Warrior girls Protecting our daughters against the injury epidemic in women's sports

Michael Y. Sokolove

Book - 2008

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Subjects
Published
New York, NY : Simon & Schuster 2008.
Language
English
Main Author
Michael Y. Sokolove (-)
Edition
1st Simon & Schuster hardcover ed
Physical Description
viii, 308 p. ; 24 cm
Bibliography
Includes bibliographical references (p. 283-289) and index.
ISBN
9780743297554
  • Prologue
  • Chapter 1. Amy
  • Chapter 2. Warrior Girls
  • Chapter 3. Inconvenient Truths
  • Chapter 4. "We Can Bring It"
  • Chapter 5. Proving Grounds
  • Chapter 6. Amy: Eighteen Minutes
  • Chapter 7. In the OR
  • Chapter 8. A Medical Detective Story
  • Chapter 9. Among the Plebes
  • Chapter 10. The ACL Witch
  • Chapter 11. One-Trick Ponies
  • Chapter 12. "Are You Asking Me Why I'm Doing Something I Know Is Bad for Kids?"
  • Chapter 13. "I'm a Stressed Person"
  • Chapter 14. Head to Toe
  • Chapter 15. Amy: "I Miss It So Much"
  • Afterword: Prescriptives
  • A Note on Sources
  • Acknowledgments
  • Index
Review by Choice Review

Journalist and author Sokolove provides an excellent collection of first-person insights and interviews with top experts on anterior cruciate ligament (ACL) injuries and youth sports injuries in general. Addressing and explaining myriad sources from the current literature, the author reviews both the epidemiology and the psychology of injury in female athletes. Girls' and women's participation in club and elite sports has changed significantly since the inception of Title IX, and the author's coverage of the psychological aspects of this is thorough. Sokolove alludes to an ACL exercise program but does not prescribe a specific set of exercises (he urges the reader to seek out a local athletic trainer, personal trainer, or physical therapist). Though this book is geared toward parents and practitioners, its audience extends to anyone interested in sports in general and issues surrounding elite sports and girls in particular. Summing Up: Recommended. All readers, all levels. M. Moore Northern Michigan University

Copyright American Library Association, used with permission.
Review by New York Times Review

SOON after finishing "Warrior Girls," Michael Sokolove's persuasive account of how injuries are felling too many female athletes, I read a newspaper column about a college runner whose Olympic hopes were dashed by a broken foot. The young woman competed with the injury for two months before it was diagnosed, a heroic effort that drew the approving comment "Only the real special ones can do this kind of thing." Both the runner's toughness and the applause it won struck me as evidence for Sokolove's claim that we Americans demand too much from our athletes, particularly our girls. An epidemiologist he quotes sums it up neatly: "We're in love with the idea of the wounded warrior. The warrior girl who fell at the last hurdle or the one who goes on despite some awful injury." It's not that Sokolove, a contributing writer for The New York Times Magazine, which published an excerpt from this book, opposes girls' sports. In fact he asserts that "in many regards, sports are better for girls than for boys," who often end up being socialized in the wrong ways, pushed toward "misogyny, overaggression, entitlement." But he thinks the benefits of competition (self-confidence, joy in physical strength) are being diminished as girls, especially in team sports like soccer and basketball, increasingly adopt the nose-bloodying male model of athletic prowess. This ethic of gutting it out, "Warrior Girls" contends, has merged with other dangerous practices: pushing athletes to specialize in one sport and to play it year round, and discounting the particular effects of puberty on girls' bodies. The result is high rates of serious injuries, often to vulnerable knees. Sokolove cites studies showing that young women who play soccer, basketball and volleyball suffer tears to the anterior cruciate ligament (or A.C.L., a flexible, rectangular-shaped band of tissue that stabilizes the knee joint) up to eight times as often as men in the same "jumping and cutting" sports. And the injury parade doesn't end with hobbled knees. Female athletes tend to get shin splints more often than their male counterparts; women who play on college soccer teams suffer the same rate of concussions as men on the football team do. Over all, female athletes may simply be more prone than male athletes to chronic ankle sprains and to overuse injuries - stress fractures, tendonitis, bursitis. Sokolove interviewed a sports doctor in Washington, D.C., who treats "young female athletes with a chain of injuries, from the feet up through the trunk." "There's a chain of events with boys