Female athletes emotionally affected by knee injury

Researchers writing in the Clinical Journal of Sports Medicine say that knee injuries can negatively impact emotional health-related quality of life.

The researchers looked at 255 women who injured their knee participating in sport or recreational activities. Injuries were categorized as anterior cruciate ligament (ACL) tears, anterior knee pain, patellar instability, meniscus tear, collateral ligament sprain, and other. Use a scoring system they measured physical functioning, bodily pain, general health, vitality, social function, and emotional and mental health. They noted: “In addition to negatively affecting knee function, sport medicine providers should be aware that knee injuries can negatively impact the health-related quality of life in these athletes immediately after injury.”1 In other words, knee injuries go beyond a pain and dysfunction. Emotional quality of life is at stake, placing an even greater emphasis on sports injury healing.


Hormones and Healing 

Unique to the female athlete is her constantly changing hormonal milieu throughout her reproductive years. For most of her life, the female athlete is exposed to rhythmic variation in either endogenous hormones during a regular menstrual cycle or exogenous hormones via oral contraceptives. Recent research has suggested that there are estrogen receptors on the fibroblasts of the human ACL, suggesting that female sex hormones may have an effect on the structure and composition of this ligament.2

Dr. Stephen Liu and associates at the UCLA School of Medicine initially made this discovery and went the next step to find out exactly how estrogen affects ligament growth.3 They investigated the effects of 17B-estradiol on the cellular proliferation and collagen synthesis of fibroblasts derived from the rabbit ACL. They found that collagen formation was significantly reduced with increasing local estradiol concentration. Levels of estrogen ranging from 0.025 to 0.25 ng/ml correlated with 40% reduced collagen formation compared to the control group. At pharmacological levels of 2.5 and 25 ng/ml, as typically occurs in female athletes taking birth control pills or estrogen replacement therapy, collagen synthesis was 50% less than the control group. A significant reduction of fibroblast proliferation was also observed with increasing estradiol concentrations.

Bottom line: estrogen, the female hormone, dramatically inhibits fibroblasts, and consequentially collagen synthesis. These results are startling. Fibroblasts produce the collagen that makes up ligaments and tendons, the structures involved in sports injury. Estrogen was shown to inhibit the fibroblastic growth and thus collagen formation in a dose-dependent manner.

Sports Injury Healing for Female Athletes

The more estrogen a woman has, the more inhibited healing occurs. This correlation has direct effects for all women taking birth control pills. Birth control pills have pharmacological levels of estrogen, which are far in excess of a woman’s normal production. The simplest way for a female athlete, who is on artificial estrogen, to overcome sports injuries, is to stop taking them.

Inevitably, women are placed on birth control pills because of menstrual irregularities. These irregularities, however, are easily treated with natural medicine techniques including diet manipulation and nutritional supplements. For instance, female athletes are typically deficient in essential fatty acids. This means they need to ingest more good fats in their diets in the form of omega-3 fatty acids as found in fish oils. They are encouraged to drink cod liver oil and eat more fish. These fats are also found in nuts and seeds, flaxseed oil, and olive oil. Just this mild change in diet is typically enough to get rid of menstrual cramps and other menstrual irregularities. Sometimes, however, more sophisticated dietary manipulation, herbal supplementation, or other natural medicine techniques may be needed.

For overall joint health, emotional health and sports injury prevention, the female athlete needs to take her hormones into consideration. High levels of estrogen can be detrimental to healing. Proper diet and alternative sports injury treatments such as Prolotherapy can ensure pain-free living and optimal quality of life.

Questions? Contact Caring Medical.
1- McGuine TA, Winterstein A, Carr K, Hetzel S, Scott J. Changes in Self-Reported Knee Function and Health-Related Quality of Life After Knee Injury in Female Athletes. Clin J Sport Med. 2012 May 23. [Epub ahead of print]

2 – Faryniarz DA, Bhargava M, Lajam C, Attia ET, Hannafin JA. Quantitation of estrogen receptors and relaxin binding in human anterior cruciate ligament fibroblasts.In Vitro Cell Dev Biol Anim. 2006 Jul-Aug;42(7):176-81.

3 – Liu SH, Al-Shaikh RA, Panossian V, Finerman GA, Lane JM. Estrogen affects the cellular metabolism of the anterior cruciate ligament. A potential explanation for female athletic injury.Am J Sports Med. 1997 Sep-Oct;25(5):704-9.