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  • Writer's picturedrjfortier

Preventing Female Sports Injuries

Updated: Jan 1, 2023

Female athletes have a greater chance of joint injury due to hormones!

In my practice I see many cases of joint injuries: sprained ankle, hurt knee, low back sprains, rib pains, shoulder, elbow, and wrist injury etc.

And often hormones play a role!

Ligaments have receptor sites for estrogen hormones, and estrogens can create ligament laxity, or loose joints, which seems to correlate with the menstrual cycle and estrogen fluctuations.

ACL injuries have been studied extensively with female athletes. It seems the medical consensus on treating this is to take birth control pills to reduce ACL injuries.

Like this one:


Herzberg SD, Motu’apuaka ML, Lambert W, Fu R, Brady J, Guise J-M. The Effect of Menstrual Cycle and Contraceptives on ACL Injuries and Laxity: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. July 2017. doi:10.1177/2325967117718781

-study analyzed 68,758 participants across 21 studies

-Studies to date suggest that knee ligament laxity and risk of ACL injury may be increased during the ovulatory phase of the menstrual cycle

- Studies to date suggest a potential connection between hormonal levels in the menstrual cycle and knee laxity and/or injury

-Hormones have been hypothesized to influence ACL injury by exerting a direct effect of ligament laxity or stiffness through collagen synthesis and tensile properties given estrogen, progesterone, testosterone, and relaxin receptors on the ACL or through neuromuscular changes affecting knee alignment

- the timing of injury and laxity appears to coincide with the estradiol peak

- In conclusion, the literature suggests that ACL laxity and risk of injury may be increased in the ovulatory phase of the menstrual cycle


Besides give postpubescent females birth control pills, the medical side doesn’t seem to offer many solutions here.

Birth control pills are toxic and hormone altering. 300-400 healthy women die each year in the US from birth control use, usually blood clots to the lungs.

And there’s an innumerable number of females faced with breast, cervical, uterine, and ovarian cancer related to birth control pill use as well.

I come across a new female every week who has been diagnosed with breast cancer, either recently or in the past.

Let’s get these hormones under control so they cause less problems for you!

Managing hormonal disorders and imbalances can be frustrating and tricky for most people.

By understanding the systems that impact hormone regulation and balance, you will save a lot of time and effort!

To balance your hormones, so estrogens stop harming your body, you will want to look at these four areas first, before any emphasis is placed on managing symptoms.

1. Manage any adrenal gland imbalances and blood sugar disorders.

a. This includes identifying any imbalance in cortisol, hypoglycemia, insulin resistance

2. Fix your gut

a. This includes the proper digestion of proteins, carbs, and fats

b. Any overgrowth: bacterial, fungal, candida, parasites

c. Leaky gut areas, food sensitivities, etc

3. Identify and support any areas in Liver detoxification that needs help

4. Any imbalance in essential fatty acids

You will find by addressing these four areas most people will have their hormonal imbalances

resolve, even in some of the hardest cases.

Hormones are the whipping boy of the body. Any imbalance seems to throw them off.

Adrenal Gland and Blood Sugar Imbalances

The adrenal glands are known as the stress glands because they release the hormones that allow us to handle stress.

These hormones like cortisol are secreted in chronic stress, but also to help manage blood sugar.

Epinephrine is used to stimulate the sympathetic “fight or flight” response. Also, hormones like DHEA, estrogen, and testosterone.

These glands react to stress, and what the body perceives as a stress.

In an immediate stress, like waking up in the middle of the night and seeing an intruder, the adrenals will secrete epinephrine, place you in fight or flight mode, and your body will make the adaptions:

Epinephrine kicks in, the blood goes from your frontal “fun” brain to deeper more primitive survival centers.

Our bodies instantly prepare to fight or run.

  • Blood moves from your gut into your muscles for fighting or running.

  • Digestion slows or halts.

  • Hormones become altered.

  • The body produces sugar, to provide energy for fighting or running.

  • Wound healing, immune system, making hormones, going to the bathroom, having sex – not needed to fight this intruder - and the body makes all the necessary adjustments to make that (or not) happen.

Afterall there’s a problem we need to fight or run from.

Not digest food with adequate stomach acid levels, make sex hormones, or go to the bathroom – its go time!

This is great when there’s an acute stressor.

Chronic stress can affect your health because we need some of those functions to work for us on a daily basis.

Chronic stressors are anything your body thinks is stressful, even if you don’t.

Work or school stress, needing money, fighting with family, having chronic pain, exercising too hard or too long, not sleeping, not eating, not eating healthy, stimulants, exposure to extreme heat or cold, allergies, etc.

In this case instead of running on epinephrine the adrenal glands will continuously pump out cortisol.