too," she said. "But I see it more with the girls." Sokolove focuses on knees, which he calls "the site of the most dire long-term consequences." An athlete who ruptures the A.C.L., sometimes from the simple act of planting her foot on the turf, loses a season and may have to swear off her sport. The shredded A.C.L. is replaced in a complex surgery that requires fashioning a new one - ideally, from the nearby patellar tendon - and grafting it into place. The procedure leaves scar tissue and puts the athlete at risk for arthritis, even for knee replacement before menopause. And it's costly: one expert puts the tab for the surgery and months of rehab at $17,000 to $25,000 per injury. Exhibit A for Sokolove's argument that the American way of youth sports - early specialization, endless seasons - can be worse for girls than for boys is Amy Steadman, a former member of the University of North Carolina's powerhouse women's soccer team. Over two years, Steadman, a fearless competitor nicknamed "the Killer" by teammates, ruptured the A.C.L. in her right knee three times. After each surgery, she returned to the field as quickly as she could, forgoing the rest and strength training that, in Sokolove's view, might have protected her knee. When her A.C.L. ruptured for the third time, the surgeon told her there was "nothing in there left to fix." Her playing career over, Steadman suffers chronic pain and, in her early 20s, moves "like an old woman." Sokolove offers this as a cautionary tale, especially for girls who, like Steadman, base their identity on a sport begun early in life. He has named these sorts of girls C.D.A.'s: competitive, devoted, ambitious. These traits may someday land their owners in the boardroom, Sokolove argues, but they're dangerous for young athletes, whom he depicts as being pressured - by coaches, by the ethos of youth sports - to join private club teams. Soon, the girl is competing year-round, with weekends devoured by out-of-town tournaments. (Often, in Sokolove's depiction of these situations, parents seem oddly passive, pulled along by strong-willed C.D.A.'s.) Since A.C.L. tears are "overexposure injuries" - the more often a girl plays, the greater her odds of suffering one - nonstop games and practices take a predictable toll. One 17-year-old who has ripped her A.C.L. twice tells Sokolove that among the 18 members of her elite club team, the injury has struck nine times. The precise mechanics of A.C.L. tears remain a puzzle, but many researchers attribute their higher rates among women to differences in how the sexes run and land and in how hormones affect their bodies. (After puberty, women's hips widen, and women develop a higher fat-to-lean-muscle ratio than men, which means they're less strong.) A National Institutes of Health study in progress at the country's military academies seeks to compare how men and women land from jumps. One expert involved believes women have an imbalance of strength in their legs, with their dominant quadriceps - which are stronger relative to their hamstrings than men's are - causing them to land straight-legged and exerting pressure that pulls the A.C.L. apart. He and other researchers propose that girls build strength in their hips, hamstrings and abs, and learn to run and land more like boys: knees bent, crouched low to the ground. A.C.L.-injury-prevention programs based on these principles exist but are rarely used. Sokolove calls for parents of girl athletes to insist on them. The prescription makes sense, along with Sokolove's other advice. (Don't let girls play just one sport year-round; coach them to heed pain, fatigue, even seemingly minor hurts.) But Sokolove's insistence that talking about sex differences and sports injuries is controversial, or might even halt the gains women have made in organized athletics, seems overstated. While Title IX, the 1972 legislation that boosted girls' opportunities in sports, still raises hackles among those who think it takes resources away from boys, girls' sports are part of our culture, at least in middle-class suburbia. Sokolove is a bit dismissive of players on so-called rec teams who "create so little force that they don't stand much chance of hurting themselves." Yet rec teams serve kids who can't or won't do the intense, early training that's now required to make the team in high school, much less college. A recent study showed that on average, 15-year-olds in the United Sates got less than an hour of moderate to vigorous exercise each day, down from three hours a day at age 9 - a statistic that bodes ill for the nation's future health. It seems the challenge lies not just in teaching girls to move safely, but in inducing our girls - and boys - to move at all. Polly Morrice is a regular contributor to the Book Review.

