Ask the Expert: Dr. Lisa Callahan, Sports Medicine Physician, Answers Your Questions on Injuries & Risks for Female Athletes

by Dr. Lisa Callahan

September 26th is National Women’s Health and Fitness Day.  In honor of this, our “Ask the Expert” feature is focused on injuries and female athletes.

Q1. Wondering what your thoughts are regarding the etiology of the female triad, ACL and MCL lateral collateral knee damage?

The term “female athlete triad” refers to the relationship of three factors: low energy availability produced by disordered eating, infrequent or absent menstrual cycle, and low bone mineral density. There is no known association between the female athlete triad and knee ligament injuries.

Q2. How can a female college soccer player prevent plantar fasciitis and heel stress fractures? Could wrapping the ankles too tightly have caused the plantar fasciitis? My daughter has never had a problem with either condition until this year.

Plantar fasciitis is an inflammation of the tough, fibrous support tissue on the undersurface of the foot called the plantar fascia. It attaches at the heel and often becomes inflamed in athletes who participate in running sports. Applying ice, stretching the calf and foot, wearing cushioned supports in the shoe, and using a “night splint” can all help prevent or alleviate plantar fasciitis symptoms. Athletes can often play through plantar fasciitis symptoms, but a stress fracture in the heel bone (the “calcaneus”) is a different issue entirely. It is much less common than plantar fasciitis, and would require evaluation by a specialist. An athlete should not play with an unhealed stress fracture. It is possible that inappropriate taping or bracing could irritate the plantar fascia temporarily, but shouldn’t cause prolonged symptoms and would not cause a stress fracture. Your daughter should consult a physician before returning to playing soccer.

Q3. What do you consider the greatest underlying factor that gives female athletes such a disproportionately high risk for ACL and other knee joint injuries? What is the best way to prevent these injuries for female athletes specifically? And are there any new or upcoming surgical techniques that help to reduce recovery time and improve back-on-the-field prognoses?

Studies have shown us that biomechanics play a large role in ACL injuries. There are several programs developed for ACL injury prevention that focus on teaching girls how to correctly jump and land. These appear to be very helpful and are recommended especially for girls who play sports with high risk of ACL injury such as soccer and basketball. Talk with your physician or physical therapist about an injury prevention program.

My colleague, Dr. Sabrina Strickland, Orthopedic Surgeon, says that it takes years to really know whether new surgical techniques actually lead to a better outcome. However, she says that we are now using just one hamstring, instead of two, as a source for the graft tendon in some patients, which has the benefit of preserving one’s own tendon.

Q4. My friend runs around 50 miles a week and doesn’t eat a lot. How does her level of exercise and lack of nutrients affect her health?

Supplying the athlete’s body with adequate nutrients is critical for fueling performance, helping to prevent injury, and maintaining general health. Not eating enough is what doctors refer to as “low energy availability,” a situation that places a woman’s general health at risk. We often see this first as low bone density, which can be associated with stress fractures. Stress fractures are micro-cracks in bone that occur when a bone is exposed to more load, or “stress,” than it can support. Studies suggest that running more than 35-40 miles/week also increases the risk of stress fractures, so the combination of not eating enough and running 50 miles/week puts the female athlete at risk for poor bone health.

Q5. Besides knee pads and helmets, what advice do you have for post-total knee patients who just started to bicycle again … and I fell twice right on my one-year-old knee?

After a surgery like knee replacement, it is important to work on strength, endurance, and flexibility of the leg muscles. However, it is equally important to be sure your balance is good. Talk to your doctor or physical therapist about simple exercises you can do to maintain or improve your balance, which hopefully will help you avoid future falls.

Dr. Lisa Callahan, Sports Medicine Physician

Dr. Lisa Callahan is a Sports Medicine Physician and Co-Director of the Women’s Sports Medicine Center at Hospital for Special Surgery. She currently serves as the Director of Player Care for the NY Knicks and Liberty basketball teams.