Friday, April 12, 2019

The gender gap in sports injuries


The sun’s rays had not yet lit the sky in the early morning of August 10, 2008 when the lives of two people changed forever. Nineteen-year-old Candy Lynn Baldwin was driving home after having been awake for much of the previous day and night. While crossing the Chesapeake Bay Bridge, she fell asleep. Her car swerved over the median and crashed into a semi truck. It plummeted into the bay, killing its driver.

Ms. Baldwin suffered non–life-threatening injuries, but will have to live with her guilt for the rest of her life. The driver, John Short, became one of over 6,000 people per year who die as a result of drowsy driving. He joins an unfortunate list that includes the driver of comedian Tracy Morgan’s limousine (hit by a truck whose driver had been without sleep for 24 hours) and Maggie McDonnell (killed in a head-on collision by a truck driver who had been awake for 30 straight hours). Ms. McDonnell’s death has since inspired “Maggie’s Law,” which makes it illegal in New Jersey to drive a vehicle while knowingly impaired from sleep deprivation.
How low can you (technically) go?

Most likely, everyone has driven a car while feeling sleepy on at least one occasion. But how much sleep do you truly need before it is definitely unsafe to drive? Recently, the National Sleep Foundation, in consultation with experts from the field of sleep medicine and the transportation industry, convened a panel to answer this question. It’s a complex one because there are several other factors besides sleep duration that determine one’s level of sleepiness. For example, a large amount of pre-existing “sleep debt” will magnify the impact of acute sleep deficiency. In addition, the time of day makes a difference. At night, your natural body clock (circadian rhythm) is set for “sleep,” and therefore the reduction in alertness from acute sleep loss will be worse than during the day. This is why drowsy driving accidents occur mostly at night. And of course, the quality of one’s sleep is critical — which is why, for example, trying to pay back your sleep debt with a motel room next to railroad tracks is ill-advised!

After considering all these issues and the available evidence, the panel concluded that a driver is definitely impaired if he or she has had less than two hours of sleep in the preceding 24 hours.
Putting drowsy driving in perspective

Does this mean that it is safe to drive if you sleep for only two hours? The answer to this question is an emphatic no. Most people will still be impaired from sleep deficiency even if they sleep for more than twice this amount. As stated by the chair of the panel, Dr. Charles Czeisler, chief of the Division of Sleep and Circadian Disorders at Harvard-affiliated Brigham and Women’s Hospital and the Baldino Professor of Sleep Medicine at Harvard Medical School, “the two-hour threshold should serve as a red-flag warning for individuals and a guide for public policy makers.” In other words, in the development of future legal statutes such as “Maggie’s Law,” it should be the absolute lower limit used to define drowsy driving, similar to the way driving under the influence is defined as a blood alcohol content greater than .08%.

Are there ways to reduce the impact of sleep deficiency on driving performance? Stimulants such as caffeine can certainly reduce sleepiness for a short period of time, but not indefinitely. Other commonly employed methods have been shown to be ineffective. For example, turning up the volume on the radio and opening the car window are both useless. Furthermore, even if you do not feel sleepy, you may still be impaired because there is a poor correlation between sleepiness and performance. Only sleep can reverse the impact of sleep deficiency!

Drowsy driving is a significant public health hazard in the United States. According to an estimate from the Institute of Medicine, up to 20% of all motor vehicle crashes are related to drowsy driving. That means that drowsy driving causes more than 1 million crashes per year. And the actual number may be much larger because drowsy driving is often under-reported.

The only remedy is for people not to drive without adequate sleep. Two hours may be the lower limit, but you should not be fooled into thinking it is safe even if you’ve slept for longer. The bottom line: “Sleep-Deprived? Don’t Drive.” Yoga is a gentle and restorative way to wind down your day. A national survey found that over 55% of people who did yoga found that it helped them get better sleep. Over 85% said yoga helped reduce stress. You can use supportive props like bolsters, blankets, and blocks to make poses comfortable so that you can stay in the pose for longer and continue to breathe.

Your breath is key to be able to relax in these poses. Breath in yoga is equally important—if not more important—as the physical pose. Use a gentle and calming yoga breath technique called Ujjayi Breath, also known as Ocean Breath or Victorious Breath. Inhale deeply through the nose. With your mouth closed, exhale through your nose while constricting the back of your throat as if you are saying “ha” but keep your mouth closed. This exhalation should sound like the waves of the ocean (or like Darth Vader from Star Wars). Use this slow and steady breath to soothe yourself in each of these poses.

Practice these yoga poses right before bedtime and stay in them about 3 to 5 minutes each. Use your Ocean Breath in each pose, with the exception of Corpse Pose, where your breath returns to normal.