Copyright (c) The New York Times Company [October 27, 2009]
Review by Booklist Review

Roughly a month before the publication of this book, a university softball player, having just hit a home run, missed tagging first base; when she reversed direction to make the tag, her right knee gave out, and she collapsed. The story made national news because members of the opposing team carried her around the bases, but it also lends an air of immediacy to Sokolove's examination of the prevalence and sometimes life-altering effect of injuries in women's sports. He examines the differences in male and female anatomy, compares the competitiveness in men's and women's sports, and focuses on a handful of specific individuals to explore how an athlete's drive for perfection can lead to disaster. Although some may accuse the book of gender stereotyping, the charge doesn't hold water. Sokolove certainly does say that differences in body structure may make women more prone to certain types of injury, but he bases his argument on physiology not gender. This well-researched, well-reasoned, and forcefully argued book makes an important contribution to the literature of sports.--Pitt, David Copyright 2008 Booklist

From Booklist, Copyright (c) American Library Association. Used with permission.

CHAPTER 1 AMY Amy Steadman was no cosseted suburban child. She grew up in the far western part of North Carolina amid scenic waterfalls and rugged rock formations, an excellent setting for a girl of her temperament. "She was wired at birth," her father, Ned, a high school science teacher, recalls. "She was inconsolable until she could walk, and as soon as she could walk, she ran. If she saw a hill, she took off and sprinted up it. It was just something within her." Three-hour car trips took six hours because of the stops required to give her time to burn off energy. Her birthday parties were always the same: an overnight camping trip to a favored spot where she liked to dive off a fifty-foot ledge into a lake. For show-and-tell one day in the fourth grade, she came dressed as the football coach Knute Rockne. She begged her parents to visit the campus of Notre Dame, in South Bend, Indiana, until they finally relented. "She wanted to see the temple of football," her father says. "She loved football. She would have played that if she could." She played sports in the school yard with friends, often as the only girl, and was not happy unless she returned home scraped up and caked in mud. She joined her first organized team in fourth grade, a boys' squad because her area had no girls' soccer, and it was not long before the coach was telling her parents they needed to find her a higher level of competition. Don Scarborough, a college soccer coach who happened to be coaching Amy because his son was on the team, believed she played as if the game had been preprogrammed into her. "It was almost like she could play soccer before she ever got on a soccer field, you know what I mean? You could throw a ball at her feet or body or head and she intuitively could handle it. She didn't need to train to learn a skill; she got it the first time. She needed something beyond what our county parks-and-recreation league could offer her." Ned Steadman had run track and was still an avid hiker, but neither he nor his wife, Carol, had ever been high-performing athletes. Their daughter was a marvel and a mystery to them. Where had she come upon those bountiful gifts? Carol's father and two brothers were good ballplayers, so the Steadmans joked that maybe the athletic genes had skipped a generation and Amy got them. At first, they had had no interest in rearranging their lives just for the sake of Amy's soccer. They had another child, a younger son. Ned had his teaching, and Carol worked as an aide at the local elementary school. It took two years for them to finally put her into a girls' league in Asheville, which was forty-five minutes away. There they almost immediately began to hear the same refrain from coaches: This isn't enough for her. You need to put her with better players. "It all began mushrooming," Ned Steadman says. "Other people saw what was coming way before we did. She was probably in the third grade when the pediatrician said after he examined her, 'I'll see you in the Olympics.' I said, 'Please don't say that.' I'd been around high schools and heard that said of kids, and it was never true." In junior high school, Amy began playing for the Greensboro Twisters, a top club team halfway across the state, two and a half hours away. By the time she reached high school, she was playing for a team in Atlanta, four hours away. Don Scarborough teased Ned: "You didn't want to take her to Asheville, and now Amy's playing in Atlanta?" Ned Steadman took most of those long drives with his daughter -- all through the Southeast and as far away as Dallas. He would try to talk about the game on the way home -- to rehash and analyze it and perhaps learn more about a sport he knew little about -- but she was rarely interested. Sometimes Amy would say, "I played OK," which Ned learned to translate as "I played great." Usually she was quiet in the car. She listened to music on her headphones or slept. It was not false