She was struck by the finding that girls were often intimidated to use the school’s weight room because of the unwelcoming environment and the attitude of many of the boys.

“Sports injury prevention is all about getting people stronger,” she says. “But if this is what girls are experiencing in the weight room, why would they want to submit themselves to that?”

Parsons, an associate professor of physical therapy, joined the College of Rehabilitation Sciences in 2014. Recently, her research focus has been on the effect of gendered environments (settings such as gyms that reflect stereotypical gender roles and gender bias) on injury risk among female athletes.

In 2021, she co-authored a paper with two British professors, challenging the traditional view that girls are more prone than boys to anterior cruciate ligament (ACL) knee injury solely because of their hormones and biology.

The paper, published in the British Journal of Sports Medicine, argued that gendered expectations of physical abilities; inequitable access to funding, training, and facilities such as weight rooms for women’s sport; and gender-based differences in post-injury rehabilitation all play roles in the higher rate of ACL injury for girls and women.  

The paper attracted considerable international attention and won two prizes from the Canadian Institutes of Health Research.

Parsons and her team recently developed an online exhibit with the UK Sports Institute on the experiences of female Olympic athletes. Drawing upon interviews with 20 athletes from 11 sports, More Than Medals tells stories about women’s challenges in gendered environments. Its themes include stereotypes, physiology and unequal power dynamics.

“The hope is that coaches, parents, and others involved in sport can hear these stories and reflect on their own environments.”

Parsons, who grew up in Birtle, Man., played volleyball and

other sports in high school. She started her career in athletic therapy, working with sports teams. After moving into physiotherapy, she became interested in research as a way to make change.

“Advocacy is the common thread that goes through my work,” says the professor, who has been published in journals such as the International Journal of Sports Physical Therapy and the Clinical Journal of Sport Medicine.

One area she’s passionate about is the need for physio services through the public health-care system for those who can’t afford private care.

She has a forthcoming paper in Physiotherapy Canada on how outpatient physiotherapy services in Manitoba were affected by the closure of most of Winnipeg’s hospital-based clinics in 2017.

Her team found that initial physiotherapy assessments conducted per month in Winnipeg dropped by 85 per cent, meaning many in need are likely not receiving care.

“A substantial proportion of this population may not be able to afford $80 to $120 for one private physiotherapy assessment or treatment, never mind transportation and other barriers.”

The next step is an advocacy plan to try to get some of the publicly funded services reinstated.

“People are falling through the cracks,” Parsons says. “We need to let the powers that be know that this needs to be addressed.”

The EDGE Lab – Environments Designed for Gender Equity in Sport & Physical Activity Lab – will explore gendered environments in elite sport, inequities in everyday exercise environments, and inclusive youth sport and physical activity.

Dr. Joanne Parsons, associate professor in the College of Rehabilitation Sciences at the Rady Faculty of Health Sciences and Dr. Stephanie Coen, associate professor in the School of Geography at the University of Nottingham, have partnered in the project with a goal to reduce disparities in health and well-being.

EDGE Lab reimagines equitable and inclusive sport and physical activity using what is called a ‘gendered environmental approach’—a concept coined by Parsons and Coen in their landmark paper in the British Journal of Sports Medicine in 2021.

This approach takes into account how gendered social factors contribute to inequities in sports injury risk, increasing potential for improving girls’ and women’s sport and physical activity participation, enhancing performance, and reducing injuries.

“EDGE Lab will serve as a virtual locale to support our focus on gendered environments and how they affect athletes’ health and performance. We anticipate the virtual lab will facilitate the growth of our research program through increased visibility and expanded opportunities for developing partnerships,” said Parsons.

One example is a project called More Than Medals, developed in collaboration with the UK Sports Institute, which uses an online multimedia exhibition combining poetry, audio narration and original artwork to share stories of gendered environmental challenges from retired elite female athletes.

“With our international network of community, sport and academic collaborators, EDGE Lab is a hub for developing new and impactful ways to positively improve the landscape of girls’ and women’s sport and physical activity,” said Coen.

