Multiple Perspectives About “The Injury Epidemic” Facing Female Athletes

Given the continuing discussion about injuries of female athletes, particularly ACL tears, I decided to revisit a blog piece I wrote before One Sport Voice was born.

kneeinjuryIn 2008, a controversial book—Michael Sokolove’s Warrior Girls: Protecting Our Daughters Against the Injury Epidemic in Women’s Sport—was released, along with a companion article which appeared in the May 11 issue of the New York Times Magazine. The premise of the book asserts that “[the] immutable facts of anatomy and physiology? cause girls to incur significantly more sport injuries (e.g., ACL tears, concussions) than their male counterparts, resulting in what Sokolove terms a female “injury epidemic?

As a response to the underlying premise (and purported facts) of Warrior Girls, the Tucker Center for Research on Girls & Women in Sport felt it necessary to provide a scholarly critique from relevant academic disciplines. The TC invited internationally recognized scholars from the U of Minnesota in Public Health, Sports Medicine, Sport Psychology and Sociology to read the book and respond independently. You can read all the pieces, including Sokolove’s detailed responses and rebuttals here. The intellectual exchange is very interesting as it is from multiple persons perspectives, not all of whom agree. I’m going to post my sociological critique below, with some added updated information and thoughts.

A Sociological Perspective on Warrior Girls
Let me begin by stating that sport injuries and sport injury prevention are very real and important issues—for both girls and boys. I am aware of the data which states female athletes are 8 times as likely as male athletes to tear an ACL. However, framing the issue of sport injuries as an inevitable biological difference based on the sex of the athlete is sensationalistic and irresponsible. First, an argument based primarily on biology and physiology altogether ignores that sport performance (and therefore injury) is also shaped by social forces such as coaches’ and parents’ beliefs about what it means to be a “female athlete?” Second, this sort of deterministic approach assumes that males, by definition, are naturally (physically) superior to females. In this framework, male athletes are the norm to which females are constantly compared, and any gender differences are therefore constructed as inherent female deficiencies. The consequence of such biology-is-destiny arguments? Professor Cheryl Cooky, Purdue University, sums it up best: “Concerns regarding the supposed biological limitations of the female body to withstand rigorous athletic competition have historically served to justify restricting girls’ and women’s access to sport”.

Though Sokolove does indicate that we should also be concerned about sport injuries males sustain, rarely, if ever, are books published devoted to the negative consequences of sport participation on the health and well-being of boys and men. Interestingly, a search for a similar book or article on the “epidemic” of male sport injuries yielded nothing, despite published research which indicates that NFL players’ life expectancy is 15-20 years lower than the general American male population and that many suffer ill effects from playing professional football, including obesity, heart disease, chronic pain and crippling arthritis. I prefer Mark Hyman’s blog and book Until It Hurts: Americas Obsession With Youth Sports, as both provide a more gender-balanced approach to youth sport injuries-including much discussion about “Tommy John” syndrome in boys’ baseball.

The anatomy-is-destiny perspective also ignores the reality that some female athletes are stronger, have better motor skills, and are more coordinated than some male athletes, and that risk for injury runs along a continuum, rather than a sex-determined binary. In the final analysis, males and females are more similar than they are different—both compete in sports and both get injured in a variety of sports and physical activities. As a result, concerns relating to all the correlates of sport injury, social and psychological as well as biological and physiological, need to be given equal consideration.

4 Replies to “Multiple Perspectives About “The Injury Epidemic” Facing Female Athletes”

  1. I am more than surprised about the slant you take because your credentials indicate that you would have read Sokolove’s entire book, processed it and not have succumbed to reducing its premise via the 25-word-or-less method. I did not read “Warrior Girls” as a biology-as-destiny tome at all and feel like you are itching for a fight and therefore creating your own enemy. I read arguments that biology contributed to the TYPE of injury being discussed (ACL tears), but I also read data and anecdotal information about factors, cultural, psychological, economic, that also contributed to that injury.

