Celebrating the 50th Anniversary of Title IX with Dr. Susan Sigward

Dr. Susan Sigward is a WiST Mentor, an Associate Professor at the USC Division of Biokinesiology and Physical Therapy and the director of the biokinesiology master’s program which includes an emphasis on sports science. Dr. Sigward’s research focuses on lower extremity mechanics and how they relate to anterior cruciate ligament (ACL) injury or how they change after injury.  Dr. Sigward has also studied sex-based differences in ACL injuries where women are 3 to 6 times more likely than men to experience ACL injury.   

On this 50th anniversary of Title IX, we are grateful to have Dr. Sigward’s insights on the opportunities for women in her field and on the advancements in research on female athletes.

*****

WiST: Where have recent technological advances had the biggest impact on your research?

I've been fortunate enough during my research career to have really expensive equipment to do some intensive work to come up with conclusions on what we’re studying. Being able to use that type of equipment to get more objective insights on movement has really been isolated to laboratory settings and artificial types of testing.  We can see how people move in a lab setting. But I have no idea how many times they do that movement throughout the day.  I have no idea if they do it the same way as in the lab, the same way when they're thinking about it or when they're not thinking about it.

We now have equipment that's not attached to a wire and is a lot smaller. There’s a lot more usability of different types of equipment, whether it be from cameras or those little wearable sensors. All those things make it more convenient to walk outside the lab and look at movements. There is also this idea of being able to get multiple sources of data, and lots of it, and to be able to go back and look at it and get more insight.  

So, this idea of understanding how the environment and the context affect some of these movement principles, or how these movement strategies then relate to an accumulation of loads that might cause an injury or decrease the exposure or experience for some type of movement needed for a sport, that is the biggest change that technology has brought to my field.

WiST:  How have you experienced the evolution of the female athlete in relation to your work of studying athletic injuries? 

I was reflecting on my trajectory and realized that my career has followed this path of the benefits and consequences of Title IX. The reason that we need a Title IX is one of the factors. Now that we have it, it that changed how women get to participate in sport. It also raised questions. Are they prepared? How are they becoming injured? I think the evolution is framed nicely in the idea of the ACL injury. That’s really where the focus of my research has been. 

As a physical therapist, I worked for about 10 years as an athletic trainer and a physical therapist. First of all, it was a really hard place for a woman to be as a clinician in sports. That wasn't necessarily a place where a lot of women were welcome or respected.  One thing that I started to see toward the mid to late ‘90s, is a lot of my female patients and athletes were coming in with ACL injuries. It felt like an epidemic of ACL injuries. Even in medical circles, we thought, maybe these injuries were here before, but now, as surgeries were becoming more successful and getting athletes back out on the field, we’re simply hearing about them more. 

From a clinical perspective, I thought, ‘They must be moving differently. That's why they tear their ACL.’ I pivoted my career to look at this and see what was going on. When I got into a PhD program and was writing my dissertation, every paper I started reading said since the passage of Title IX, the increase in participation in sports by female athletes has been exponential. This was in the early 2000s. I was citing R. Vivian Acosta and Linda Jean Carpenter who tracked female athletes, extensively, in NCAA sports across Division I, II and III and showed that hundreds of thousands more women were playing at a high, competitive level than they were just a decade before. 

One perspective that came out of this is that women had more opportunities and were participating at a level where it was more competitive than what, historically, was available for the majority of athletes. So now, we're starting to see injuries that are popping up that may be attributed to that increase in opportunity. So that started this idea of we’ve got to figure this out.

WiST: What did you find as you started looking more closely at the discrepancies in ACL injuries between male and female athletes?

We looked at how women move and how they performed athletic tasks, in a somewhat artificial way, compared to males. Just merely looking at sex differences, we found different types of movement strategies. We started to hypothesize different factors of why that may be occurring. If we go back to the structural pieces of it – maybe women’s ligaments are smaller or they have a bigger Q-angle or a wider pelvis - those are not obvious answers. In fact, there's some data out there looking at groups of athletes comparing males and females and finding out that's just not true. 

In the decades of evolution of how we look at this injury, there's a recent paper in the British Journal of Sports Medicine by Joanne Parsons, Stephanie Coen and Sheree Bekker describing a gendered approach to understanding ACL injury. They’re really sparking a lot of introspection here. The women in this category of science are thinking about the differences in how women move that are not driven by their sex, meaning their biological sex, but from this idea of gender and this identity that the community or the environment places on what a female should or should not do, how a female athlete should or should not be supported.  It goes back to, what opportunities do women have early on to get good training and build good strength? What does it mean to be a strong female, the perception of what her body looks like? What opportunities does she have for mentors on a coaching level that understand all of these things? All of these things could very well have been at the root of why these movements were different. Not because women had different muscles or different nervous systems, but because there's just a lot less development in the same skills when you compare them to the boys or the men.

A large group of women has never been pushed to a level to see what they can do. For a big community of girls and women, just given similar opportunities, what could that skill level look like? On the other side of it, how exciting it is to watch female athletes and their advancing skill levels!

WiST:  What are the opportunities for employment for women in sports tech in your field? What are some of the challenges that women still face? 

Given the history of having fewer women in engineering jobs, in data analysis, and on the education side, we could have a gendered approach to getting a job in sports tech. I think those unconscious biases, or maybe even conscious biases, are still out there. But there's an exciting landscape right now for women to be standing up and taking those positions.  Our sports science program was specifically developed for students to learn all of these really strong foundations of physiology and biomechanics and neurophysiology, and there's a lot of stuff out there that is coming out as far as technology can be applied in these areas. Those technologies are being developed by companies, not necessarily scientists. This is a big place for women to come in and say, I know how to start to apply these technologies to sports. 

In my experience, most of those technologies are being applied to sports that have money and teams that have money. Two categories of these would be the high-level athletes and the consumer base, think something like a Fitbit or an Apple watch. Those higher-level athletes are typically on male sports teams, the teams that can afford this technology and actually use it. That’s an area where I'm hoping we're able to get women into using that technology. The big dream, though, is to get women into those areas using technology for female athletes.

WiST: What does Title IX mean to you? 

Fifty years may sound like a long time, but living through most of Title IX and being able to see the progress that has been built along a bunch of lines, has really been huge. I think younger athletes and younger students could easily get caught up in the frustration of ‘I don't have what the boys have.’  I could sound like an old person and say, ‘You should have seen how it used to be!’ and be pessimistic about it. But, I think it's more of, ‘Wow! Look what we can do, and what we continue to do.’ 

In this world of technology and media and focus, I think people are starting to see that this is something that could reach even bigger heights. As things are getting less expensive to make, easier to use, and more applicable to the regular person, that’s where we can really bump up the timeline and progress of how female athletes can stay healthy and perform better.