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Stovitz and Arendt Continue the Conversation

10/24/2008

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

We read your extensive reply to the Fall 2008 Tucker Center newsletter. We will take this opportunity to comment on the points directed toward our section that was entitled, Sports Medicine Perspective. Of note, our comments were based solely on a reading of your May 11, 2008 New York Times article entitled The Uneven Playing Field, which dealt primarily with Anterior Cruciate Ligament (ACL) injuries in the knee.

We share your concern with injury rates in athletes, and agree with your message that rates in certain sports with certain injuries tend to be higher in female athletes as compared to male athletes. As sports medicine physicians (and, parents) we agree that more research should be devoted toward the study of these facts. In addition, we are in agreement with your disdain for single sport specialization which appears to be a part of your book, but not a major part of the article to which our comments were directed.

In terms of your response to our comments, you included the statement, “It’s simply not true that I “imply”? that all girls inherently contain every risk factor.”? Our point was that girls tear their ACLs at higher rates than boys, but that we do not know why. Thus, researchers find attributes of girls that are different than boys and then say that the higher risk may be due to this or that particular attribute. You used circular logic by stating that the risk factors listed were known risk factors, all coincidentally noted to be more common in girls, and not theories trying to explain why girls tear their ACLs at higher rates than boys. In fact, your article included the following quote, “Girls, as their estrogen levels increase, tend to add fat rather than muscle…The influence of estrogen makes girls’ ligaments lax, …an injury risk when not accompanied by sufficient muscle to keep joints in stable, safe positions. Girls tend to run differently than boys — in a less-flexed, more-upright posture — which may put them at greater risk when changing directions and landing from jumps. Because of their wider hips, they are more likely to be knock-kneed — yet another suspected risk factor.” If that doesn’t imply that each of these distinct qualities place girls at higher risk, we have a disagreement on the definition of “imply.”

We suggested that you exaggerated the benefits of ACL injury prevention programs. To which you replied, “if the program works just half as well as its claims, I’d highly recommend it.” We agree. In fact, that’s our main point. The facts support the widespread implementation of ACL injury prevention programs. We are strong advocates of the work being done by Drs Hewitt, Bahr and others. Why not present the facts in a fair manner.

Finally, your reply to us included the following “They criticize my “over-the-top” and “emotional” approach. I am a journalist. We tell stories. We do tend to deal in more emotion than academics. I would not ask Drs. Arendt and Stovitz to put more emotion into their medical or epidemiological research. It’s unclear to me why they’d like me to subtract it from mine.” We do not know how one can reply to such an argument.

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2 Comments leave one →
  1. Michael Sokolove permalink
    10/30/2008 11:54 am

    I don’t think it is useful to get into an endless back and forth, but I’d like to as briefly as possible reply to the most recent post by Drs Stovitz and Arendt. We can disagree about what “imply? means. What I will say is this: When I use such language as girls “tend to run differently than boys“ or that they are “more likely to be knock-kneed“ most readers will understand I’m not talking about all girls, or saying that every girl has every combination of suspected risk factors. The readers of the New York Times Magazine, and those who go into bookstores and pay $20-plus dollars for a hardcover book, tend to be fairly discerning. I’m never fearful that they are going to infer things that I have not written.
    Now, to the larger point. You believe that I “exaggerated the benefits of ACL prevention programs,? but you also state: “The facts support the widespread implementation of ACL injury prevention programs.? As you well know, very few girls are enrolled in such programs. Few parents even know the programs exist. And yet your issue with my work is that I have exaggerated their effectiveness? I think I did a public service by calling attention to their existence.
    I’ll close by saying that I think we’re generally on the same side of the fence here, although I suspect my work is a bit noisy for your taste. I understand. It’s not what you do. It’s not how you write. But from what I learned over the course of three years of research, and from encountering far too many young women playing in pain, or taken off the field entirely by multiple ACL tears and other injuries, this issue needed some noise.

  2. John Melvin permalink
    05/30/2009 5:09 pm

    I’m a parent of three girls and one boy. To Mr. Sokolove, I’d like to say I am sorry his book is not a bestseller. I am part of the reason. I read the whole thing standing in Barnes and Noble over three or four long visits. Maybe when it comes out in paperback….
    Mr. Sokolove’s points were made and clear. The doctors should be more positive and stand around bookstores if they are too cheap to buy and read a copy. The point is: Our kids are specializing too soon and losing the skill and physical advantages of training in several different games. (And, most of all, the fun.) It seems to result in a higher rate of injury to girls, for some reason not known yet. I’ve seen it; just look at the girls soccer and basketball teams by senior year. Just look down at their knees.
    Perhaps some of those soccer players should try to hit a ball with a stick for three months; or some of those basketball stars should spend a season swimming; perhaps some volleyballers should think about a season running track or learning to put a shot. (Early specialization also denies the development of the late bloomer–such as Michael Jordan was.) Our kids may need to play different sports–I think it might even have benefits in the eventual favorite one. It might help them avoid burning out and quitting all sport.
    The critical doctors seem to want to keep the statistics to themselves until they can tell us why, definitively, this leads to that. We pedestrians could panic. The government might declare girls physically inferior. Maybe they do have a point….
    Parents and people need to hear these things; we are seeing the injuries and we love our kids. If doctors suspect something, say it in plain English. That’s all Mr. Sokolove did. His “sin” of speculation about causes was just what we would think, too.
    And there’s another reason doctors should rest easy: most of us won’t read the book because we’re coaching our 7th graders in year-round AAU basketball.

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