  29. Muscle Stretch Reflex

  30. Rectus Femoris Casey 2014 4x 1.5x

  31. Origin of the change?

  32. How can we intervene? Neuromuscular Re-education Modify the hormonal milieu

  33. Neuromuscular Training is Effective Hewett 1999

  34. Nm retraining + hormones? • Is there an optimal time during maturation or within the menstrual cycle to conduct Nm re-education?

  35. Summary • ACL injury is multi-factorial • Modifiable factors • Biomechanics/Nm control • Sex hormones? • A more complete understanding can inform injury prevention strategies

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