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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 increased risk for injury and musculoskeletal dysfunction.

  • Identify and manage modifiable factors that lead to increased susceptibility of the female to LE dysfunction and anterior cruciate ligament (ACL) injury, including mechanism of injury, intrinsic factors, extrinsic factors, typical muscular activation and timing patterns, kinematics, joint position, and combined factors.

  • 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.

  • Understand the importance of incorporating core strengthening into the exercise prescription and management 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.

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

  • Describe the components of The Triad (previously Female Athlete Triad) and Relative Energy Deficiency – Sports (RED-S) to enable prevention, identification, and management 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.

  • Educate and guide postpartum physically active females in proper exercise guidelines and return to activity/sports during this unique time.

  • Encourage and educate physically active females to sustain this lifestyle throughout the lifespan including before, during, and after menopause.


The visibility and participation of the athletic female have grown dramatically over the past century, and are now established throughout the world. While the modern Olympic Games were founded in 1890, women were excluded from participation in the 1892 and 1896 Olympics. At that time, women’s sports were considered to be “against the laws of nature.”1,2 In the 1900 Paris Games, 15 women participated in lawn tennis and golf.3 In 1972, Title IX of the Educational Assistance Act was passed. This was a pivotal point in the history of U.S. education, affecting 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.”4 After Title IX, a 600% increase in the number of women participating in collegiate sports5–8 and a 990% increase in high school women’s athletic participation were seen.9


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