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Stovitz’s and Arendt’s Sport Medicine Perspective on Warrior Girls

09/20/2008

by Steven D. Stovitz, MD, FACSM — Assistant Professor, Department of Family Medicine and Community Health & Elizabeth A. Arendt, MD, FACSM — Professor, Department of Orthopedic Surgery

As sports medicine providers, we are aware of the devastation that an ACL tear can have on both the musculoskeletal system and the mental health of an adolescent. In certain sports, females sustain a higher rate (not a greater number) of non-contact ACL injuries when compared with males. However, the emphasis on the emotional interplay among the athletes, parents, and coaches Sokolove writes about detracts the focus from a more scientific presentation of injury risk. Warrior Girls suffers from the following:

1) False comparisons—One major theme is that females simply can’t do what males do. Therefore, when they try to “act like males,” meaning be competitive, powerful and aggressive, they will inevitably become injured.

2) Misrepresentation of scientific literature—We don’t know why girls suffer ACL injuries at rates higher than boys. Theories include factors such as differences in strength, joint laxity and gait. The author presents each theory as a “known risk factor” implying that all girls inherently contain every risk factor which places all females at enormous risk.

3) Fudging of statistics—Imagine something happens in 0.1% of population X, and 0.2% of population Y. You could say that the difference between the populations is 0.1% (i.e., the absolute difference), or you could say that the difference is 50% (i.e., the relative difference). While both numbers have meaning, when discussing an ACL injury prevention program, Sokolove only presents the relative difference—in this case, 74% fewer ACL tears occurred in girls who completed an ACL prevention program compared to girls who did not complete the program. A more honest (and accurate) approach would be to present both numbers.

4)  Emotional language—“The ACL does not tear so much as it explodes”, and “parents scream ‘No! No! Oh, no!’ from the sidelines.” Such overwrought language permeates Sokolove’s writing and contributes to the sense of fear he creates when discussing the “injury epidemic” he claims exists.

There is an identifiable gender disparity with regard to non-contact ACL injuries. To address this concern, parents and coaches could, for example, be much more aware of ACL injury prevention training and its many benefits for females and males. Unfortunately, these critical messages get lost within Sokolove’s over-the-top and misleading approach.

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