modesty on Amy's part or even teenage sullenness. She was spent. And truly not interested in the periphery of sport, the rankings and the awards and accolades. That was for others. For her, it was all about the personal competition, not the postgame commentary. Ned and Carol Steadman were immensely proud of their daughter's accomplishments but ambivalent about her fierce independence. They certainly had not pushed her into soccer, and she was the opposite of one of those kids of whom you had to wonder, Is she playing to please her parents or because she truly loves it? She loved it. But as Amy rose into the elite levels, she inhabited a world her parents could not enter. She was guided by coaches, mentors, and her own passion. It was not that different from what happens with a lot of good young athletes as they climb the ranks of their sport -- their decisions, increasingly, are directed from outside the home. Often mothers and fathers hesitate to be too involved, not wanting to be seen as clamoring or insistent -- as stereotypical sports parents. It is a difficult thing to balance: coaches may know a sport, but they are rarely the best judges of what is best for a child. The Steadmans watched and listened from a respectful distance, picking up what they could. Amy was not a mystery to them: they knew what she cared about and what motivated her; they knew that her deepest passion was her sport. It was just that she kept the details to herself. "We didn't know too much about the soccer," Carol said. "She was her own person." Ned adds, "That's the way she wanted it, and we respected that." The local newspapers -- the Transylvania Times in her hometown of Brevard and the bigger Citizen-Times in Asheville -- picked up on her story as she began to climb the ranks of U.S. soccer and make national teams. "She Packs a Big Kick," one of the headlines said. After she set conference records at a track meet and was named "high school athlete of the week," the story noted how remarkable her performance was, considering that all her soccer travel barely left her time to train for sprinting. She just dropped in on track meets and dominated. Amy, as always, was thoroughly unimpressed by it all. She cared about the next game, about winning every single "one v. one situation," as she called them -- every race in which she and an opponent were in furious pursuit of the ball and the victor would be determined by speed and heart. That's what soccer was for her: one challenge after another, each of them deeply personal. "All those write-ups and other hoo-hah, they don't mean anything," she told her father. "They don't get you playing time." Anson Dorrance loved everything about Amy's game. "Her discipline was off the charts," he says. "She had speed and a high pain threshold. She took physical risks -- she was fearless. This is a positive problem. You want players who are hell-bent for leather. And she had a sophistication to her game. She knew how it was supposed to be played. She had everything you could possibly want. She was a coach's dream." He got a particular kick out of Amy's being a state high school sprint champion, observing, "Not bad for a white chick." For all her love of mixing it up on the field, Amy was a wholesome-looking beauty, unadorned and natural looking, very much the girl next door if the girl next door would bury you on her way to a soccer ball. Her loveliness made the nickname she acquired playing soccer all the funnier: "the Killer." In addition to being a fast runner, Amy was a young woman in a big hurry. In the middle of her sophomore year of high school, she took the SATs and scored a perfect 800 on the math portion. She decided early in her junior year to forgo the rest of high school and enroll at North Carolina. Other talented female players had done the same at various NCAA schools, including former UNC star Mia Hamm, who arrived in Chapel Hill in what would have been her senior year of high school. While it would be difficult for a boy that young to compete on equal footing with a twenty-two-year-old college senior, it is far easier for young women, who by that age are further along in their physical maturity. Amy's force of will was so strong that no one could ever really stand in its way. One of her elementary school teachers told the Steadmans they had never seen such a focused child. "She was intense in everything she did," Ned says. "She set getting the 800 in her math SATs as a goal. As soon as the scores were available, we had to call the test center to see if she had accomplished it." By the time Dorrance suggested that she leave high school early and come to Chapel Hill, her parents were accustomed to letting her make her own choices. The coach assured them that she was ready athletically and academically. "I realized at that point that Amy's dreams are going to be realized," her father recalls. All her parents asked was, Are you sure this is what you want? But they knew she had already made up her mind. By that time, Amy was already a seasoned veteran of youth national teams and had competed internationally in England, Sweden, and the Netherlands. She had been playing with the American team that would compete in the first women's