Puberty in Female Athletes May Protect Against Injury

A new study, “Age-Dependent Patellofemoral Pain: Hip and Knee Risk Landing Profiles in Prepubescent and Postpubescent Female Athletes,” published in The American Journal of Sports Medicine on August 9, 2018, suggests that the progression from prepubertal to postpubertal status in female athletes may have a protective effect on high-risk hip mechanics associated with patellofemoral pain in female athletes.

The researchers recruited 506 high school female athletes to complete a detailed medical history, the Anterior Knee Pain Scale and a knee examination for the diagnosis of patellofemoral pain. They also attended follow-up appointments.

Biomechanical measures were used to classify the female athletes into high- or low-risk knee and hip landing profiles. The biomechanical measures used in the knee landing profile included sagittal-plane knee range of motion, peak knee abduction angle, peak knee abduction moment, and peak-to-peak transverse-plane knee moment. Those measures used in the hip landing profile included sagittal-plane hip range of motion, peak hip extensor moment, peak abductor moment, and peak hip rotator moment. The testing occurred over a two-year period.

According to the data, female athletes with high-risk hip landing profiles experienced increased hip flexion and decreased abductor, rotator and extensor moments. Those who had transitioned to postpubertal status at follow-up had higher odds (OR, 2.1 [95% CI, 1.1-4.0]; p = .02) of moving to a low-risk hip landing profile compared with those who had not reached postpubertal status yet.

Those athletes with high-risk knee landing profiles however didn’t experience a similar protective effect. They experienced decreased knee flexion and increased knee abduction, external abductor and external rotator moments.

Gregory D. Myer, Ph.D., FACSM, CSCS*D of the division of sports medicine at the Cincinnati Children’s Hospital Medical Center told OTW that the biggest takeaway from their study was that the progression from prepubertal to postpubertal status may have a protective effect on high-risk hip mechanics but not on high-risk knee mechanics.

He said, “Female athletes entering puberty who demonstrate high-risk landing mechanics may benefit from neuromuscular training targeted to their deficits which could ultimately reduce their injury risk.”