Why Do Girls Sustain More Anterior Cruciate Ligament Injuries Than Boys?

Wild, Catherine; Steele, Julie R.; Munro, Bridget J.

doi:10.1007/bf03262292

Cited by 69 publications

(35 citation statements)

References 71 publications

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“…12 The teen years may represent a particularly vulnerable time period, given the dramatic changes in hormones, muscle and bone structure and weight. Given increased risk for connective tissue injury during adolescence in girls, 41 it is biologically plausible that high strenuous activity during this period may affect future pelvic floor function.…”

Section: Discussionmentioning

confidence: 99%

Lifetime physical activity and female stress urinary incontinence

Nygaard

Shaw

Bardsley

et al. 2015

American Journal of Obstetrics and Gynecology

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Objective To estimate whether moderate/severe stress urinary incontinence (SUI) in middle-aged women is associated with overall lifetime physical activity (including leisure, household, outdoor, and occupational), as well as lifetime leisure (recreational), lifetime strenuous and strenuous activity during the teen years. Study design Recruitment for this case-control study was conducted in primary care level family medicine and gynecology clinics. 1538 enrolled women ages 39–65 years underwent a Pelvic Organ Prolapse Quantification examination to assess vaginal support. Based on Incontinence Severity Index scores, cases had moderate/severe and controls no/mild SUI. We excluded 349 with vaginal descent at/below the hymen (pelvic organ prolapse), 194 who did not return questionnaires, and 110 with insufficient activity data for analysis. 213 cases were frequency-matched 1:1 by age group to controls. Physical activity was measured using the Lifetime Physical Activity Questionnaire, in which women recall activity from menarche to present. We created separate multivariable logistic regression models for activity measures. Results SUI odds increased slightly with overall lifetime activity (OR 1.20 per 70 additional MET-hrs/wk; 95% CI 1.02, 1.41), and were not associated with lifetime strenuous activity (OR 1.11; 95% CI 0.99, 1.25). In quintile analysis of lifetime leisure activity, which demonstrated a non-linear pattern, all quintiles incurred about half the odds of SUI compared to reference (2nd quintile; p=0.009). Greater strenuous activity in teen years modestly increased SUI odds (OR 1.37 per 7 additional hours/week; 95% CI 1.09, 1.71); OR 1.75; 95% CI 1.15, 2.66 in sensitivity analysis adjusting for measurement error. The predicted probability of SUI rose linearly in women exceeding 7.5 hours of strenuous activity/week during teen years. Teen strenuous activity had a similar effect on SUI odds when adjusted for subsequent strenuous activity during ages 21–65 years. Conclusion In middle-aged women, a slight increased odds of SUI was noted only after substantially increased overall lifetime physical activity. Increased lifetime leisure activity decreased and lifetime strenuous activity appeared unrelated to SUI odds. Greater strenuous activity during teen years modestly increased SUI odds.

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Section: Discussionmentioning

confidence: 99%

Lifetime physical activity and female stress urinary incontinence

Nygaard

Shaw

Bardsley

et al. 2015

American Journal of Obstetrics and Gynecology

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“…Exclusion criteria were: (i) history of lower limb injury, knee pain or medical condition affecting walking, running and jumping (ii) previous ACL or meniscal injury or (iii) bi-or tri-phasic oral contraceptive pill (OCP) use. The decision to exclude girls using a bi- or tri-phasic OCP was to limit the influence estrogen could have on lower limb biomechanics, as these types of pills produce fluctuations in estrogen across the menstrual cycle [ 3 ]. All participants, together with parents/guardians of those < 18 years of age, signed an informed consent form.…”

Section: Methodsmentioning

confidence: 99%

Effect of high and low‐supportive footwear on female tri‐planar knee moments during single limb landing

