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the complete review - medicine / health / sports

The Female Athlete

edited by
Mary Ireland and Aurelia Nattiv

general information | review summaries | our review

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Our Assessment:

-- : well-presented and thorough, making for a valuable reference work

See our review for fuller assessment.

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The complete review's Review:

       The Female Athlete is a comprehensive compendium of information about the female athlete, with a focus on physical and medical issues. The sixty-seven chapters range from introductory overviews ('Participation and Historical Perspective') to discussions of specific medical conditions, with separate chapters devoted to the particular issues and areas of concern regarding each of some twenty popular sports.
       There are obvious reasons for a volume devoted to The Female Athlete (as opposed to the athlete in general). Physical differences between the sexes mean there are numerous conditions that solely or predominantly concern one sex or the other; a majority of these affect women. In the US participation by women in sports, especially at the school level (high school and college, in particular) has also increased dramatically over the past three decades or so (since the passage of Title IX, which essentially mandated equal opportunity for female participation in school athletics), but the demographics differ considerably from male participation. In particular, (American) football remains by far the most popular school-sport for men (in terms of participants -- more than a million in high schools alone, almost double the next most popular sport (basketball)), while barely a handful of women play it at any level: a book dealing with the male athlete would have to devote considerable space to football-related concerns (many of which are unique, or close to that), but a book on the female athlete can safely ignore these. Similarly, there are sports with significantly greater female participation, which require greater attention. Usefully, many of the chapters specifically contrast male and female perspectives, from participation rates to nutritional requirements to specific injury concerns.
       Many of the chapters, all written by specialists in the subject under discussion, are of general interest to anyone interested in athletics. Chapters devoted the surge of female involvement in athletics, as well as the psychological aspects of participating in sports, serve as useful introductions. Chapters on nutrition, supplements, and substance abuse offer good surveys of the major issues of concern in these areas, making for a handy reference -- though substance abuse, in particular, probably should be more extensively treated. (Suggestions that women should "look to positive images" and disregard competitive athletes' testimony that performance enhancing drug use is widely considered necessary to remain competitive is laudable but unrealistic for any but the youngest audience.) A later chapter focusses specifically on 'Disordered Eating', but this is perhaps also a subject that could have been highlighted more in the chapters on nutrition and substance abuse. (Among the surveys cited in the chapter on substance abuse is one from 1985 among female college athletes that "indicated that 32% practiced pathologic weight control"; almost all these surveys must be treated cautiously, but any finding of the problem being on this scale is deeply troubling.)
       One section on The Female Athlete is devoted to Obstetric/Gynecologic Conditions, and from general discussions of contraception (and both the efficacy and potential side-effects of various methods) and sexually transmitted diseases to conditions that are more prevalent among athletes (for example amenorrhea, i.e. lack of a regular menstrual period), again offers both a good general female-health as well as athlete-specific introduction. Fertility and pregnancy (and post-partum athletic participation) are also covered in overview-fashion, at least addressing the major concerns and issues.
       The section of general Medical Conditions discusses the general areas of concern regarding (female) athletic participation. A clear description of the 'preparticipation physical examination' (complete with a copy of the standard form) is a handy reference and reminder of particular areas of initial concern. Usefully, areas of major concern -- the so-called 'female athlete triad', disordered eating, amenorrhea, and osteoperosis -- are treated both together and disordered eating and osteoperosis then also covered in individual chapters (as is amenorrhea elsewhere). Other significant issues -- anemia and cardiac concerns -- are also treated.
       An entire section is devoted to Orthopaedic Conditions, as these are by far the most prevalent athletic injuries (at all levels of activity). Much of this material is general, but there are numerous gender-specific aspects -- either due to physiology or far greater numbers of females participating in certain sports. The longest chapters are on knee and shoulder injuries, detailing specific areas of concern, usefully describing methods of diagnosis, as well as discussing treatment. It is comprehensive coverage, rather than a focus on areas that might be of particular concern -- anterior cruciate ligament (ACL) tears, for example, are concisely addressed where one might have expected a bit more extensive discussion -- but this should make it useful as a general first-look reference work when confronted by any injuries or pains.
       Another section deals with Rehabilitation and Strength Issues. Obviously, the primary source of information specifically regarding rehabilitation issues should be the medical professionals involved in such cases. Nevertheless, these chapters provide good overviews for both athletes as well as those supervising athletics and should be helpful in facilitating rehabilitation and the taking up of athletic activity again.
       The most extensive section of The Female Athlete addresses Sport-Specific Conditions, offering twenty separate chapters on specific concerns in a wide variety of sports, from basketball and cheerleading to rowing and winter sports. Many of the chapters include tables of the most common injuries, useful quick reference-points that suggest areas of particular concern. All focus on the most common injuries in each sport, discussing them at some length.
       Some of the information can, at first glance, be disturbing: almost half of all direct fatalities and catastrophic injuries at high school level (and three quarters at college level) among female student athletes occurred in cheerleading, of all things -- but careful reading should allay many fears (fatalities are extremely rare). Particularly in mass-participation sports that are also played casually (e.g. outside school) -- such as basketball and soccer, but also jogging or bicycle riding -- participants are often not aware of the the main areas of injury-concern, and The Female Athlete consistently covers these in depth, make these chapters useful reminders even (or perhaps especially) for those not involved in organised sports programmes. Similarly, school officials that have to deal with a wide variety of athletic activity should find it a good first-look reference work, giving a fairly in-depth sense of areas of particular concern.
       The chapters on individual sports are not identical in format, the authors choosing to focus on different concerns and also to present these in a variety of ways. A bit more uniformity -- especially regarding the central issues (the major sport-specific areas of concern, injury rates, female-specific areas of concern) -- would have been helpful, but most of the basic information is provided in each chapter. Certain tables are particularly stark and useful reminders -- so, for example, a table in the chapter on fencing that notes that almost fifty percent of respondents attribute their worst injury in the last year to 'personal factors' (i.e. the easily -- and personally -- remediable). (Interestingly, in that table only 1 per cent blame 'poor coaching' though some of the personal factors -- poor technique, inadequate warm-up, fatigue -- certainly are all areas which better coaching could have helped.)
       The focus throughout the book on what are essentially problems -- injuries and other medical issues -- can seem a bit alarming, especially to a parent. As many of the authors note, however, the benefits of athletic activity generally greatly outweigh the risks. What's important is that given that there are risks one does one's best to minimize these. In making readers aware of the risks (great and, more often, very small) and how best to address these The Female Athlete allows for more informed activity and reaction for all involved -- parents, school officials and athletic trainers, and female athletes themselves.
       The Female Athlete is a reference work, and should be of particular interest and use to those dealing with large numbers of female athletes. Certainly, any high school or college athletic department would find it a handy reference work. While it is more comprehensive than most individuals might need, multi-sport female athletes (or parents with athletically-minded daughters) would likely find the broad coverage of interest and use. It is a surprisingly engaging volume, with an enormous amount of valuable information (as well as a good deal of curious but often interesting information), and the material is well-organised and presented. A few chapters don't offer quite enough depth, but overall this is a superior reference work.

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