Sports Medicine Finally Prioritizes Gender Equality

W.When cyclist Alison Tetrick joined the ranks of the sport’s pros, she received the perks that come with the job — including new bikes and clothing. But she was never comfortable riding in the saddle of her bike. Years later, Ms. Tetrick suffered severe damage to her genital area and eventually underwent surgery to remove excess skin from her labia. Tetrick was not alone. Sadly, many of her female cycling buddies also needed this treatment.

Since my Tetrick experience nearly a decade ago, I’ve seen some bikes, as amateur athlete and journalist Christine Yu writes in her new book, Up to Speed: The Breakthrough Science of Female Athletes. A company has developed a saddle and cycling shorts specifically for women. But Tetrick’s case represents a huge gap in exercise medicine and science that has long neglected the study of women.

The effects of this gap range from sporting goods that fail to take into account the physiological differences in the female body, to the higher incidence of injuries such as ACL tears and stress fractures in women in sports such as soccer and running. it is continuing. “Female athletes make up about 50% of the population, yet there are clear knowledge gaps in areas such as sports performance, cardiovascular health, musculoskeletal health, postpartum physiology and lactation research,” BMJ Open said. The authors of an article in Sport & Exercise said: In May, the medical journal called for greater representation of women both as research participants and as researchers in the field.

The starting point of the research gap goes back to Hippocrates, according to Rachel E. Gross, author of the 2022 book Vagina Obscura, which explores female anatomy from both a scientific and historical standpoint.

“Hippocrates and other eminent physicians considered the female body to be an inferior variant of the male body,” Gross told STAT. “Until the 1800s, there was always the problem of obtaining enough female bodies to dissect. Also, the basic premise was that women’s bodies were ‘smaller’ and did not require rigorous examination. had.”

This thought process has inspired all kinds of science going forward. “It’s a contradiction,” says Gross. “Science has long thought that women’s bodies are too different and bizarre to be included in clinical trials, but they are not so different that men’s data cannot simply be extrapolated.”

Even though scientists are increasingly acknowledging that women are more than just smaller versions of men, there’s a lot to catch up on. It wasn’t until 1993 that she mandated the inclusion of women and minorities in clinical studies funded by the National Institutes of Health. Since then, researchers have frequently excluded pregnant women and people of color from clinical trials.

“Medical research on the female body has focused on reproduction and disease, but neglected general health, immunity and pleasure,” says Gross. “It’s not that we don’t have the tools, it’s that we don’t find it interesting or urgent enough.”

Sexist attitudes towards women’s bodies also affect many of the sports in which women compete. Women did not compete in the World Cup until 1991, and women were not allowed to compete in the Olympic marathon until 1984. Major tennis tournaments still feature only best-of-three sets for women and best-of-five sets for men. And despite ample criticism, the National Collegiate Athletic Association still has a 6-kilometer cross-country running course for women and a 10-kilometer for men.

As female athletes continue to fight for a level playing field, it is important to understand how the very biology of female athletes influences their training, nutrition, health, and ultimately performance. No wonder we continue to lack sufficient information.

“Women’s sports science is really in its infancy,” says Kathryn Ackerman, director of the Women’s Athletes Program at Boston Children’s Hospital. “If you look at her research papers from 2016 to 2020, only 6% focus on female athletes.”

Alison Tetrick rides a bike - STAT health insurance.
Cyclist Alison Tetrick Courtesy of Alison Tetrick

Impact of research gaps on female athletes

The birthplace of exercise science is widely considered to be the Harvard Fatigue Institute. Founded in 1927, the institute studied male athletes performing experiments such as running on treadmills in cryogenic chambers below freezing and in “artificial deserts” with temperatures reaching 115 degrees Celsius. For example, blood was drawn from Olympic marathoner Clarence Demar in 1930, allowing researchers to better understand endurance during exercise. But that study didn’t include women, and “it matters where you start,” Yu said.

When the institute was closed in 1947, Yu explained: “Male researchers and students dispersed to other institutions, established their own laboratories, and continued the study of male athletes. That tradition continues today.”

One of the biggest exclusions in women’s sports science to date is the role of hormones, especially during puberty and the peri-menopausal period. “When you read sports science results, you ask yourself if the subject was in control of their menstrual cycle, or if they were on the pill, and what that means,” said Ackermann of Boston Children’s Hospital. It’s important to know,” he said. “Much of the body of research used to coach female athletes is not as sound as it should be.”

With so little to do, female athletes need to figure it out on their own or with coaches who don’t have a deep understanding of gender differences.

Esther Goldsmith, a sports scientist at ORRECO, a bioanalytical company, and FitrWoman, a period-tracking app that helps women sync their cycles to their workouts, tried to get a master’s degree in exercise physiology 10 years ago. I noticed this gap when I was “We were taught all the modules on how to improve athletic performance, but none of them were backed up by data on female athletes,” she said. “It is still underestimated, but now there is at least a realization of the need to push this forward.”