Sayer

Hinman

Paterson

et al. 2018

Journal of Foot and Ankle Research

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BackgroundHigher landing-related external knee joint moments at later stages of female pubertal development likely contribute to a higher incidence of non-contact anterior cruciate ligament (ACL) injury. Athletic footwear may provide a potential strategy to alter higher knee moments.MethodsThirty-one late/post-pubertal girls (Tanner stage IV-V, menarche and growth spurt attained) performed a single limb drop lateral jump in three footwear conditions (barefoot, low support shoes and high support shoes), in which peak knee abduction moment (KAbM), flexion moment (KFM) and internal rotation moments (KIRM) were measured. Repeated measures ANOVA and ANCOVA were used to test for a main effect of footwear with and without foot posture index (FPI) as a covariate (p < 0.05) with post-hoc test carried out via Fisher’s Least Significant Difference (LSD).ResultsA main effect of footwear condition was observed for peak KFM (p < 0.05), but not KAbM or KIRM, in both unadjusted and adjusted models. Post-hoc analysis demonstrated that both high- and low-support shoes increased peak KFM compared with barefoot (p < 0.001).ConclusionOur findings indicate commercially available high- and low-supportive footwear increase peak KFM, but do not effect KAbM or KIRM while landing among late/post-pubertal girls. This suggests that these styles of footwear are inadequate at reducing higher knee moments in an at-risk cohort.

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“…32 The teen years may represent a particularly vulnerable time period, given the dramatic changes in hormones, muscle and bone structure and weight. Given increased risk for connective tissue injury during adolescence in girls 41 , it is biologically plausible that high strenuous activity during this period may affect future pelvic floor function.…”

Section: Physical Activity and Urinary Incontinencementioning

confidence: 99%

Physical activity and the pelvic floor

Nygaard

Shaw

2016

American Journal of Obstetrics and Gynecology

136

124

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Pelvic floor disorders (PFDs) are common, with one in four U.S. women reporting moderate to severe symptoms of urinary incontinence, pelvic organ prolapse or fecal incontinence. Given the high societal burden of these disorders, identifying potentially modifiable risk factors is crucial. Physical activity is one such potentially modifiable risk factor; the large number of girls and women participating in sport and strenuous training regimens increases the need to understand associated risks and benefits of these exposures. The aim of this review is to summarize studies reporting the association between physical activity and PFDs. Most studies are cross-sectional and most include small numbers of participants. The primary findings of this review include: Urinary incontinence during exercise is common and is more prevalent in women during high-impact sports. Mild to moderate physical activity, such as brisk walking, decreases both the odds of having and the risk of developing urinary incontinence. In older women, mild to moderate activity also decreases the odds of having fecal incontinence; however, young women participating in high intensity activity are more likely to report anal incontinence than less active women. Scant data suggest that in middle-aged women, lifetime physical activity increases the odds of stress urinary incontinence slightly and does not increase the odds of pelvic organ prolapse. Women undergoing surgery for pelvic organ prolapse are more likely to report a history of heavy work than controls; however, women recruited from the community with pelvic organ prolapse on examination report similar lifetime levels of strenuous activity as women without this exam finding. Data are insufficient to determine whether strenuous activity while young predisposes to pelvic floor disorders later in life. The existing literature suggests that most physical activity does not harm the pelvic floor and does provide numerous health benefits for women. However, future research is needed to fill the many gaps in our knowledge. Prospective studies are needed in all populations, including potentially vulnerable women, such as those with high genetic risk, levator ani muscle injury, or asymptomatic pelvic organ prolapse, and on women during potentially vulnerable life periods, such as the early postpartum or postoperative periods.

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Why Do Girls Sustain More Anterior Cruciate Ligament Injuries Than Boys?

Cited by 69 publications

References 71 publications

Lifetime physical activity and female stress urinary incontinence

Lifetime physical activity and female stress urinary incontinence

Effect of high and low‐supportive footwear on female tri‐planar knee moments during single limb landing

Physical activity and the pelvic floor

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