Anatomy Isn’t Destiny: A Multidisciplinary Response
to
Michael Sokolove’s Warrior Girls
Tucker Center Newsletter - 2008 Fall
In 2008, a controversial book—Michael Sokolove’s Warrior Girls: Protecting Our Daughters Against the Injury Epidemic in Women’s Sport—was released, along with a companion article which appeared in the May 11 issue of the New York Times Magazine. The premise of the book asserts that “[the] immutable facts of anatomy and physiology” cause girls to incur significantly more sport injuries (e.g., ACL tears, concussions) than their male counterparts, resulting in what Sokolove terms a female “injury epidemic.” As a response to the underlying premise (and purported facts) of Warrior Girls, the Tucker Center felt it necessary to provide a scholarly critique from relevant academic disciplines. We invited internationally recognized scholars from the U of M in Public Health, Sports Medicine, Sport Psychology and Sociology to read the book and respond independently. Their perspectives—and research findings—follow.
A Sociological Perspective
Nicole M. LaVoi, Ph.D. Associate Director, Tucker Center
Let me begin by stating that sport injuries and sport injury prevention are very real and important issues—for both girls and boys. However, framing the issue of sport injuries as an inevitable biological difference based on the sex of the athlete is sensationalistic and irresponsible. First, an argument based primarily on biology and physiology altogether ignores that sport performance (and therefore injury) is also shaped by social forces such as coaches’ and parents’ beliefs about what it means to be a “female athlete.” Second, this sort of deterministic approach assumes that males, by definition, are naturally (physically) superior to females. In this framework, male athletes are the norm to which females are constantly compared, and any gender differences are therefore constructed as inherent female deficiencies. The consequence of such biology-is-destiny arguments? Professor Cheryl Cooky, Cal State-Fullerton, sums it up best: “Concerns regarding the supposed biological limitations of the female body to withstand rigorous athletic competition have historically served to justify restricting girls’ and women’s access to sport.”
Though Sokolove does indicate that we should also be concerned about sport injuries males sustain, rarely, if ever, are books published devoted to the negative consequences of sport participation on the health and well-being of boys and men. Interestingly, a search for a similar book or article on the “epidemic” of male sport injuries yielded nothing, despite published research which indicates that NFL players’ life expectancy is 15-20 years lower than the general American male population and that many suffer ill effects from playing professional football, including obesity, heart disease, chronic pain and crippling arthritis.
The anatomy-is-destiny perspective also ignores the reality that some female athletes are stronger, have better motor skills, are more coordinated than some male athletes, and that risk for injury runs along a continuum rather than a sex-determined binary. In the final analysis, males and females are more similar than they are different—both compete in sports and both get injured in a variety of sports and physical activities. As a result, concerns relating to all the correlates of sport injury, social and psychological as well as biological and physiological, need to be given equal consideration.
A Public Health Perspective
Toben F. Nelson, Ph.D. Assistant Professor, Epidemiology & Community Health
Warrior Girls tells compelling stories of exceptional young women as they struggle with serious sports injuries—stories that need to be told. The author is sensitive to the hard-won gains that have opened doors for young women to experience the benefits of sport. We cannot go back. Higher sport injury rates among girls is not evidence of weakness nor an indication they should not play. But that does not excuse serious efforts at understanding the etiology and distribution of sports injury, with the goal of prevention. Sokolove does raise important questions about sport injuries, but the prescriptions he offers are preliminary and unsatisfying. Should we push young women to play hard? Should we allow them to push themselves? Do young women lack the self-awareness to know when they have gone too far? Such questions send us backward, not forward.
Though the personal stories Sokolove highlights are compelling, they restrict our vision of the full problem—if we use only the comparison of girls to boys, we remain limited in our overall understanding. While it might be tempting to wonder about the physical attributes of young women that may make them susceptible to injury, we also need to ask questions about the conditions that contribute to injury rates among young men. Fundamental inequities still exist between sport opportunities for boys and girls. Do differences in field conditions, types of equipment or coaching styles contribute to higher injury rates?
Some excellent work has been done to study sports injury using NCAA Injury Surveillance data. Although these data are the best available, they are incomplete, and as a result, reliable answers about adequate prevention remain elusive. Expanding the set of questions we ask—and collecting the right data to answer them—will go far in furthering our understanding of the complexities surrounding this issue. Sports participation can be a safe and rewarding pursuit. We should continue to strive to protect young women (and men) from the risks they encounter in sport through rigorous science.
