Dr. Carol Frey

Female athletes need to be evaluated for certain problems specific to girls before they start into the new season. In this blog we examine those specific evaluations.

1. Scoliosis

Curvature of the spine is much more common in female athletes and tends to occur in adolescence. During the preseason examination, your doctor should include a check for curvature of the spine, and, if present or suspected, x-rays and referral to a specialist may be recommended.

A change in posture or a difference in shoulder height or hip height should raise concern and should be evaluated by a doctor. Scoliosis evaluation begins with a history of physical examination for female athletes. This includes a forward-bending test. This test has the girl bend forward at the waist, with the arms hanging loose with palms touching. The doctor visually checks for a curve of the spine and an uneven back and ribs.

Scoliosis can be hereditary

Scoliosis is often times hereditary, and if someone else in the family has it, your daughter should be checked regularly. Scoliosis usually becomes apparent during puberty and the early teenage years. An x-ray can be used to measure the size of the curve.

2. Mitral valve prolapse

A common and usually harmless problem with the heart valves is mitral valve prolapse. It occurs mostly in female athletes. With this condition, a very specific type of murmur (heart sound) can be found on the preseason heart check as the doctor listens with a stethoscope.

Most cases have no symptoms and will not prevent sports participation for female athletes. A heart specialist should see athletes with a history of fainting, irregular heartbeat, chest pain, or family history of heart disease.

Be sure your child’s doctor knows the family history for not only heart issues but any other conditions. It just makes diagnosis so much more accurate and early. And knowing a family history of any condition raises the bar of suspicion in case your female athlete is showing early sings that should not be ignored.

3. Menstruation

The preseason physical for female athletes should include a menstrual history. The doctor will ask your daughter when her periods began. You’ll want to make note of it too because this is an important date or lots of hormonal reasons (and injury prevention). Delayed onset of menstruation should be noted and many indicate possible eating disorders.

4. Ligament laxity

Female athletes with excessive laxity (looseness) of their ligaments should be told that they may be at increased risk of knee, shoulder, and ankle injuries and should be encouraged to participate in preseason strengthening exercises to protect the joints. Girls are more flexible than boys at any age.

Increased looseness in the shoulder may lead to shoulder instability. Girls tend to have decreased upper body strength compared to boys, which may also add to risk.

Kneecap problems common in female athletes

Girls with very loose kneecaps (patella) might be discouraged from running and twisting-type sports like basketball. The kneecap dislocation occurs when the patella moves or slides out of place. The abnormal movement of the kneecap is usually toward the outside of the leg. Kneecap dislocations are most often seen in female athletes, usually after a sudden change in direction with the leg planted on the ground.

This maneuver is seen in basketball, volleyball, and tennis. Girls with this problem will show a sloppy kneecap that slides around easily.

In sports with overhead movements such as volleyball, tennis, swimming, and softball, shoulder laxity may be a problem. If a girl has very lax shoulders, she might be told not to participate in swimming or volleyball. However, I am reluctant to restrict the patient unless she has had a significant episode of problem with the shoulder. Elite-level swimmers also will develop more rotation and apparent looseness in the shoulder.

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