Cortisol will continue to break the body down, stimulate sugar production called gluconeogenesis, and when we don’t need sugar for fighting it stores the sugar as body fat.

This will eventually create the body type of thin arms and legs, and fat deposits around the body.

The increase in body fat creates more estrogen through a process called aromatization.

Estrogen being an inflammatory hormone, creates more inflammation.

The inflammation being a stressor releases more cortisol.

The loop becomes created:


You’ll find that many of these systems intertwine and effect each other back and forth.

For example, your body must detoxify this influx of stress hormones.

The cortisol pouring in can overwhelm your liver’s detoxification.

Nutrients needed to detoxify hormones get used up and limit the repair of your joints as the nutrients to repair are being used up in the detoxification.

(Example: sulfates needed to detoxify steroid hormones are also needed to repair connective tissue)

Stress can affect stomach acid levels, erode the gut lining, deplete the immune system, and cause constipation.

These are all main factors that cause the gut to develop overgrowths, become leaky, unload inflammation into the body, and then in return create massive internal stress reactions which cause the body to release more stress hormone.

Stress—impaired gut—inflammation—stress

Blood sugar imbalances will also create a stress response.

As blood sugar levels drop, the adrenal glands release cortisol or epinephrine to raise the levels.

This can cause insulin resistance, as the body has an imbalance of stress hormones, leading to fluctuations in blood sugar and insulin levels.

You’ll need to support your adrenal gland to allow it to heal if it’s been fatigued.

And figure out it’s stressors and eliminate them.

You can have salivary lab testing to see if your cortisol is too low or too high.

Blood tests checking hemoglobin A1C can tell you if your average blood sugar is too high.

Signs your adrenals are over functioning:

  • Cannot fall asleep

  • Perspire easily or excessively, with little activity

  • Weight gain under stress

  • Digestive Issues

Signs your adrenals are under functioning from exhaustion

  • Cannot stay asleep

  • Crave salt- you urinate out your salt with over stressed adrenals

  • Slow starter in the morning

  • Afternoon fatigue

  • Dizziness when standing up quickly

  • Afternoon headaches

  • Headaches with exertion or stress

  • Weak nails

Signs your blood sugar is imbalanced

  • Crave sweets during the day

  • Irritable if meals are missed

  • Depend on coffee to keep you going

  • Get lightheaded if meals are missed

  • Eating relieves fatigue

  • Feel jittery or shaky if you don’t eat

  • Poor memory or forgetful

  • Blurred vision

If you’re reaching insulin resistance

  • Fatigue after eating

  • Crave sweets during the day, but they don’t relieve your cravings

  • Must have sweets after meals

  • Waist girth equal or larger than hip girth

  • Frequent urination

  • Increased thirst and appetite

  • Difficulty losing weight

Fixing your Gut

There is a lot of information that can go into why you want to fix the gut, and how to fix the gut. I will do my best to be brief and still informative for you.

Stress and high stress hormones can affect the gut in many ways.

It can:

  • Create stomach acidity imbalances

  • Erode the lining of the intestines

  • Alter the immune system allowing infections to develop

  • Affect the ileocecal valve- valve connecting the small intestine to the large intestine

  • Cause constipation leading to overgrowth

  • Impair digestion and assimilation of nutrients

And the problems of the gut will kindly in return create a powerful stress response keeping you in a feedback loop.

**This is a step of utmost importance**

When healing the gut, you want to be sure your stomach acid levels are correct.

Most people have low acid, even though they think, or were told they are too high.

Low acid comes from being stressed, age, or nutritional imbalances.

If your stomach acid levels are not high enough, you can get microbes from your food (or mouth) overgrowing in your intestines.

You will have microbes fermenting your protein, which can be devasting to your gut lining, your health, and potentially cancer causing.

You will be deficient in many vitamins like B vitamins, calcium, magnesium, iron, and protein.

Low acid, aka hypochlorhydria:

  • Excessive belching, burping, or bloating

  • Gas immediately after eating a meal

  • Bad breath

  • Constipation

  • Sense of fullness after eating

  • Difficulty digesting fruits, vegetables, proteins

  • Vitamin and mineral imbalances

Stomach acid levels should be treated with the utmost importance because it’s the initial event required to simulate the release of bile from your gallbladder, and enzyme release from your pancreas.

The symptoms like bloating, fullness after eating, bad breath, stinky gas and stools are from protein fermentation.

Even situations of actual hyperacidity are usually first caused by low acid levels.

Proteins that ferment can easily irritate, and damage the stomach lining, and create an environment where acid because painful and inflammatory.

Most acid reflux and heartburn are related to hiatal hernias or gas from overgrowths or fermentation pushing the stomach contents into your esophagus.

