Do male and female athletes recover differently? The answer is more complicated than you might think. Many factors, from social dynamics to muscle-fiber composition, can affect recovery after an injury such as an ACL tear. But there isn’t necessarily a different set of recovery rules to follow for males versus females.
Here, Dr. Michele LaBotz, TrueSport Expert and sports medicine physician, breaks down four commonly held beliefs about how males and females recover in different situations, and which ones hold up.
Recovery after Concussions
What you might hear: “Women recover more slowly than men from concussions.”
What the research says: Partly, but it’s not for the reasons people often assume. It’s not about being ‘tougher’ or more capable, says LaBotz. Instead, a mix of biological and psychological factors affect how female and male athletes recover from a concussion. For instance, female athletes may be more likely to report symptoms and injuries early, influenced by factors that can include body awareness and attitudes toward playing through pain. That can potentially change the recovery trajectory, and it also impacts how concussion statistics are reported.
LaBotz explains that female athletes also tend to have a higher initial burden of symptoms after concussion, which is the main reason their recovery can take longer. After that initial burden of symptoms eases, male and female athletes tend to recover at the same pace.
Female athletes may have a higher risk of developing post-concussion vestibular and oculomotor issues. When these impairments are present, athletes often struggle to focus their eyes and may notice nausea or a feeling of being off-balance during everyday tasks. Reading is often particularly difficult.
Best recovery practices: There is no sex-specific concussion treatment protocol, says LaBotz. Rather, treatment is based on an athlete’s specific symptoms. She recommends being honest with your doctor, athletic trainer, and coach about how you are feeling, and working with them to develop a treatment plan based on your needs. An athlete with balance or vision problems may need a different care plan than an athlete experiencing minor headaches. The difference in treatment approaches comes from symptoms, not sex.
Recovery after ACL Surgery
What you might hear: “Female athletes have a harder time and take longer to recover from ACL surgery.”
What the research says: This is true, to a certain extent. “When you talk about recovery after ACL reconstruction, it’s all about dedicated rehabilitation. One thing that researchers have found that speeds up an athlete’s return to sport is the strength of the muscles that support the knee and leg movement,” says LaBotz. “Female athletes often have a harder time and take longer to recover their quadriceps strength than male athletes do. Part of this could be because young female athletes tend to have more slow-twitch muscle fibers compared to young male athletes, who have more fast-twitch muscle fibers. There’s also a hormonal component, particularly after the start of puberty. Young male athletes often have higher testosterone, which helps them build muscle more readily, even with the same amount of strength training.”
But there’s also a mental component, LaBotz adds. “In ACL recovery, there are significant psychological differences in terms of the recovery and the return to sport,” LaBotz explains. “Male athletes tend to experience more psychological distress because they’re not performing as well when they come back, whereas female athletes may experience reduced self-efficacy and feel less in control of their lives.”
Best recovery practices: For athletes of all sexes, building and maintaining quadriceps and hamstring strength can support recovery. Take rehabilitation seriously, says LaBotz, and work with doctors and physical therapists to create a return-to-sport plan that’s right for you.
She also recommends getting clear on what will best serve your mental health and well-being. “It’s important to figure out what the best continued engagement with your team is during your recovery,” she says. “For many young female athletes, continued engagement is helpful. For some young male athletes, it isn’t as useful—so you need to find the balance that works for you. If you can’t do all the drills, maybe you can do some conditioning alongside your teammates so that you still feel connected, or participate on the sidelines working on the team’s overarching strategies and tactics. Or, you might be better off taking a break, joining a different club at school, or spending time with friends while you focus on rehabilitation.”
Recovery from Bone Fractures
What you might hear: “Female athletes heal fractures more slowly than males.”
What the research says: Bone healing occurs at about the same rate in males as in females in healthy young athletes. However, this is not true in older adults where females will tend to take longer to heal due to changes in hormones, particularly as they approach menopause.
However, LaBotz notes several key differences in fracture patterns in young athletes. “Males are at higher risk for acute fractures, particularly in sports like American football where there is lot of high intensity and intentional contact. However, females are at much higher risk for stress fractures.”
“This increased risk of stress fracture is less about anything specific to being female and more about the correlation with nutritional status,” says LaBotz. “Young female athletes are less likely to get enough calcium, protein, and overall calories for optimal bone healing.”
Relative energy deficiency in sport (REDs) is not limited to female athletes, but it is more prevalent in them, and it often precedes stress fractures in athletes. “Having REDs not only leads to an increased risk for stress fracture, but athletes with REDs, whether they are male or female, will often have slower healing of acute fractures as well” LaBotz says.
Best recovery practices: Prevention is key. Make sure that you are fueling well before, during, and after training, and that you’re eating a diet built around whole foods that contain enough calories, protein, and calcium for strong bones. Female athletes should also pay attention to changes in their menstrual cycle, such as a missed period or a longer time between periods, since these can be potential signs of low energy availability or REDs. If you’ve already experienced a stress fracture, LaBotz recommends working with a dietitian to make sure that your current nutrition plan is working for you.
Recovering Throughout the Menstrual Cycle
What you might hear: “Recovery is going to be affected significantly at different phases of your cycle.”
What the research says: It depends. “The data does not support a strong universal effect of the menstrual cycle on performance,” says LaBotz. “That’s not to say that the menstrual cycle has no effect on athletes, but there is so much variability. It’s not so much the cycle itself that affects performance and recovery. It’s the symptoms, like headaches or cramps, and how they affect sleep, appetite, and the ability to train, and those symptoms vary from person to person.”
“I never want to minimize the fact that some athletes are really uncomfortable around the time of their periods,” adds LaBotz. “If your appetite is messed up, or you’re constipated or have diarrhea, that can absolutely influence how you perform.”
Best recovery practices: “Pay attention to how your body responds and then address those specific symptoms. That works better than any universal advice,” LaBotz says. To do that, she recommends learning your cycle and how it affects you. If you notice symptoms that keep coming back at certain points in your cycle, such as trouble falling asleep, record them in a planner or calendar app.
The goal is not to determine what phase you’re in so that you can follow specific recommendations for that phase. The goal is to learn your own symptoms and when they show up, so that you can troubleshoot them in a way that works for you. For example, if you tend to struggle to fall asleep during the week before your period, you might go to bed 30 minutes earlier and read a boring book.
Finally, if your symptoms are impacting your performance, or start to affect it more than usual, talk to your doctor. Bring any notes that you’ve made about your cycle since you began tracking, so that your doctor can work with you to pinpoint any medical issues.
