Issue link: https://maltatoday.uberflip.com/i/1211430
3 LETTERS & EDITORIAL maltatoday | SUNDAY • 16 FEBRUARY 2020 Mikiel Galea Letters & Clarifications The silence of bones OVER the past decade I wore dif- ferent hats in the sports community as a PE teacher, athlete and coach in Malta. In my desire to become a more evidence-based practitioner, I pursued a Master's degree in sports and health sciences at the University of Exeter, funded by the Malta Sport Scholarship. Women differ from men in many ways, especially on an anatomical, hormonal and biomechanical level. However, most studies are conduct- ed using male participants and many times results are not sex-specific. My research project investigated a number of variables which can con- tribute to injuries in female football- er populations. Female participation in sport has increased in the past years, such as in football with a 36% increase over the past 20 years. This has been accompanied by a rise in injury rates so much so that in fe- male soccer, figures are comparable to male players in international tour- naments such as World Cups and Olympic Games and also at a recre- ational youth level. Female athletes who participate in high-risk sports such as football and basketball have as much as a two- to eightfold higher risk of ACL injury than their male counterparts. My main variable of interest was the Stiffness Index at the heel bone (calcaneus) between limbs, mainly in those footballers who had a previous history of lower limb injury. In this case, the Stiffness Index is a measure of bone microstructure quality. The calcaneus is a sensitive and ideal measurement site — being the first point of contact with the ground when walking, running or jumping. My research does not show wheth- er a certain value for the differences between limbs in calcaneal Stiffness Index may be predictive of injury risk. However, the data contributes to the characterisation of female footballers for whom data are rela- tively scarce and suggests many ave- nues for further study. There exists a direct relationship between ligament rupture and knee laxity, which changes depending on estrogen levels throughout the men- strual cycle. Females are also at a greater risk of suffering from a lower Bone Mineral Density, especially if overtrained and showing symptoms of RED-S (Relative Energy Deficien- cy in Sport) — a concept developed from the more commonly known Female Athlete Triad. Due to limited energy availability, the ability of bone to adapt to the impacts associated with activity is likely to be compro- mised, elevating the risk of injuries. Maintaining strong bones and muscles is an ongoing process and this is important for general health, sport-specific strength and injury prevention. The following are some simple training tips to particularly maintain bone strength but also im- prove muscular power. Resistance Training: get to the gym, lift weights such as perform- ing squats, use resistance bands and other body weight exercises such as push-ups, chin-ups, one-legged squats. This will generally make you overall stronger. Plyometrics: this is training which involves power such as jumping. Jumping is a high-impact movement and stimulates bone to regenerate. Unilateral Training: in order to minimise imbalances, training both sides equally is beneficial. Incorpo- rate separate limb training such as lunges, one-legged squats, one-leg- ged deadlifts holding a weight and the use of gym machines such as leg curls and leg extensions which gen- erally train one leg at a time. If you are already doing any of the above mentioned recommendations - keep at it! It is highly important to increase the load slowly as to prevent injury and to eat enough for your training demands. Marilyn Grech, Via email