Funding for the lab was made possible by two Inclusive Research Excellence Prizes the team was awarded last year from the Canadian Institutes of Health Research’s Institute of Musculoskeletal Health and Arthritis.

“The global attention Dr. Parsons and Dr. Coen have garnered for their groundbreaking work is much deserved. The opening of their new virtual lab is a crucial step in addressing the deeply entrenched, pervasive and completely unacceptable gender inequity in sport and injury risk, and opens the way to a more enlightened future for everyone engaging in physical activity,” said Dr. Mark Garrett, physical therapy department head at UM.

“It’s very exciting to see the EDGE Lab develop as a home for Dr. Coen and Dr. Parsons’ important work. The real world impact their work is already having, from women’s professional football to Olympic athletes, can only be furthered by this new virtual home,” added professor Matthew Jones, head of the School of Geography at the University of Nottingham.

For more information on EDGE Lab, visit edge-lab.org

Girls and women are approximately three to six times more likely to suffer an anterior cruciate ligament (ACL) injury, which can be career-ending for athletes. The researchers, led by Dr. Joanne Parsons, associate professor of physical therapy at the College of Rehabilitation Sciences argued that gendered environments may play a significant role in this disparity in ACL injury rates between women and men.

Parsons co-authored the paper with Dr. Stephanie Coen from the University of Nottingham, United Kingdom and Dr. Sheree Bekker from the University of Bath, United Kingdom. The researchers applied for CIHR-IMHA Inclusive Research Excellence Prizes in two out of five categories – “research impact” and “team science” – and won both, valued at $25,000 each.

The team said that embedding gender in the study of ACL injury will heighten the awareness of possible influences outside of traditional biological elements.

Joanne Parsons

“To recognize that this is an important area of research is huge because, up until this point, sports injuries and ACL injuries in particular have been approached very much from a biological or physiological perspective,” Parsons said. “But now our ideas are being talked about everywhere. We don’t even get referenced as much as we used to because it’s now being taken as fact, which is a great thing.”

Their research has since been endorsed by women’s soccer organizations in the United Kingdom, Australia and European Union, and has been featured in international and media presentations, including the Washington Post, Yahoo Sports and Women’s Health Magazine.

“Over the last two years, and especially now with the Women’s World Cup going on in New Zealand and Australia, there has been a lot of attention around our work,” said Parsons. “There are huge numbers of professional women’s soccer players who have suffered ACL injuries, and some of the biggest stars have been sidelined and are unable to play in the tournament, including Canadian athlete Janine Beckie and UK stars Beth Mead and Leah Williamson.”

Parsons said the funding will help the team conduct additional research and collect evidence to further support their model.

“Receiving the CIHR-IMHA Inclusive Research Excellence Prizes is an honour, but also a testament to the innovation and impact of our approach. The conversation around sports injuries has completely changed since the publication of our paper – the focus is now on gender inequity and its far-reaching effects,” she said.

“This funding will allow us to keep advocating for a gendered environmental approach with sport organizations around the globe and here at home, with the ultimate goal of making sport a welcoming, healthy, inclusive space for all.”

Current approaches to a common and debilitating knee injury that occurs more frequently in women than men have focused for too long on biology at the expense of understanding social factors, say the paper’s authors, who include Dr. Joanne Parsons, assistant professor, College of Rehabilitation Sciences, Rady Faculty of Health Sciences.

Dr. Joanne Parsons

“I hope that this study is the start of a real, lasting conversation about how bigger, societal forces play a significant role in the sport opportunities and experiences of girls and women, and can ultimately set them up for ACL – or other – injury,” Parsons said. “We don’t have to look farther than the recent NCAA weight-room debacle to see that equitable treatment, even at the highest levels of sport, is far from reality. This is not a women’s issue – everyone involved in sport should reflect on whether their decisions and behaviours, whether purposeful or not, disadvantage girls and women.”

Girls and women are said to be between three to six times more likely to suffer an anterior cruciate ligament (ACL) injury, where one of the key ligaments that helps to stabilise the knee joint is damaged. The devastating injury, which in extreme cases can be career ending for professional athletes, commonly occurs during sports that involve sudden changes in direction like basketball, soccer and tennis.  