This is not good; you do not want damage to your esophagus or inhale stomach acid.

Histamine can elevate stomach acid, and so can a stress system that is now exhausted and the stress hormones are no longer suppressing it.

If you’re having stomach acid issues just contact me and we’ll figure it out, but it’s a very important step.

When carbohydrates or starches are not digested properly, they can give very similar symptoms to low acid, but when eating carbs or starches, not proteins.

This can come from low acid, or even the pancreas being over worked from too high sugar levels, or the pancreas releasing too much enzyme to try and counter intestinal inflammation.

Some enzymes have anti-inflammatory qualities, and the body will use them accordingly.

The gallbladder and bile again can present very similar to low protein digestion or carbohydrates and starches:

Feeling heavy after a meal, belching, gas, constipation, are signs your bile isn’t breaking down fats.

Supplements like betaine hydrochloride with meals does a great job to add acidity to the stomach.

There are digestive enzymes you could take with food for carbohydrate digestion.

Also, there are bile and fat digestive enzymes to aid with digestion of fats.

It’s important to know what you need to be supporting, I added those so you would know there are options.

Once you have the upper digestion figured out, you’ll have to look at the rest of the gut.

Once again huge topic, but I’ll do my best to summarize.

Any microbe can overgrow in the gut, even good ones.

Bifidobacterium seems like one of the few that research and experience has shown doesn’t seem to overgrow in a negative manner.

But even good microbes like lactobacillus can overgrow.

We don’t want any overgrowth in the small intestine.

The small intestine is where we absorb our nutrients, and we want them, not the microbes eating them.

Gut microbes do best for when the vast majority is in the large intestine near the colon.

They eat parts of our food that are indigestible to humans, like soluble fiber and resistant starches.

When microbes eat soluble fiber and resistant starches, they produce short chain fatty acids (SCFAA’s), and these:

  • Heal the lining of the gut

  • Supply energy to your cells

  • Kill off bad microbes

  • Kill intestinal yeast and fungus

  • Regulate blood sugar

  • Reverse metabolic disorder, insulin resistance, blood sugar problems

  • Microbes like Bifidobacterium releases GABA which calms your brain stress like anxiety, worry, excessive thoughts, depression, improves memory

So, by eating fruits and vegetables of many colors, green tea, taking prebiotics like resistant starch and inulin, you can grow very healthy gut microbes that perform so much good for you.

However, many of you will not be able to do that off the bat.

Most people from living an unhealthy diet, too much processed sugars and carbs, excessive unhealthy fats, faulty digestion, and antibiotics will have an overgrowth or dysbiosis of bad bacteria.

If you have an overgrowth, you’ll have to reduce sugars, carbohydrates, and fiber to a minimum.

The diet FODMAP usually does a good job not feeding and letting the overgrowth die off.

In many cases this will help significantly, but you’ll need to take something like allicin from garlic, oregano oil, berberine, neem, goldenseal, or something like that to aid in killing off bacteria, yeast, and parasites as well as dissolving the protective biofilms they produce.

In the small intestine this is called a Small Intestine Bacterial Overgrowth (SIBO), or you can have a dysbiosis in your large intestine, your skin, your lungs, even the latest research shows your eyes and joints have them too.

Overgrowths of bacteria can:

  • Eat your nutrients and affect nutrient absorption

  • Produce loads of gas that cause pain, bloating

  • Skin issues like acne, eczema

  • Toxic gasses that are inflammatory to us and make us very toxic

  • Are related to insulin resistance, stress disorders, chronic pain, liver toxicity

On the topic of estrogen, certain bad microbes use an enzyme in the gut called the Beta Glucuronidase.

The beta glucuronidase will take estrogens that have been metabolized by the liver and reactivate them and put them back into circulation.

This creates an increase in overall estrogen load and estrogen dominance.

In addition, overgrown microbes in dysbiosis will wear down the lining of the gut, create what’s known as a leaky gut, and pour inflammation into the body.

Certain gut bacteria known as “gram negative” bacteria have a toxin in their cell membrane known as lipopolysaccharide (LPS).

LPS is one of the most inflammatory and toxic substances to us, is related to several inflammatory and disease states and places a heavy load on the liver.

When the gut lining becomes worn down, the tight cellular junctions that normally only allow digested tiny molecules in, now can allow much more in.

Fully intact gut bacteria, food particles, inflammatory proteins, and anything else in your gut will have access to your blood stream.

This is a worst-case scenario for your health.

Take L-glutamine and zinc to help heal the lining of your gut.

Your immune system will see large food particles in the blood and instantly develop reactions to them creating food sensitivities altering your immune response.