A Sports Medicine Perspective
Steven D. Stovitz, MD, FACSM Assistant Professor, Department of Family Medicine and Community Health
Elizabeth A. Arendt, MD, FACSM Professor, Department of Orthopedic Surgery
As sports medicine providers, we are aware of the devastation that an ACL tear can have on both the musculoskeletal system and the mental health of an adolescent. In certain sports, females sustain a higher rate (not a greater number) of non-contact ACL injuries when compared with males. However, the emphasis on the emotional interplay among the athletes, parents and coaches Sokolove writes about detracts the focus from a more scientific presentation of injury risk. Warrior Girls suffers from the following: 1) False comparisons—One major theme is that females simply can’t do what males do. Therefore, when they try to “act like males,” meaning be competitive, powerful and aggressive, they will inevitably become injured. 2) Misrepresentation of scientific literature—We don’t know why girls suffer ACL injuries at rates higher than boys. Theories include factors such as differences in strength, joint laxity and gait. The author presents each theory as a “known risk factor” implying that all girls inherently contain every risk factor which places all females at enormous risk. 3) Fudging of statistics—Imagine something happens in 0.1% of population X, and 0.2% of population Y. You could say that the difference between the populations is 0.1% (i.e., the absolute difference), or you could say that the difference is 50% (i.e., the relative difference). While both numbers have meaning, when discussing an ACL injury prevention program, Sokolove only presents the relative difference—in this case, 74% fewer ACL tears occurred in girls who completed an ACL prevention program compared to girls who did not complete the program. A more honest (and accurate) approach would be to present both numbers. 4) Emotional language—“The ACL does not tear so much as it explodes”, and “parents scream ‘No! No! Oh, no!’ from the sidelines.” Such overwrought language permeates Sokolove’s writing and contributes to the sense of fear he creates when discussing the “injury epidemic” he claims exists.
There is an identifiable gender disparity with regard to non-contact ACL injuries. To address this concern, parents and coaches could, for example, be much more aware of ACL injury prevention training and its many benefits for females and males. Unfortunately, these critical messages get lost within Sokolove’s over-the-top and misleading approach.
A Sport Psychology Perspective:
True Confessions of a Warrior Girl turned Mild-Mannered Soccer Mom
Diane Wiese-Bjornstal, Ph.D. Associate Professor, School of Kinesiology; Association of Applied Sport Psychology Certified Consultant
In many ways I was a “warrior girl”; still am, I think. So I truly do understand what these girls feel: The over-powering desire to mask pain, injury or fatigue so as not to miss a moment of playing time, give less than 100% or appear weak. But fortunately for me, this style wasn’t an option at the tender age of 10 or younger as it is for girls—and boys—today, so I survived relatively unscathed at least until college. Being a Sport Psychology Professor by day and a mild-mannered soccer mom by night, I view the topics in Sokolove’s book through two lenses. As a scholar, I see that our studies of the psychological reactions of athletes post-injury have illustrated the same full spectrum of cognitive, emotional and behavioral responses reflected in the book’s many anecdotes. Sadly, some young athletes express “relief” after sustaining an injury because they feel it is the only way to escape the pressures of sports and still “save face.” Pre-injury studies reveal that those athletes who are physically and mentally fatigued—self-imposed, such as perfectionist standards, and other-imposed, such as pressure from coaches or travel time—are more likely to sustain injuries.
As a mom, I see that parental responsibility for athlete health is often abdicated to coaches. The unhealthy decisions that parents sometimes make for young athletes—and that Sokolove highlights with such powerful examples as “we can’t stop her, she has a mind of her own,” or “I don’t want to ‘waste’ her talent”—are simply bogus. I admire those parents described in the book who drew the line in the sand when an athlete’s health was in jeopardy. But parents should also realize their beliefs and values about physical activity greatly influence their child’s behavior. Research indicates that far too often, parents perceive girls are more vulnerable, and thereby allow, even encourage, greater risk taking for boys which, ironically, puts them more at risk for injury than girls. This research finding provides additional evidence against the biology-is-destiny argument.
In sum, we must help all of our children learn to take reasonable risks within healthy boundaries in all aspects of life, sports included.
Conclusion
Warrior Girls is based on sensationalistic journalism rather than empirical evidence. Sokolove skillfully links the sport ethic—striving for distinction, accepting risks, playing through pain and not accepting barriers in the pursuit of goals—with a Mars-Venus dichotomy whereby females are routinely portrayed as different from (and inherently inferior to) males. He seems determined to create a moral panic for already overly concerned sport parents who are understandably trying to do what is best for their daughters. In Sokolove’s worldview, parents are confronted with a falsely constructed dilemma—wanting equal sport opportunities for their daughters, but in so doing, placing their daughters in harm’s way. A more honest and constructive book would have examined the current structure of organized youth sport—a system characterized by early specialization, a win-at-all cost philosophy and undertrained coaches and parents. In sum, a system that can be detrimental to both girls and boys.