These seven restorative yoga poses relieve tension and stress at the end of the day. The more that you practice these poses regularly, the more you likely you can get a good night’s rest.
1. Wide-Knee Child’s Pose (Balasana)
Wide-Knee Child’s Pose (Balasana)

Image: iStock
Relaxing exercise

Image: iStock

This resting pose provides a sense of calm and stability. Be cautious if you have hip or knee injuries.

    Kneel on the floor and bring your big toes together.
    Separate your knees hips width apart or as wide as the edges of the mat.
    Exhale and sink your torso onto your thighs.
    Let your hands relax alongside your torso, so your arms are pointed to the back of the room, palms facing up. This should release shoulder tension by widening your shoulder blades away from each other.
    If you want a more active pose, reach your hands forward, palms down on the mat.
    Keep your forehead on the ground. Roll your head to each side gently. This releases tension in your brow.
    Take slow and steady breaths, in and out through your nose.

2. Standing Forward Bend (Uttanasana)
Profile of sporty young man on white background in uttanasana with elbow grab (intense stretch pose, forward bend, forward fold, head to knees), surya namaskar, sun salutation complex

Image: iStock

    Stand with your feet hips width apart. Inhale deeply.
    Exhale and extend your torso forward and over your legs to elongate your spine.
    Hold onto your elbows or let your hands rest on your shins or the floor.
    Do not strain to reach the floor—the purpose is not to achieve a perfect shape, but is to elongate the spine and relax your neck and shoulders.

doing variation of Ardha Uttanasana pose, studio three-quarters view on white background, isolated

Image: iStock

    This forward bend allows you to relax your neck tension and gently stretches your hamstrings, calves, and hips. Be careful if you have a back injury.

    If it is difficult for your hands to reach the floor or your back is uncomfortable, place blocks under each hand to provide more support.
    Breathe in and out through your nose slowly and smoothly.
    If you have tight hamstrings, keep your knees “soft” by bending them slightly so thatyour chest can relax on your thighs.
    Gently shake your head “yes” and “no” to relax and loosen your neck muscles.
    To come up, roll up slowly to standing to avoid getting light-headed.

3. Standing Half Forward Bend (Ardha Uttanasana) at the wall

This is another modification of the pose, standing forward bend. Video available here.
Standing Half Forward Bend (Ardha Uttanasana)

Image: iStock

    Place your mat perpendicular to the wall.
    Stand about a foot away from the wall.
    Your feet should be hips width apart and parallel to the edges of the mat.
    Press your hands against the wall with your palms spread at the height of your hips.
    Step back with your feet hips width apart and lower your torso until you come into a flat back position, so that your torso is perpendicular to the floor.
    Use your palms to press the wall away from you to lengthen your back.
    Press into all four corners of your feet.
    Keep your ears in line with your arms.
    Adjust your distance from the wall to make sure your body is at a 90-degree angle (L shape). If you are too close to the wall, your back and arms will not be able to be fully extended. If you are too far from the wall, you will not be able to bend forward enough.
    Continue to breathe deeply as you press the wall away from you with your palms.

4. Reclining Bound Angle (Supta Baddha Konasana)
Sporty girl on white background resting in Reclining Bound Angle yoga Pose, Supta Baddha Konasana, restorative, relaxing asana, using bolster

Image: iStock

This pose eases tension in your hips and groin area. Be cautious if you have knee, hip or groin injuries.

    Lie down on the mat.
    Bend your knees, and place your feet on the floor, close to your tailbone.
    Bring the soles of your feet together and allow your knees to relax away from each other, while placing blocks or firm cushions underneath your knees on each side to support your hips.
    If you have tight hips, you can adjust your feet so that they are further away from your tailbone or add more blocks or cushions under your knees for additional height.
    Relax your arms on the floor about 45 degrees away from your torso, palms facing the ceiling.
    Do not press down on knees to create additional tension. Gravity is already doing the work.
    You should feel a gentle stretch in your hips and groin, but it should not be painful.

5. Legs Up The Wall Pose (Viparita Karani )
Image: iStock

Image: iStock

At the end of the day, especially if your job involves staying on your feet, your feet and ankles can get swollen and tired. This simple pose helps recirculates your blood flow.

    Find an empty space on your wall and place your mat perpendicular to the wall.
    Sit down on the mat and bring your left or right side to the wall as close as possible, so your side body meets the wall.
    Lie back onto mat, and gently place your legs up the wall.
    Relax your arms by your sides.

Optional: You can add a rolled up mat or firm cushion underneath your tailbone to give your tailbone added support.
6. Corpse Pose (Savasana)
Corpse Pose (Savasana)

Image: iStock

Corpse pose is the traditional final resting pose of yoga practice. You can let your breath return to normal in this pose.