under-nineteen World Cup in Vancouver, and although a final roster for that tournament was not yet set, she was one of the core players and seemed to have a guaranteed slot. "I kept doing well at every one of the training camps," she says. "Some girls would be invited in once, but then not for the next one, but I never really had that problem." When she wasn't training with the national team, she still played for her club team in Atlanta -- and it was in a game for her club, before she could set off for Chapel Hill, that she first hurt her knee. Amy recounted her injury history for me as we sat on a couch in a lounge area of the Dean Smith Center, UNC's indoor athletic complex. She was twenty-one years old, five years past her first ACL tear. She lived just a short walk across campus, but her boyfriend had dropped her off because she was not moving comfortably. Later, when she could not reach him by cell phone for a ride, I asked if she wanted me to drive her back, and she said, quietly, "Yeah, I guess I do." That first day we talked for close to three hours. Her tone at first was flat and unemotional, which I soon realized was her way of trying to maintain her composure. What caught me off guard was my own reaction: I can remember no other time in three decades in journalism when I have had to fight back tears of my own during the course of an entire interview. "It was a miserable game and we weren't playing well," Amy began, describing the club game in Atlanta. "So my coach just decided to throw me up top" -- move her from defense, her usual position, to striker. "There were like ten minutes left. With me being fast or whatever, he wanted to see if I could make something happen. "It was really surreal the way it happened. A ball was being played in to me, and I jumped in the air because it was high. As I kicked it, the defender pushed me in the back. It wasn't a real hard push, but I landed on one leg, my right leg, and I could just feel it hyperextend. I didn't hear anything, but I felt something. It was more than a pop." She had probably landed in similar fashion -- on one leg and off balance -- dozens or perhaps hundreds of times before with no negative result. But this one time would be life changing. "I lay on the ground, but it didn't hurt that much. So I got up and tried to keep playing, but every time I came down on my right leg, it was like there was no support. It collapsed underneath me. There were like five minutes left in the game, so the coaches took me out and helped me over to the sidelines, and people were saying that maybe I'd just strained it. I didn't know enough to think differently, so I was hoping that was the case." She sat on the bench for the few minutes until the game concluded, then hobbled to the car for the four-hour drive home with her father. About halfway, they made a rest stop. "I didn't notice my knee swelling until then," she recalled. "But when I got up to go to the bathroom, it was just huge and I couldn't walk. I knew I had done something pretty bad, but I didn't know too much about ACLs. I figured I would get it looked at and they'd tell me what the problem was. In Brevard, things move kind of slow, so it took like two weeks to get an MRI and for them to tell me I'd torn my ACL. So at that point, I had to call Anson and the national team coaches and tell them what happened." Amy underwent reconstructive surgery in early November 2001, a couple of months after turning seventeen. Her surgeon grafted a new ACL from part of her patellar tendon in the same knee. The U-19 World Cup was scheduled for late the following summer, less than ten months away. And after that, she was to begin her first season as a Tar Heel -- a member of the famed UNC women's soccer team. "To be on that World Cup team was my ultimate goal at the time," Amy says. "I just wanted it so bad. I had ten months to recover and get back to close to 100 percent, or I wasn't going to make the team. I still had two months at home before going to UNC. I couldn't run yet, but I rode the bike and I swam. I worked out like three or four hours a day. I was really determined, and being so young, I didn't know anything about patience. So I was doing this really, really aggressive rehab program." In her understated way, Amy says that she had "a lot of complications with that first one." What she describes sounds more like a nightmare than a set of complications. "They give you pain pills, and basically, I unknowingly got addicted to them. I was in so much pain that I couldn't sleep without them, so I took them regularly. I couldn't go to school for like two or three weeks, because I couldn't keep anything down. Everything I put in my mouth came right up. "I finally had to be hospitalized and get an IV because I was dehydrated, and I got a huge lecture from the nurses about how I had to eat. I went down to a hundred and five pounds from a hundred and twenty pounds. I could do upper-body work at the gym, but I felt like all the weight came out of my legs because I couldn't do anything with them yet. It was like my legs were wasting away." After that first injury, Amy says, "I probably screamed at my parents a couple of times. It's not like it was their fault, and I should