When injury rears its ugly head, we place our trust in medical professionals – doctors, nurses, physiotherapists, chiropractors – to help aid our recovery. But, evidence points to deeply entrenched prejudices – both structural factors and unconscious biases – which hinder fair treatment. I want to explore just one key areas of discrimination – gender – and consider what it means in the field of sports science.
In 2021, the UK had the largest gender health gap in the G20 and the 12th largest globally. The government’s consultation on a new women’s health strategy for England found that 84% of women felt ignored and not listened to when seeking help from the NHS.
These are startling statistics but what do they mean in relation to sports injuries? The evidence we have suggests that women are more at risk for the most common sports-related injuries than their male counterparts. Women are three-times more likely to rupture the ACL than men, for example. Partly, this is anatomical: women have a wider pelvis, resulting in their thigh bones angling downwards more sharply, which can increase tension on the knee joint; women’s intercondylar notch where the ACL passes through the femur is naturally narrower, making the ACL more prone to tears; finally, limited studies on the impact of hormones on physiology show that higher levels of oestrogen can affect the stability of joints and collagen levels.
But this very vagueness speaks to one of the key issues in sports medicine. Dr Emma Ross found that just 6% of sport and exercise research was conducted on women. Moreover, in 2018/9, women made up just 33% of first authors and 33.2% of last authors in the four major sports medicine journals (Cowan et al., 2023). With the underrepresentation of women as participants in and authors of sports research, it is perhaps unsurprising that there is so much left unknown regarding their injuries.
While part of the gender inequality can be explained by a lack of understanding of women’s physiology and injuries, the other major factor is unconscious bias. University of Rhode Island researcher, Karen L. Calderone, found that women are half as likely to receive painkillers after surgery as men, representing the ‘pain bias’. Men are more likely to see their pain as the result of external factors such as physically strenuous work, while women are more likely to blame themselves and are told to ‘be careful’ (Stenberg, Fjellman-Wiklund and Ahlgren, 2014). Men are even less likely to be offered group rehabilitation as men are perceived to be less willing to talk about their feelings (Stenberg, Pietila Holmner, Stalnacke, and Enthoven, 2016).
These biases are reflected in the fact that while 74% of physios in the UK are female (based on membership of the Chartered Society of Physiotherapy), physios specialising in musculoskeletal and sports health are mainly male. Physiotherapy is an example of a ‘gender regime’ in healthcare where women are overrepresented within the profession but men have more power at an organisational level. In 2019, the Brazilian National Society of Sports Physical Therapy (SONAFE)’s female associates launched a campaign to amplify the voices of female sports physios; yet, even after this, women made up just 25% of SONAFE membership in 2021. Clearly, in its current form, there is no equality of treatment and outcome for those seeking medical assistance after injury. But while this article began by stating we shouldn’t ‘expect’ equal treatment in medical care, I’m now going to say the opposite. We should be expecting fair treatment. We should be demanding it. The responsibility should not just fall to individual women to be more vocal in questioning treatment or demanding better pain relief. It is also the responsibility of the NHS and private healthcare professionals to breakdown the patriarchal system which exists.
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