    Lie back on the mat.
    Hug your knees in towards your chest tightly and take a deep inhale.
    Exhale and stretch your legs out away from you while keeping your tailbone grounded on the mat.
    Your feet should be hips width apart and relaxed away from each other, toward the edges of the mat.
    Let your lower back soften and relax. You should not feel any pain or tightness in your lower back.
    Relax your arms at your sides, palms facing upward.
    Check to make sure your shoulders are not hunched, and, if so, relax your shoulders away from your ears.
    Optional: Place a folded towel over your eyes to block out any light.

7. Legs on a Chair Pose

This pose is useful for people who might have more difficulty fully extending their legs up the wall due to lower back, knee, or hip injuries. You can find a video of how to get into this pose here.

    Place a chair at the end of your yoga mat so that it faces you.
    Place a folded towel or blanket on the seat of the chair. Depending on the height of the chair, you may need a few folded blankets under your sacrum as well.
    Sit close on the mat, with your seat close to the front of the chair.
    Lie down on one side with knees bent in fetal position. Scoot onto the center of the mat.
    Roll onto your back with bent knees so that your calves can rest on the seat of the chair.
    Your thighs should be at a 90-degree angle to your shins.
    Keep your arms relaxed at your sides, palms facing up.
If you’ve watched any football this fall, you’ve probably seen some exciting games, some spectacular plays, and unfortunately, some major injuries. From what you see at the game or on television, you might think that sports injuries are more common among male than female athletes.

That may be true for college and NFL football players, since nearly all are male. But, women are actually more prone than men to suffer many of the most common sports-related injuries. There are a variety of reasons for this “gender gap,” and there is much about it that remains uncertain. But the recognition of this gap has led to innovative efforts to prevent injuries among women in sports.

Consider the anterior cruciate ligament (ACL). It’s a vital structure in the knee that provides stability under stress. Injuries of this ligament are up to 6 times more common among women than men. And a number of other sports-related injuries are also more common among women.
What injuries are most common among female athletes?

    Ankle sprain. This is the most common sports injury in both men and women, but it’s particularly common among women.
    Shoulder troubles. Examples include rotator cuff problems (including tendon inflammation, or tendinitis) and instability.ACL
    Knee injuries. These include irritation under theknee cap (called patellofemoral syndrome) and ligament damage (including tears to the ACL), which is especially common among soccer and basketball players.
    Stress fractures. These are especially common in the foot or lower leg (tibia) among women with the “female athlete triad,” a combination of inadequate calorie and nutrient intake, irregular menstrual periods, and bone loss. Eating disorders, including anorexia nervosa, contribute to this triad.
    Plantar fasciitis. Abnormal alignment of the foot and flat feet may contribute to these small tears in the supporting tissues along the arch and heel.

Why are women more prone to these injuries than men?

There is probably a combination of factors that contribute to the higher incidence of injuries among female athletes. And we have more theories than actual answers. The most common explanation is that it’s due to basic differences between the bodies of men and women. For example, the typical female athlete, as compared with her male counterpart, has:

    higher estrogen levels, along with less muscle mass and more body fat
    greater flexibility (due to looser ligaments) and less powerful muscles
    a wider pelvis, which alters the alignment of the knee and ankle
    a narrower space within the knee for the ACL to travel through
    a greater likelihood of inadequate calcium and vitamin D intake.

Women also tend to move differently than men. For example, when landing from a jump, women tend to land more upright and with the knees closer together. And when female athletes suddenly change direction, they tend to do so on one foot (perhaps due to their wider pelvis), while men tend to “cut” from both feet.

Another theory suggests that hormonal changes during the menstrual cycle make women particularly prone to injury. However, this has not been proven and research on the subject is inconclusive.
What can women do to avoid these injuries?

Fortunately, women can take steps to reduce the chances they’ll suffer these injuries. The rate of ACL injuries may go down if muscles are strengthened, especially the hamstrings (located at the back of the thigh) and the vastus medialis (a major muscle that lies along the inside of the thigh and knee). A 2012 analysis of the medical literature concluded that training programs to prevent ACL tears were highly effective, reducing them by more than 50% for women (and 85% for men).

Training to change direction from both feet (rather than one), training to land from jumps in a safer position, and weight-lifting programs that target specific muscles may also prove effective. Bracing can help limit ankle sprains. Orthotics (shoe inserts) may provide support and re-alignment for those prone to plantar fasciitis or other foot injuries. Counseling from nutritionists, primary care physicians, coaches, and psychologists can help address the “female athlete triad” and other challenges facing female athletes.
The bottom line

A female athlete may be just as fit (or more so) than her male counterpart, yet there appear to be different vulnerabilities among men and women for certain athletic injuries. Lack of recognition, an incomplete understanding of why injury risks are increased among women, and athletic training programs that don’t take these differences into account are all part of the problem. However, there are some ways to counter this. Even though anatomy and biology may not be easily modified, the difference in injury rates between male and female athletes is a reason to promote additional research so that we can understand these differences better and figure out how to prevent injuries in both genders.

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