Q&A: UW researcher aims to understand common women’s sports injuries

Women’s Sports Injuries:- Everyone is watching women's sports. From the record-breaking 19 million viewers of the 2024 NCAA women's basketball title game to the two sports bars in the Pacific Northwest dedicated to women's sports, and even new brands dedicated to promoting coverage and investment in women's sports, female athletes are finally having their moment. 

Even though there's much to celebrate, there are still some huge gaps. Pay is one example, with Caitlin Clark, the top pick in the 2024 WNBA draft, earning just 1% of what the top pick in the NBA draft will be paid. Several common injuries also seem to haunt women’s sports, such as the ACL tears that plagued last year's Women's World Cup. An ACL tear is two to eight times more common for women than for men in the same sports. 

Jenny Robinson, a University of Washington assistant professor of mechanical engineering, studies differences between how male and female tissues recover after sports injuries. Specifically, Robinson is interested in designing better methods to help female athletes train to prevent and recover from injuries.

With the Paris Olympics Opening Ceremony upcoming on July 26, UW News asked Robinson, who is also the endowed chair in women’s sports medicine and lifetime fitness in the orthopaedics and sports medicine department in the UW School of Medicine, to discuss common injuries for female athletes and how her research field is working to address them. 

Let's talk about ACL tears. We seem to hear about them happening in a variety of sports. Why?

ACL tears are extremely common in activities that require cutting, pivoting, quick turns of directions (high strain rate) and/or high-contact sports. We see this injury often in sports such as soccer, basketball, rugby, downhill skiing and football. I tore my ACL and my lateral meniscus playing soccer when I was 12 years old. 

Why is it more common for women to tear their ACL?

There are many possible reasons including anatomical differences that lead to altered biomechanics, differences in tissue structure and properties, and sex hormone differences, including fluctuations that occur in women during the menstrual cycle.  

How are ACL tears typically treated?

If the ACL is completely torn, it needs to be reconstructed. One method involves grafting a tendon from another part of the body. For example, using patellar or hamstring tendons are some of the most common options. But this can lead to additional risk for injury at the donor site — I strain my hamstring often because my hamstring tendon was used to repair my ACL tear. 

Sometimes the reconstructions are torn again, which requires revision surgery. It’s not career-ending the first time this happens, but any subsequent injuries and/or post-traumatic osteoarthritis can make this career ending. 

What makes an injury career-ending for female athletes? 

I was just reading up on Olympian Lindsey Vonn’s total knee replacement this past spring. She’s 39 years old and the typical age range for these types of surgeries is 60 to 70 years old. She’s had so many knee injuries to treat multiple ACL, MCL and meniscus tears. That is career-ending. 

This is personal for me. When I tore my ACL and meniscus, my orthopedic surgeon told me to stop playing soccer — I was 12 years old — to reduce the risk of additional injuries or post-traumatic osteoarthritis. When I was 16, I went back to the doctor with pain and they confirmed it was post-traumatic osteoarthritis. They told me again to just stop playing soccer, insinuating this wasn’t a major part of my life, a part of my identity, something I could make into a career. 

If there has ever been a time to invest in ACL injury prevention, it’s now. For professional athletes, tracking ACL risk is critical for reducing the likelihood of degenerative conditions after acute injuries. These steps ensure athletes have long careers, livelihood and support for their families. Understanding ACL injury risk is also important for non-professionals, youth athletes, parents and coaches as well. It ensures a lifetime of peak physical and mental health.

How does your research focus on female athletes' recovery from injuries? 

We may think we know how women's bodies operate. But we don't. Most of the research is based on men's bodies or bodies of undisclosed sex. Also, much of the research is based on what's happening at the tissue and joint level without considering how the cells within the tissue are responding based on hormonal and mechanical signaling cues. But changes at the cellular level happen first and then lead to changes at the tissue level. 

My research group is trying to determine what cues lead to tissue scarring versus regeneration so that we can develop processes that inhibit scarring and promote regeneration. How do sex hormones and mechanical cues regulate tissue structure and function? What happens to the cells in these tissues when there are different mechanical or hormonal changes? 

We need this information to be able to design methods that reduce or prevent injury, provide clearer and more patient-specific surgical and therapy recommendations, and develop techniques to promote functional regeneration and reduce scarring.

Women's sports are also having a moment in your research field. You've been attending multiple conferences that focus on women's health and engineering. What are these conferences like? 

This past summer I have been part of two meetings that bring together professionals in engineering for women's health — the Engineering Research Visioning Alliance: Transforming Women’s Health Outcomes Through Engineering meeting and the ElevateHER meeting. They are both supported by the National Science Foundation and they aim to define the major questions we need to tackle in the next 50 years, especially around developing strategies to understand female physiology and address conditions that disproportionally impact women. 

While I'm in these meetings, my thoughts have gone something like this: 

• I'm so happy to be in a room with all these amazing researchers focused on women’s health! I’m pumped to continue working on these major questions

• Wow, there are so many basic questions that we don’t have any clue how to answer

• Oh, but the people in this meeting can figure it all out

• Wait, they don’t know how to approach these questions either

• Ahhh, we have so much to do

• OK, but there is hope because people are working in areas that we previously were clueless about and doing some really impactful research

• Now that we all know each other we can brainstorm and slowly but surely start to tackle these problems

This is a necessary step, and it's been wonderful being in the same space with people who are all focused on women’s health and how to use engineering design principles and tools to tackle questions.