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After completion of this chapter, the physical therapist should be able to do the following:

  • Recognize/identify the general anatomic, physiologic, and neuromuscular differences that exist between genders.

  • Develop an understanding of common gender differences that predispose the female athlete to development of patellofemoral dysfunction.

  • Identify characteristics that may contribute to increased susceptibility of the female to anterior cruciate ligament (ACL) injury, including mechanism of injury, intrinsic factors, extrinsic factors, and combined factors.

  • Identify typical muscular activation and timing patterns, as well as the kinematics and joint position of the lower extremity during performance of physical tasks by females.

  • Educate physically active females, coaches, and other sports medicine personnel regarding prevention of ACL injuries, including proper cutting and jumping techniques and neuromuscular reeducation/strengthening of the lower extremity.

  • Prescribe a lower-extremity reactive neuromuscular training exercise program for the physically active female to aid in ACL injury prevention.

  • Identify possible sequelae to ACL injury and rehabilitation.

  • Utilize the concept of “envelope of function” to minimize adverse effects of musculoskeletal injury and subsequent rehabilitation.

  • Understand the importance of incorporating core strengthening into an exercise program of the physically active female.

  • Identify the potential stresses and risks that occur in the shoulder joint complex as a consequence of softball windmill pitching.

  • Prescribe an exercise program specific to the windmill softball pitcher.

  • Understand the potential stresses to the shoulder complex during freestyle swimming and identify which musculature is at greatest risk for fatigue and subsequent impingement.

  • Develop a comprehensive rehabilitation program for the swimmer with a shoulder injury.

  • Develop a general understanding of most common injuries sustained by female gymnasts and identify potential risks involved in the excessive training at an early age common among female gymnasts.

  • Acknowledge the implications that excessive, early training may have on hormonal and growth processes in the young female athlete.

  • Describe the components of the female triad to enable prevention, identification, and treatment of these components as a member of a multidisciplinary medical team.

  • Educate physically active females in proper exercise guidelines when planning for, during, and after pregnancy with a thorough knowledge of the physiologic changes that occur during this unique time.


The visibility of the athletic female, which has grown dramatically over the past century, is now established throughout the world. At the beginning of the century, in 1902, the modern Olympic Games were founded, but women were excluded from participation. At that time, women’s sports were considered to be “against the laws of nature.”212 In 1972, Title IX of the Educational Assistance Act was passed. This was a pivotal point in the history of the United States regarding female participation in sports and exercise. Title IX states that “no person in the U.S. shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subject to discrimination under any educational program of action receiving federal financial assistance” 212, p. 841 After Title IX, a 600% increase was ...

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