Knees, Food, Periods: Top 10 Medical Tips If Your Daughter Plays Sports

You could call this "Title IX Medicine."

Title IX, of course, refers to the landmark 1972 anti-discrimination law that gave huge added impetus to school sports programs for girls, helping create cohorts of more athletic grrrrrrrls.

In Title IX's 40-plus years, American girls' participation in high-school and college sports has jumped more than 10-fold to well over 3 million. That means many stronger, healthier girls — but it also means more girls at risk for sports-related injuries and what's known as the Female Athletic Triad, a worrisome mix of poor nutrition, menstrual dysfunction and danger to bone health.

This week, Boston Children's Hospital announced the creation of its new "Female Athlete Program," aimed at treating "the entire female athlete - not just a single injury."

"We know that the build of girls — both their musculature and bone structure — is different than boys', as is their hormonal milieu," said the program's co-director, Dr. Kathryn Ackerman. "We really need to start tailoring our care of these athletes in a slightly different way."

Certain specific issues need extra attention among girl athletes, she said. They're at a five to eight times higher risk of anterior cruciate ligament knee injuries. "Aesthetic" activities like ballet tend to be linked with higher risks of eating disorders. If menstrual cycles become abnormal, bone development could suffer.

Some articles suggest that girls' soccer is second only to men's football in terms of concussions.

The new program aims to contrast with the traditional piecemeal approach to girls' injuries and other health issues, Dr. Ackerman said. For example, "A girl comes in having sustained multiple stress fractures, and no one has asked her about her menstrual status or her calcium or Vitamin D intake or her overall caloric intake." Some studies, she said, suggest that up to 60 percent of girl athletes have at least one component of the Female Athlete Triad: eating dysfunction, loss of menstrual cycle or low bone density.

Dr. Ackerman, herself a former national team rower, and the program's co-director, Dr. Martha Murray, an orthopedic surgeon with a swimming background, kindly generated this list of their top 10 tips for parents of girl athletes. Dr. Ackerman expands in the comments below.

1. Your daughter can minimize her risk of ACL (anterior cruciate ligament) injury with a simple training program.

It would include hamstring strengthening, landing bio-mechanics, core stability and overall muscular balance. More details in the program's ACL handout.

2. She needs to be getting good nutrition to play well, especially enough calories and the right amount of calcium and vitamin D.

Calorie counts depend on a girl's level of activity and growth, but she should be getting 1,300 milligrams of calcium a day until she's 19, then 1,000 milligrams a day until menopause, when calcium again needs an increase. Vitamin D recommendations vary, but many bone experts recommend at least 800 international units a day for a blood level of at least 30. More details on nutrition here.

3. Athletes play better if they get their bodies in shape for sports before the season starts.

Many kids think the beginning of the season is their first day of practice. Actually, to avoid injuries, they should begin conditioning in advance.

4. Concussion symptoms can be different and last longer in girls.

Recent research suggests that girls may experience more headaches and the pain may last a little longer. Some articles suggest that girls' soccer is second only to men's football in terms of concussions. Studies are now looking at the effects of heading to see if that's a significant cause, or if it's just the way girls are made or how they're playing. The research hasn't teased this out yet.

5. Cross-training is good for you. It helps with muscle balance, strength, coordination, speed, and it can be fun to learn new skills.

6. If a girl has not gotten her period by age 15, or if her periods become irregular, she should see her doctor. In athletes, sometimes it's because they're not getting in enough calories for how much they are burning, and this can be detrimental to bone health and sports performance.

When a girl first experiences her menses, it's not uncommon for them to be irregular for about the first year and a half, but after that, they really should become monthly.

7. Eating disorders are more common in girls, and particularly in aesthetic or weight-restricted sports. It's important to discuss sports performance and health, rather than focusing on the scale.

Some higher-risk sports: Ballet, lightweight rowing in which you have to 'make weight' and sports where a lower weight might seem to offer a speed advantage, such as running.

The interesting thing about running is that girls often find initially that after losing weight they do get faster and their performance improves, but then it either plateaus or gets worse, because they're more prone to injury and have a harder time recovering. An example would be a patient who comes to me because her parent is concerned that she lost weight, no longer gets a period, and had a stress fracture, but she's gotten better from the fracture and doesn't see how these things relate. She goes back to running, thinks she's doing well, and then her performance declines and she gets more significant injuries. We've had patients come back to our clinic and say, 'OK, now I'm ready to listen and do this better.' That's what we want to help them do.

8. Sleep is vital. Getting a good night's sleep and having appropriate rest after workouts is important for mental and emotional health, in addition to sports performance.

9. A snack 15-30 minutes after exercise helps muscle recovery.

Some kids wait until they get home before having dinner — which could be hours — or they're trying to lose weight and think if they don't eat after practice that will help. But they really need to restore the glycogen stores in their muscles.

10. Sports are intended to be fun. Pay attention to clues that your daughter still enjoys the activity. Downtime is underrated these days, and sometimes taking a break is the key to longevity.

These days, kids are getting so sport-specific early on that they're getting a high burn-out rate. They're not getting to just be kids and try different things.

A final point: We've come so far since Title IX. We know girls and women are tough. Now we want to help them embrace their differences and address in a more holistic way some of the difficult issues that keep them from reaching their goals.

Readers, particularly girl athletes and their parents: Any particular tips of your own to add?