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The need for further research into female athletes in sports research

Dr Paulina Kloskowska

Lecturer in Physiotherapy Education

20 September 2023

Health

Female athletes are underrepresented in all areas of medical research, particularly sports research. There is little female-specific data that would inform the training, rehab, prehab and exercise protocols for women athletes – and all guidelines are currently based on data based on male athletes.

Considering the anatomical differences between male and female athletes, the lack of data and – in consequence – specific guidelines, puts women in disadvantage and may lead to suboptimal training, rehab and prehab plans. This is particularly important in the pelvis and hip area, which are very different in men and women.

In male and female athletes participating in sports, pain and dysfunction in the hip and pelvis area are common. Due to similar forces going through hip joint while doing sports, male athletes are more likely to have symptoms related to groin, while female athletes are more likely to suffer from hip and hip-related pain, increasing their risk of early osteoarthritis.

At King’s we decided to start addressing this issue and started looking into a simple hip strength measurements in female athletes with two MSc projects. Firstly, we measured strength in healthy female athletes, and looked at various factors that may affect the strength. Secondly, we compared these results to a small sample of female athletes with hip pain to see whether the strength, and in what muscles, is in fact affected by pain.

For our project we invited female athletes to a one-off study session to answer some questions about their hip function and have their hip strength measured using a special force device called a hand-held dynamometer. We had a wide variety of participants from recreational gym-goers to elite athletes in sports such as sprinting, triathlon, hockey and gymnastics. The study involved measuring the peak isometric (static) strength of four hip movements; flexion, extension, abduction and adduction for each participant. When analysing the data, for my project I compared individual strength values, strength ratios of opposing muscle groups and self-perceived hip function scores, between the two groups.– Natasha Williams, 2nd year MSc Physiotherapy student

We found that in healthy female athlete cohort the strongest movements were hip flexion (bending the hip) and abduction (moving the leg to the side). This is a new and interesting finding, as while hip flexion movement is similarly strong in male athletes, the abduction is weaker than adduction movement – which is opposite, and means moving the leg in. So female athletes seem to be stronger in moving the leg out rather than in – opposite to males. We therefore now have evidence to show that female athletes move differently, and training plans that are based on male based data may not be optimal for these athletes.

Understanding what the normal hip strength values are for female athletes was unknown but is needed for healthcare professionals. In our project we found that hip strength was similar between dominant and non-dominant legs in the athletes and the strongest movement was hip flexion. We also found that strength reduced as age increased and hip flexion and hip abduction decreased significantly, this project means we can also begin to explore how the normal strength values will differ depending on age. – Bradley Barbour, 2nd year MSc Physiotherapy student

Secondly, when investigating the hip pain cohort, we observed the greatest hip strength deficits in the hip abduction movement – moving the leg to the side. These findings are consistent with previous research, and show that the hip abductor muscles need to be addressed in the pre-hab protocols for this group of athletes. Additionally, we saw that athletes reporting more hip pain symptoms showed higher adduction and flexion movements - suggesting that there is a particular way of movement that is implemented by athletes when they are in pain.

These two projects clearly show that female athletes need more attention and female-specific data. This will not only allow to increase their health and wellbeing, optimise performance and keep them injury free, but will also contribute to the equal sports playground.