Goldsmith, in collaboration with Oleco, is studying blood biomarkers to understand hormone levels throughout the menstrual cycle and how they affect female athletes. The group launched the Women’s Athletes Program, which aims to help women athletes stay active in their cycles to maintain peak performance. This may include advice on nutrition, hydration and how to lower your risk of injury and illness at different points in your cycle. For example, some studies have shown that female athletes are more susceptible to muscle and tendon damage during ovulation. “As we learn, we educate female athletes from younger generations to high-performance elite athletes,” she said.

Christine Yu, author of Up to Speed: The Groundbreaking Science of Women Athletes Courtesy of Sylvie Rosokov

There are also gaps in our understanding of the female anatomy, including the breast, when it comes to exercise performance. “Breast tissue has no muscle structure or bone and has a very complex movement pattern,” Yu said. “How a woman experiences physical activity really has an impact, but it wasn’t until the 1970s that we invented the sports bra.”

If gear like sports bras were developed without research-based insight into the female body, it would not be able to provide women with the amount of control they needed to fully participate in sports. Yu’s book points to the fact that wearing an ill-fitting sports bra during a marathon can cause women to take shorter strides, leading to poorer performance. Meanwhile, a 2020 study found that 44% of 540 female athletes reported experiencing exercise-induced chest pain during training or competition, which negatively impacted their performance.

This lack of understanding of female anatomy has contributed to horror stories like Tetrick, where gearmakers applied a “shrink and pink” approach.

Yu points to some sports where women’s gear only offers smaller versions of men’s, or entry-level or slightly better. From women’s soccer spikes to downhill skis to running shoes, the gear available to women often tends to fit poorly and put more strain on the knees due to women’s wider pelvises. Did not support academic differences. .

Progress towards gender equality

Part of the solution to these problems lies in further research specifically focusing on women in sports. For example, a 2021 study of sports-related concussions in high school girls over a 20-year period found that female athletes experienced almost twice as many concussions as men in comparable sports. They are also more likely than men to have repeated concussions. Researchers are still trying to understand why this is the case, but such knowledge informs treatment both in the field and afterwards.

Providing well-informed and comprehensive health care for female athletes is also necessary. When Ackermann first started working as a sports medicine doctor, she noticed a pattern. “Young athletes were coming to me with issues like eating disorders, multiple stress fractures, gastrointestinal issues, and mental health concerns,” she says. “They needed to see different doctors for each problem, and there was no interdisciplinary approach to the problem.”

Ackermann’s boss, a forward-thinking male orthopedic surgeon, supported her vision when she consulted him on the idea of ​​intensive care for female athletes. Ackermann said she started the Women’s Athletes Program in 2013 and now provides holistic care for female athletes. The center offers a holistic approach to care that assesses exercise habits, hormonal balance, nutritional needs, exercise experience, and more. Demand for the program is so high that Ackermann is actively recruiting clinicians to serve.

Ackermann is also the leader of the biannual Women’s Athletes Conference. The conference brings together interdisciplinary researchers and clinicians from around the world to present and learn from each other. “My hope is that we can work with the Center to develop authoritative guidelines for female athletes and their coaches to better inform and understand women’s bodies and performance,” Ackermann said. Told.

Clinics like Ackermann’s and other similar clinics like the FASTR program run by Emily Krauss at the Stanford Center for Pediatric Orthopedic and Sports Medicine promote understanding of female athletes and how they are coached and treated. is useful for

The dangers of gender essentialism in research

While it is not surprising that sports science has evolved to include more women, there are also dangers in “over-correcting” or over-simplifying the consequences of gender dichotomies. As more trans athletes take to the field, it is also important to consider their needs and preferences. This is the concern of Kathryn B.H. Clancy, professor of anthropology at the University of Illinois and author of Periods: The Real Story of Menstruation.

“There’s been a long misconception that cycles don’t matter, but it’s important to start understanding that cycles do,” says Clancy. “But we also need a middle ground, one that doesn’t make it one-sided and suggests that when it comes to exercise, the cycle is everything.”

Yu also agrees. “I’m concerned that we might oversimplify the issue and boil things down to just hormones, as if hormones were the only thing that mattered,” she said. “But we’re not just hormones, nor are we how hormones work in a laboratory setting or the methodological parameters defined in a single study.”

Goldsmith also worries about misinformation pipelines and the tendency to oversimplify messages. “If you want to change events or races around your menstrual cycle to improve your performance, do so,” she said. “But it’s not always a viable option, and it’s different for everyone. Instead, it’s more important to understand how to manage your own symptoms throughout the cycle.”

Similarly, making gear specifically for women is a welcome but too slow progress, but it also comes with a minefield. Gender-specific products aren’t always the answer, and in some cases, they aren’t even needed. Yu’s book connected him with the bicycle manufacturer Specialized. The brand has revolutionized the design of saddles for women’s bodies, but said it has discontinued its previous line of women’s-specific bicycle frames because they weren’t backed up by science.

But as researchers push for more comprehensive research and young female athletes have higher expectations of their coaches, gear and performance, exercise science experts believe there is reason for optimism. .

“The female body has already shattered a lot of myths and myths in science, and I can only hope it will continue to do so,” Gross said. “The point is not to ask what the female body can do differently, but to ask what it can do. We have not yet reached its full potential.”

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