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

by Dr. Lisa Callahan
Soccer player

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, 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. 

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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Have you ever thought about including a little bit more than just
your articles? I mean, what you say is valuable
and all. Nevertheless think about if you added some great graphics or videos
to give your posts more, “pop”! Your content is excellent but with pics and clips, this site could definitely be one
of the best in its field. Wonderful blog!

HSS on the Move says:

Thanks for your comments and feedback. We’re glad you enjoy our content, and we agree that including photos and videos present a more dynamic experience for our users. We’ve got some things in the works along those lines, so look for more multimedia soon. In the meantime, you can view our video collection on our YouTube page (http://www.youtube.com/hspecialsurgery) and photos on Facebook (https://www.facebook.com/hspecialsurgery). Thanks again for sharing your opinion.

Ocie Secrease says:

Plantar fasciitis is particularly common in runners. In addition, people who are overweight, women who are pregnant and those who wear shoes with inadequate support are at risk of plantar fasciitis.

andie says:

I wish ONE doctor could have some new groundbreaking info on Chronic Costochondritis I can actually use….running out of doctors and same old. It”s over a year and can”t workout.

HSS on the Move says:

Hi Andie, sorry to hear you’re in pain. If you’d like to make an appointment with an HSS physician, please contact the Physician Referral Service at +1.877.606.1555 or https://www.hss.edu/secure/prs-appointment-request.asp?pageid=6463.

Susan says:

Your age: 67
Gender: F
Activity level: Good

This is my issue.

I developed a very sever itching rash around my shoulder blades & upper left arm, ongoing for over 6 years!
Been to many many docs…no luck.
From research on the web I found a photo of someone with pressure ulcers on her back. Looks exactly like what I have.
Right shoulder blade higher than left as well.
Finally, as a favor, a neurologist viewed my MRI and reports & diagnosed it as an impinged tendon.

I am assuming the pressure ulcers are due to the impingement. How do I unlock this impingement, are there exercises, or sleep positions that could do the trick?

Please help have been suffering for quite some time.

Thanks,
Susan I.

HSS on the Move says:

Hi Susan, thank you for reaching out. If you wish to receive care at HSS, please contact our Coast to Coast (C2C) Program at 212-606-1610 or by email at C2C@hss.edu for further assistance. For more information on our Coast to Coast Program, visit http://www.hss.edu/coast-to-coast.asp.

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