Gender Differences in Sports Medicine

 

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Metabolic Differences

There is increasing evidence of gender-related differences in risk factors and clinical manifestation of metabolic conditions. Gender related metabolic differences are important to understand for medical treatment of men and women. Conditions such as diabetes, fat storage, and cardiac disease have an understood gender related mechanism and are conditions that have differing effects on men and women (Kautzky-Willer & Handisurya, 2009). Impaired glucose and lipid metabolism as well as energy balance and body fat distribution have a great impact on overall health and can have a greater effect on women than man. This is important to understand for sport activities and particularly for sports training in men and women.

One of the biggest reasons for sports performance differences in men and women is glucose use and skeletal muscle fiber type. Women tend to have a greater proportion of Type 1 fibers and greater capillary density leading to the ability to hold off fatigue. This means better tissue perfusion and greater capacity for glucose and fatty acid oxidation. Men have a higher glycolytic capacity meaning they can burn through more glucose in the absence of oxygen, which lends itself to better performance for short-intense bursts of effort. This is related to a higher percentage of Type II fibers. This is one reason male athletes tend to be faster and stronger in athletic competition(Lindle et al., 1997).

Another major difference is attributable to men’s higher testosterone levels and women’s higher estrogen levels. Testosterone is attributed to higher amounts of muscle mass and the ability to build muscle. Estrogen has been associated with better metabolic health and increased muscle sensitivity to glucose. Studies show when compared to sedentary men, endurance-trained men have 3-5x as many estrogen receptors on mitochondria increasing the rate of glucose uptake into the muscle when activated. This also relates to men’s ability to excel at high performance events while women tend to convert fat to energy better and fatigue less(Kautzky-Willer & Handisurya, 2009).

Overall, efficiency of skeletal muscle energy use, fat storage, and sex hormones all play a role in men’s and women’s training.

Epidemiology

Occurrence of injuries is common place in sporting competition and other athletic/fitness events. Common injuries that can occur include ACL injury, generalized knee pain, ankle sprain, meniscus injury, stress fractures, low back pain, patellar tendinitis, MCL and LCL knee injury, lumbar spondylolysis, and muscle strains. Although there is no evidence to suggest that there are gender related differences in the type of injury to an athlete (only one gender getting a certain injury), there is evidence to suggest that the prevalence of certain injuries can be linked to gender (women injuring a structure more than men).

Research has found significantly higher proportion of females who engaged in basketball, volleyball, or skiing presented with an ACL injury, compared with their male counterparts. There is also a higher proportion of females than males among the track and field athletes who present with stress fractures (Iwamoto, Takeda, Sato, & Matsumoto, 2008). Aside from ACL injuries; prevalence of other types of sports injuries between genders is not well established or studied.

It appears lower extremity injuries are more directly correlated to gender. Research has suggested that sex hormones, dynamic neuromuscular imbalance, and anatomy play a role in the increased risk of injury in female athletes. It also appears that the effects of sex hormones on lower-extremity neuromuscular control patterns differ across the menstrual cycle phases in female athletes (Dedrick et al., 2008).

References

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Kautzky-Willer, A. & Handisurya, A. (2009). Metabolic diseases and associated complications: sex and gender matter. European Journal of Clinical Investigation, 39(8), 631-648. doi: 10.1111/j.1365-2362.2009.02161.x

Iwamoto, J., Takeda, T., Sato, Y., & Matsumoto, H. (2008). Retrospective case evaluation of gender differences in sports injuries in a japanese sports medicine clinic. Gender Medicine, 5(4), 405-414. doi:10.1 016/j.genm.2008.1 0.002

Dedrick, G., S., Sizer, P., S., Merkle, J. N., Hounshell, T., R., Robert-McComb, J., J., Sawyer, S., F., Brismee, J., & James, C., R. (2008). Effect of sex hormones on neuromuscular control patterns during landing. Journal of Electromyography and Kinesiology, 18, 68-78. doi:10.1016/j.jelekin.2006.09.004

Lindle R., S., Metter, E., J., Lynch, N., A., Fleg, J., L., Fozard, J., L., Tobin, J., Roy, T., A., & Hurley, B., F., (1997). Age and gender comparisons of muscle strength in 654 women and men aged 20–93 years. Journal of Applied Physiology, 83 (5), 1581-1587. PMID: 9375323