The difference in injury rates for men and women has not changed for two decades, but, say the authors, this might be partly due to how injury prevention and management have been approached to date. In the paper titled Anterior cruciate ligament injury: towards a gendered environmental approach, they argue that much of the focus still centres on biological and hormonal factors, with little attention paid to how sex-based factors are affected by gender and might influence each other. 

“This study is important because the higher rate at which girls and women experience ACL injuries compared to men has not changed despite over 20 years of research,” Parsons said. “We think this is largely because, up to this point, the approach to ACL injury prevention and management has taken a strictly biological approach.”

The authors – which also includes Dr. Sheree Bekker, assistant professor, Department for Health, University of Bath, United Kingdom, and Dr. Stephanie Coen, assistant professor, University of Nottingham, United Kingdom – suggest that gendered experiences matter in shaping girls’ and women’s participation in sport as well as disparities in injury outcomes. They demonstrate how this could play out across the life course with gendered expectations of physical abilities (e.g. ‘throw like a girl’), to inequitable access to funding, training, and facilities for women’s sport (e.g. disparities in access to weight training). 

Finally, they suggest there may be a difference between post-injury rehabilitation for men and women recovering from an ACL injury. They say that these social and environmental factors play a much bigger role in how sports injuries occur than once thought, and urge that much more attention be given to these topics.  

“We need to stop reducing girls and women who experience an ACL injury down to their hormones and biology,” Parsons said. “By doing that, we are suggesting that the bodies of girls and women are at risk of injury just because they are female. Besides propagating sexism, we’re missing the opportunity to look at the bigger picture, and realize that societal influences have a significant impact on sports injury risk. Until we acknowledge that, we are not going to have any significant ability to decrease injury risk in girls and women.”

The postdoctoral fellow in physiology is one of 10 faculty members, students or trainees in the Rady Faculty of Health Sciences who have received 2020 leadership development awards through The Winnipeg Foundation’s Martha Donovan Fund.

Rabinovich-Nikitin’s award will fund her to take the online Laboratory Leadership Course offered by the European Molecular Biology Organization.

“It’s a career-development program to help advance a postdoctoral fellow’s next career step in becoming an independent investigator with their own laboratory,” said Rabinovich-Nikitin, whose long-term goal is to lead cardiovascular research on women’s heart health.

“I anticipate learning techniques and tools for leading teams, tailored specifically to the lab and research setting.”

The $250,000 Winnipeg Foundation Martha Donovan Fund was established in 2019 to provide leadership development opportunities for women in the Rady Faculty of Health Sciences. Up to $50,000 will be awarded annually for five years.

“In this second year of the awards, we received 16 exceptional applications from women at all stages of their academic careers,” said Dr. Sara Israels, vice-dean, academic affairs of the Rady Faculty.

“I was struck by the diversity of academic interests of our awardees, extending from biomedical science to health professions education. We look to these women as future leaders across the full scope of activity in the Rady Faculty of Health Sciences.”

In light of the pandemic, many of the award recipients will enrol in online leadership programs.

DR. JOANNE PARSONS

Dr. Joanne Parsons, assistant professor of physical therapy in the College of Rehabilitation Sciences, will use her award for online training through Academic Impressions, which offers programs for faculty and staff in higher education.

“I anticipate that the training will improve my understanding of leadership styles and principles, with the intention of ensuring that I’m a collegial, effective and efficient leader,” Parsons said. “It will elevate my ability to contribute to service within the university and the physiotherapy profession.”

Dr. Sonia Udod, assistant professor of nursing, will enrol in the Certified Health Executive Program and LEADS Inspired Leadership Program offered by the Canadian College of Health Leaders.

DR. SONIA UDOD

Udod foresees that by expanding her own leadership capabilities, she can disseminate more leadership knowledge to graduate students and build research capacity in the area of leadership.