    I’m not sure why you are imposing “gender balance” as a crtieria for a valid examination of the subject matter. The point you bring up about the consequences of NFL careers, as well as points you didn’t bring up regarding the consequences of concussions or labrum tears or ankle sprains on male athletes is so well known as to not require books to point them out. Male sports dominate mainstream media to the point that books on those subjects would be redundant.

    There are a vast number of us “on the ground” who have seen ACL injuries as a major issue in female sports and applaud ANY discussion of it. The consequences also are far more severe than any so-called “male epidemic injuries.” To ignore the ACL issue is to bury one’s head in the sand and contribute to its perpetuation.


  2. Glenn,I have read the entire book and this piece is a sociological critique of not only that book, but others who take a biology is destiny approach. While Warrior Girls does tangentially mention other factors that contribute to female athlete injury, the major theme that stuck out to me is the biology argument. My point is to highlight that this approach is problematic, not to dismiss that ACL tears of female athletes happen. I disagree that male athlete injuries are “so well known as not to require books” and that consequences of female sport injuries are more severe than those for male athletes. When we think this way one danger is that injuries of male athletes get erased and female injuries are attributed to “the weaker sex”. All sport injuries have consequences. The reasons why sport injuries happen are complex and should never be attributed to “female biology or physiology” until the science indicates as such….and to my knowledge, that has not been proven. So yes, I will argue for a gender balance approach to the study of sport injuries as all are equally important. -nml


  3. Hi Nicole
    Given your most excellent critical eye for the gendered aspects of sports, your expertise as a sport-psychologist, and the “nature” of your current post, I would love to get your reaction to a question (and the subsequent, gendered responses) posted by a Dad-Coach having recently completed a Positive Coaching Alliance workshop (
    In this post, the Dad-Coach is seeking information about how to develop girls’ self-image through sports. My interest is in no way intended to criticize the sincerity of this coach or the importance of knowing how to promote a positive self-image in children. Instead, I am interested in how the question is framed and who is asking the question. How the question is framed begs the obvious response, which is that if it’s good for girls it is also good for boys. I agree that, whether ACL injuries or low self-image, framing the question to be specifically about girls bolsters the argument that gender differences in sports are biologically based and often places female athletes in the “other” category as sport participants. This does not diminish the importance of their impact on girls, instead this suggests that there is a need to examine how girls and boys experience sports differently (and possibly even their play before their involvement in organized sports), which may be another contributing factor to higher incidence of ACL tears or low self-image in girls (not simply the V-notch and hormones as some might wish it be reduced to). What might be the impact on coaching if coaching education (particularly for youth coaches) provided a space for coaches to critically examine and reflect on sports as a gendered domain? Why is this a topic currently limited to academic circles (and very specific circles at that)?
    My second concern, who is asking the question. Male youth coaches are desperate to figure out how to coach girls and there are plenty of “how to coach girls” books to meet this demand. Should we coach girls differently? What will that kind of coaching look like, who will be designers of that method, and who will train the coaches in these methods? Or, is this training already taking place as implied by this Dad-Coach’s experience at a PCA workshop? And, what are the consequences if we do coach girls differently? Finally, if we coach girls differently, will they become different coaches (and is that so bad)? What does it mean for female coaches if we view female athletes as unique? Will female coaches then be less prepared to coach boys?
    I look forward to reading more from your blog (even if not in response to my questions).


    1. d’Alary,
      Thank you for a thought provoking post!, and for the feedback on the blog. You’ve hit on a couple of my favorite topics with your questions. I’m going offline for today, but will either respond or write a new blog about this important topic. I have written an article which critiques these “coaching girls” books, here is the citation that gets buried, as you aptly point out, in academic circles and read by few. I will pull from that article when I respond
      [LaVoi, N.M., Becker, E., & Maxwell, H.D. (2007). “Coaching Girls”: A content analysis of best-selling popular press books. Women in Sport & Physical Activity Journal, 15(4), 8-20.]


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