Sexism Hurts: ACL Injuries & Women Athletes

Sexism can be simple and obvious (e.g. the FA ban on the women's game, or Man U's Christmas 'Rape' party). More often, it's subtle, complex, and really hard to tackle. Take, for example, the impact of poor medical understanding of women in general on women athletes in particular.

We see this in the alarming frequency with which women athletes who play especially soccer and basketball suffer ACL tears. The ACL tear is a very serious knee injury, requiring complex surgery and a lot of recovery time. (Pictured, right: Danielle Fotopolous, USNWT retired in 2007 after tearing her ACL for the third time in 2006.)

The New York Times Sunday magazine just published a long, in-depth story about young women soccer players, the injuries they sustain, and the difficulty we have in dealing with them (The Uneven Playing Field). The article is adapted from Michael Sokolove's forthcoming book Warrior Girls: Protecting Our Daughters Against the Injury Epidemic in Women’s Sports. (Can I just say: I hate that title. It's so paternalistic! And aimed at the parent-reader, not at the female athlete. How about - Match Fit: Injury Prevention for Young Women Athletes?)

This interesting article is unfortunately wrapped in a sensationalist package. Problematically, Sokolove makes news of the fact that more women are injured as more women play (really?!). The following rhetoric, for example, makes it seem like Title IX is the cause for the increase in 17 year olds needing knee surgery - and as if this were in itself the problem:

This casualty rate [JD: no statistic here, the author just means the number of injuries suffered by a couple of high school teams] was not due to some random spike in South Florida. It is part of a national trend in the wake of Title IX and the explosion of sports participation among girls and young women [No soccer teams = No ACL tears]. From travel teams [these are the club teams not based in the school system] up through some of the signature programs in women’s college sports, women are suffering injuries that take them off the field for weeks or seasons at a time, or sometimes forever. [Unlike men? I mean, of course women suffer career-ending injuries! At least they don't break each other's legs!]

The author then goes on the explain how girls develop differently - e.g. boys get more muscle, but less flexible; girls get more fat but more flexibility. The author's language flirts dangerously close to naturalizing girls and women as weaker, more delicate etc. I'm not the only one to spot this slant.

The main issue in this article, however, is women athletes' specific vulnerability to the ACL tear and the lack of understanding of the specific needs of female athletes - a failure caused not by Title IX, but by the ingrained sexism of medicine and sports culture.

Towards the end of the article, the author interviews Holly Silver, a physical therapist who has developed a knee injury prevention program that should be adopted by all footballers and their trainers.

Silver touches on some possible reasons for the high rate of ACL tears in women athletes: Girls are taught to walk and stand and move through the world differently. We curl around our chests - our bodies become shells, in a way, protecting/hiding everything 'feminine' - those bits are sources of shame, abuse, negative attention. [Ed: Found this note on Kickster, about the reception of the first women's game in 1894: "The British Medical Journal offered its professional opinion that 'we can in no way sanction the reckless exposure to violence, of organs which the common experience of women had led them in every way to protect'."]

One of the beautiful things about playing football is that it forces women to free their bodies from this shell: You can't trap the ball with your chest if you are hiding it from the world. You can't make a good play if your eyes are trained on your feet. You won't have much touch or footwork if your hips are locked.

Pointing to a player with good form, Silver explains

'She moves like a boy....Believe me, that's a good thing.'

In other words, that girl carries herself like an athlete. Girls are not encouraged to adopt this stance (knees bent, butt low to the ground). And so that posture has become synonymous with 'boy'. Boys of course aren't born moving this way - and lots of boys don't carry themselves that way (and are therefore terrorized for 'walking/throwing like a girl'). The point here is that the social inscription of gender is deep: it may be culturally produced, but it is carved into our spines, and worked into our joints. Girls need to unlearn that stuff - as athletes, they sometimes literally need to learn to walk, and run. (FYI: Philosopher Iris Marion Young writes about these issues in her collection of essays, On Female Body Experience: 'Throwing Like a Girl' and Other Essays.)

Silver describes the extraordinary consequence of the way that girls inhabit their bodies as they play sports - if you run with poor posture, your running is not only inefficient, it harms your back, hips, all your joints in fact. As any yoga practitioner will tell you, holding tension in your joints not only makes you less flexible and responsive (slowing your reflexes), it makes you more prone to aches and pains.

My sister coaches girls cross-country and track at Voorhees High School in New Jersey. Her teams have been very succesfull. Injury prevention is a big part of her program. They work on building up their strength in the gym, on minimizing strain to their muscles, on overall health and well-being. For example, she has the girls keep an eye on their iron levels - anemia is a big problem for teenage girls and young women, and can have a big impact on your development as an athlete. She's always looking for the latest information on issues like these, and keys these insights to the specifics of her sport and the people she coaches (teenage girls). Not all coaches approach their work this way.

One must recognize gender differences in order to coach/train/treat athletes well. Those differences may be physiological, metabolic, social and psychological.

For example, athletes in general are loathe to report injuries. Reporting injury or medical problems can be even harder for some girls and women. Here are some reasons why:

*We don't want to seem weak. In a world that reads all physical signs of womanliness as symptoms of the weakness of your sex, getting an injury makes you feel like your body has betrayed you, again.

*Women athletes can be reluctant to own up to the differences gender makes, because admitting to those differences has meant admitting to belonging to the 'weaker sex.' Remember: every girl - even today - will be told at some point that girls can't or shouldn't play or compete. Every girl hears that girls are weak, that they aren't tough. Or that playing a sport makes them mannish - i.e. repugnant. To all of this, players say: Fuck That, and get on with it. So, not only do we not want to seem weak - sometimes we don't want to seem like 'girls'.

*Doctors treat us differently. They don't listen to what we say about our bodies. They read everything through their ideas about our reproductive system. Our experiences with doctors tend to start off bad, and get worse. We have little reason to trust them.

*We are taught to accept certain physical symptoms as 'natural': tiredness (symptom no. 1 of anemia), especially.

*We are reluctant to talk about our bodies - sport is often the only avenue through which we get to talk about our bodies in a way that is neutral, matter-of-fact and empowering. I'll never forget listening to my sisters talk about pre-race bowel-clearing nerves and the humiliating but often hilarious situations that puts you in. As much as their stories made me laugh, I didn't really 'get' it until I started playing football and found myself at Hackney Marshes trying to act cool as we waited for the mens' teams to clear out of the damn bathrooms. Never, ever, go to Hackney, ladies, without a roll. Somehow, I associate that kind of frank and humorous talk about the body with 'jock'-culture. Some of us need encouragement to adopt this kind of attitude.

*Girls aren't always used to thinking of their bodies as something they can control. Except by starving themselves.

Add onto the above the following:

*Many girls and women play team sports on bad fields/in poor facilities.

*98% of sports stores don't carry football boots made for women - and that 2 % will carry maybe two kinds. The overwhelming majority of women wear men's boots, in other words.

*Because women were prevented from playing for so long, coaching/training is modeled after the boys/mens game, and a lot of coaches are not aware of things like the frequency of ACL tears in young women footballers and the conditioning programs which might prevent those injuries.

*We accept the differences in the way that men and women move as 'natural', and so do nothing to raise girl athlete's awareness of poor posture on the field, poor running technique, the importance of being relaxed and having a good stance.

*And, most problematic of all: we don't listen to girls. We don't take their complaints seriously. We dismiss their complaints as teenage melodrama or psychosomatic weakness.

That's a lot of crap to deal with. It's why teaching/coaching/advising girls and women can be harder - but it's also why it's so absolutely rewarding. The things we learn in such settings not only change how we play - they in fact change how we live.