“I want to learn more about creating a culture of innovation in the master of nursing leadership stream, and about leading organizational and system change to improve patient care,” she said.

Any woman who is a full- or part-time academic faculty member with a primary appointment in a college of the Rady Faculty, or a student, postdoctoral trainee or resident in the Rady Faculty, can apply to the fund to support her pursuit of academic leadership training.

2020 RECIPIENTS:

FACULTY MEMBERS

• Ming-Ka Chan, Pediatrics and Child Health, Max Rady College of Medicine
• Jessica Hartley, Biochemistry and Medical Genetics, Max Rady College of Medicine
• Joanne Parsons, Physical Therapy, College of Rehabilitation Sciences
• Chau Pham, Emergency Medicine, Max Rady College of Medicine
• Christy Pylypjuk, Obstetrics, Gynecology and Reproductive Sciences, Max Rady College of Medicine
• Sonia Udod, College of Nursing

STUDENTS/TRAINEES

• Jocelyn Elias, College of Nursing
• Kathleen Glover, Medical Microbiology and Infectious Diseases, Max Rady College of Medicine
• Inna Rabinovich-Nikitin, Physiology and Pathophysiology, Max Rady College of Medicine
• Andrea Toews, College of Nursing

Originally from Birtle, Man., a small town near the Saskatchewan border, Parsons became interested in how the body functions as she played volleyball and other sports in high school. While working toward a science degree in Brandon, she started volunteering in the university’s athletic therapy clinic, which led her to pursue a physical therapy degree.

After earning U of M degrees in physiotherapy, kinesiology and applied health sciences, Parsons joined the College of Rehabilitation Sciences in 2014 as an assistant professor of physical therapy. She also leads the U of M’s Sports Injury Prevention Lab.

Parsons’ research is mostly focused on the use of strength and resistance training to prevent injury in young athletes. But she has recently been drawn to the use of this training for youth who aren’t athletes.

“Kids need to develop strength and power, not just to be good athletes who perform well, but to prevent injury and maintain health and function,” she says. “We know that as adults we are more inactive, so if we don’t build up a good reserve of muscle early on, we’re going to end up in trouble later in life.”

Parsons’ interest in strength training for youth was facilitated by a relationship she built with Grant Park High School, which has a forward-thinking vision about training and exercise. There she worked with Kayla Duna, a kinesiologist who provided physical activity and resistance training programs to the entire school community.

“She told me about the school’s philosophy and ideas around having a school kinesiologist in the weight room, and what kind of potential that can have for students,” Parsons says. “It’s not a role a lot of schools have.”

Parsons notes there is a myth born out of 1980s research that strength-building activities could lead to injury or stunted growth in youth. But that kind of thinking is out-of-date, she says, noting that recent studies show a link between low baseline strength in adolescence and an increased risk of dying early.

Strength and conditioning activities are too often thought of as a testosterone-fueled activity, she says. It’s an attitude she’d like to see change to something more inclusive.

“It’s really about making it accessible to everybody – to girls, to people who are not hyper-masculine. It’s a key ingredient to being healthy and functional at all ages,” she says.

One of Parsons’ studies was a randomized controlled trial that compared two groups of female athletes, ages 10 to 14. She found that strength training of the legs did not improve the athletes’ safe jump landing abilities any more than strength training of the arms. “This suggests trunk stability and strength may be more of factor, which has implications for the design of conditioning programs, if injury prevention is a goal,” she says.

Parsons is currently studying leg asymmetry in university athletes, with funding from the National Strength and Conditioning Association Foundation. The participants in the current pilot are U of M Bison track athletes. Bison athletes from football, soccer, volleyball, basketball and hockey will follow in the full study.

Using a device called a linear position transducer, she and her research assistant assess the athletes’ strength and power characteristics as they perform jumps under loaded and unloaded conditions, with the right and left legs alternately tested.

“These are athletes who are healthy and competing at their best, but we know that strength and power asymmetries can still be present in these athletes, which can increase risk of injury and negatively affect performance,” she says. “We’re looking to see if asymmetry is present, to what degree, and what some of the contributing factors might be.”