have never done it. But I was just overall angry." Her parents watched in awe as she pushed herself through rehabilitation, even as they had misgivings about her pace. The trainer for the UNC women's team, Bill Prentice, had sent an "accelerated rehab schedule," Ned Steadman recalls. "The physical therapist here in Brevard looked at it and said, 'Whoa.' But she wanted to be back on that U-Nineteen team, and that's what was necessary." In the initial couple of weeks after surgery, ACL rehab consists mostly of excercises to restore the range of motion in the injured leg. One example: lie on your back, grasp the backs of both thighs, pull them to the chest -- easy for someone with a healthy knee but pain-ful for a patient just off surgery. The exercises are meant to be done intermittently throughout the day, starting out with relatively few repetitions, so that the recovering patient can gain strength and flexibility while leaving time for rest and healing. But Amy made her accelerated regimen even more ambitious by doubling or tripling the recommended number of repetitions for each exercise. It was the same with the stationary bicycle. When she was allowed to start pedaling it an hour a day, she went at it hard for two hours. Ned remembers thinking, I'm tough, but I'm not as tough as she is. Asking her to back off would have been pointless. Amy says, "If anyone would have told me after that first one that I should stop and do something different, play a different sport or whatever, or slow down my rehab, I would have said, 'You know what? The hell with you. I'm going to do this.' Nobody could have stopped me. Girls are so strong-willed when they're young, and to explain to them that they have this vulnerability -- it wouldn't work. We're like guys in that way. Even girls I know who have had their first or second ACL -- they think it won't happen again, and that they'll be back one hundred percent and it won't affect their lives." After the lecture from the nurses, Amy began to put weight back on and regain her tone and strength. At the turn of the year, she moved to Chapel Hill to begin classes, during what would have been her junior year of high school, and she now had new teammates, as well as Dorrance, to push her. The UNC coach believed deeply in international soccer and wanted his players to compete for the U.S. teams, so Amy's ambition to get healthy in time for Vancouver was Dorrance's goal for her as well. "The things I needed to get back were my speed and agility, and I worked a lot in the weight room," she says. The day she was cleared to finally begin running, she didn't set off on a light jog; she did a full sprint set. After five months of being unable to touch a ball, she felt that she had lost timing, so Dorrance took her back out on the field and personally put her through workouts. "Once they started letting me play," Amy says, "I just played every chance I could get. The thing I needed to do was get back my speed and agility. In Brevard, I had to do everything on my own, but here I had Anson and all these teammates to help me. I just felt so thankful." That summer, the U-19 team gathered to train for a couple of weeks in Chula Vista, California. Amy needed not only to make the team but also to win back her starting position. The coach had changed the team's formation into a more attacking mode, so there were only three rather than four spots for defenders. "They said to me, 'We pretty much have our back three set.' It was disappointing." Instead, she was given an opportunity to play left midfield. She wasn't sure about the position, because it involved much more running of the field, but she quickly grew to like it because it gave her an opportunity to score goals. "But it was heartbreaking for me because the girl who was supposed to be in that spot, she tore her ACL and she was out for the tournament. So that's how it became open for me." There were other ACL victims and survivors. Out of the original forty in the "player pool" under consideration for that U-19 team, ten suffered ACL injuries in the two years between the time they were put into the pool and the tournament -- one out of every four. Some, like Amy, had made it back onto the field; others were still rehabbing and out for the tournament. In Chula Vista, twenty players competed to be among a final eighteen who would compete in Canada. Amy remembers being called into a room after the final decision had been made. "They said to us, 'You're the team.' At that point, you start to bond with those girls 24/7. I was so excited." She had not only won back a starting position but was named captain, a remarkable accomplishment for a young woman who not that long before had been so debilitated that she needed to be hooked up to an IV. Amy felt as though she had climbed an enormous mountain. All the pain had paid off. The team flew from its training camp to Seattle, then took a ferry into Canada. "I was so excited," she says. "It was just going to be the coolest thing ever." Copyright (c) 2008 by Michael Y. Sokolove Excerpted from Warrior Girls: Protecting Our Daughters Against the Injury Epidemic in Women's Sports by Michael Sokolove All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.