LPS and other inflammatory microbes and proteins are linked to so many disease and inflammation states – too much to write about in the context of this article.

You want to look at your gut to be sure:

  • Stomach acid, digestive enzymes are being released properly

  • Small intestine has no overgrowths and inflammation

  • Food is moving through you with no constipation

  • There’s no leaky gut present, flooding your body with inflammation and toxins.

Liver Detoxification

We’ve established how:

  • Being stressed pours cortisol into the body altering blood sugar, insulin levels, and increases estrogen.

  • An unhealthy gut sends inflammatory LPS, food antigens, and other inflammatory proteins and gasses into the liver.

  • The beta glucuronidase enzyme reactivates already detoxified estrogen back into the blood circulation needing to be detoxified again.

And there’s a world environment around us filled with estrogen mimics like plastics, BPA, and environmental pollutants.

The liver needs to break these down, or else there will be estrogens traveling the body, firing on the receptor sites in your joints (or elsewhere like the breast tissue), enabling ACL, and other joints to be loose and damaged.

There are two phases of liver detoxification, Phase 1 and Phase 2.

Many times, people will have symptoms and the labs don’t match up; this is usually from an overloaded detoxification.

The ultimate goal of liver detoxification is to transform compounds such as hormones, neurotransmitters, bacteria, intestinal bacteria, endotoxins like LPS, antigens/antibodies, drugs, pesticides, and environmental toxins into a water-soluble compound that can be eliminated via urine, sweat, or feces.

Estrogen hormones are initially metabolized in phase 1 and can be broken into one of three metabolites:

2-OH estrogen-good

4-OH estrogen-bad

16-OH estrogen-bad

Obviously, you want estrogen to break down into the good 2-OH!

A component of cruciferous vegetables Indole-3-Carbinol helps the body to make that happen.

Cabbage, cauliflower, broccoli, Brussel sprouts, kale, and collard greens are a dietary source.

Rosemary also has been shown to direct the metabolism of estrogen toward the 2-OH pathway.

Vitamin B6 in its methylated form P-5-P has been shown to reduce tissue hypersensitivity to estrogen.

A B6 deficiency will often exhibit exaggerated symptoms of estrogen dominance with even slight elevations.

P-5-P should be considered in almost any time estrogen levels need to be optimized.

B12 and folic acid in the methylated form methyl cobalamin and 5-MTHF aid in the metabolism and elimination of estrogen as well.

Magnesium is an essential mineral in the detoxification of estrogen, helping to make it more water soluble.

The sulfation and glucuronidation pathway in Phase 2 detoxification should also be supported as they are main pathways of estrogen detoxification.

Sulfation can be rapidly depleted by the influx of cortisol and other hormones, as well NSAIDS and steroidal medications.

Increasing sulfur containing amino acids not only helps the breakdown and detoxification but it will also help your joints.

The body will borrow sulfates from the joints, which are needed for joint repair, to aid in detoxification.

This is also the case with the amino acid glycine.

Glutathione, our most powerful antioxidant, also requires sulfates to function.

Fatty Acid Metabolism

The essential fatty acids (EFA) like DHA have been linked with altered cell signaling when they are low in the body.

This can make several problems appear, especially if you have normal labs, but show all the signs of altered hormones.

EFA’s are responsible for making prostaglandins which are important in cellular communication.

Abnormal EFA levels can cause a hormone to give an exaggerated response when they attach to their sites.

This is important because most Americans have inadequate EFA levels do to diet, vitamin and mineral deficiency, insulin resistance, thyroid disorders, vegetable oils, and consuming too many trans fats.

Trans fats not only contain zero essential fatty acids, trans fats also impair the ability for healthy fats to work properly.

The ratio of omega 6 and omega 3 fats for optimal function should be 3:1 to 5:1.

In the US it’s not uncommon to find 25:1 due to large consumption of vegetable oils in our diet.

Proper omega 6 and omega 3 essential fatty acids should be considered for anyone who suspects a hormonal imbalance.

In conclusion:

If you have loose joints, especially if you’re a female, or you get joint injury look to the 4 areas we discussed:

  • Adrenal and blood sugar

  • Digestion and gut health

  • Liver detoxification

  • Essential fatty acids

Most people will find by improving these areas will not only help your hormones, but many positive health benefits as well.

Some of these topics I could have written much more on, but without turning this into a textbook, it should help point you in the right direction.

As always if you have questions, or think this is you, a family member, or friend you know who to contact!

Dr. Justin Fortier, B.S., D.C.

This article is my opinion and does not reflect the opinion of others. Also, all information on is for educational purposes and not intended to diagnose or treat any individual. If you'd like personalized treatment advice, please schedule a time with me.

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