Female Athletes and ACL Injuries

Last week, I wrote about the experience that I had with working with a local high school girls basketball team and the conversation that took place with the head junior varsity coach and myself. I briefly explained the goals that the coach was seeking with working with me; however, I failed to talk about one other issue or topic that came up in the discussion.

Anterior cruciate ligament commonly known as the ACL.

Eight years ago 2.5 million high school girls and 145,000 college girls played some type of competitive sport. No longer are the days that girls are just participating in non-contact sports such as golf or tennis. They are now participating in more violent contact sports like football, basketball, boxing, roller demolition derby, field hockey, and lacrosse to name a few. Each year, females participation in sport has rising substantially in every major market or competitive arena from club sports all the way to collegiate competition. Even though, more females are signing up and participating in sports, more are watching on the sideline rather than playing on the field due to sustaining more injuries like ACL injuries.

ACL injuries are the most common injuries that most females will be faced with while participating in athletics. Each year, 1 out of 100 high school female athletes and 1 out of 10 college female athletes will go down with an ACL injury. The National Collegiate Athletic Association (more commonly known as the NCAA) reports that in a given year, approximately 2200 collegiate females are expected to go down with an ACL injury. These stats suggest that females are 4 to 8 times more likely to sustain this type of injury than males. Also research data shows that on average, an ACL reconstruction surgery costs a family $25,000 a year. In addition, the data from high school and college suggest that they spend over $100 million annually on reconstruction surgeries for females.


The question is why are females more susceptible to ACL injuries than males? And are there exercises that can be done to prevent them from being injured?

Many experts (myself included) think the reason why females are so susceptible is because of the anatomical differences that females have in comparison to males. In addition other common factors are muscle imbalances and variations in movement patterns.


Anatomical Differences

In the knee joint, an intercondylar notch lies between the femoral condyles. The ACL moves within this notch, connecting the femur (more commonly known has the thigh bone) and the tibia(more commonly known as the shin), providing stability to the knee. The ACL prevents the tibia from sliding forward and rotating inward. The majority of women have a small notch, therefore restricting ACL movement. When movement is restricted, the femoral condyles can easily pinch the ACL within the joint, especially during twisting or hyperextended movements. This ultimately can result in a tear or rupture.

The other difference lies in what is called the Q angle or the angle from the hips, femur, and tibia. The femur is affected because it meets the tibia at this angle and if a person has wider hips (which most females do in comparison to their male counterparts) it can have an affect on their ACL. The wider the hips, the larger the Q angle. At this greater angle, forces are concentrated on the ligament for stability each time the knee rotates. This increases the rotational forces on the ACL, raising the probability of a tear. A large Q angle also results in a more pronated foot (a foot that is turned outward), further stressing the knee.

Muscle Imbalance

The balance and relationship between how the quadriceps and hamstrings work together plays a crucial part to knee stability. Research shows that female athletes tend to have quadriceps to hamstrings muscle imbalances -- with the quadriceps as the dominating knee stability muscle. On the other hand, men have a better balance between quadriceps and hamstrings. They engage the hamstrings first when performing a movement, which actually decreases stress on the ACL. Therefore, the stability of the knee is more quadriceps-dominant (an ACL antagonist) in females and more hamstrings-dominant (an ACL agonist) in men.

So let's relate this concept to female involvement in sports. As stated earlier, females are now engaging in similar activities like their male counterparts which place the same demands on their bodies and knee structures with similar intensity (equal twisting and loading forces on the knee joint). Twisting, cutting and landing movements all stress the ACL to provide stability. As the quadriceps contract, additional stress is put on the ACL, increasing the risk of injury. So, if females or more quadriceps dominant, they are more susceptible in putting their ACL in danger of tearing because it is stressed more during the activity.

Variations in Movement Patterns
Contrary to what a lot of you reading this article may think, the majority of ACL injuries come from non-contact incidents on the field or court. These injuries are divided equally among the three main non-contact movements -- planting, cutting and straight-knee landings with hyper-extended knees. For unknown reasons, women tend to perform all these movements with straight legs. Straight-legged activities require the knees to absorb forces equal to four times an individual's body weight as well as encourage hyperextension of the knee joint. Hyperextending the knee is one of the major contributors to non-contact ACL injuries. Also, videos have show that women tend to perform planting, cutting and landing movements by turning the knees inward, further exaggerating the Q angle stress on the ACL and therefore increasing risk of an ACL rupture.

How can the athletic community assist females to decrease the risk of an ACL tear?

Obviously, anatomical characteristics that increase the risk of ACL rupture cannot be changed. As a result, the focus for prevention has been on teaching athletes the correct motor patterns to prevent excessive stress on the ACL through jump training (landing and propelling). Finally, because quadriceps-hamstring strength imbalance appears so important, athletes must also work to maintain flexibility of both of these muscle groups. As muscles are strengthened, flexibility can be lost unless athletes conscientiously cool down and stretch at the end of the workout..

The bottom line is:
• ACL injuries are a big problem
• ACL injuries are a bigger problem for females
• ACL injuries are preventable

Every serious female player (of ANY age) should:
Practice proprioceptive training (a good idea for competitive male soccer players as well)

Strengthen hamstrings by:
• Jump training and/or leg curls
• Avoid turning and landing with straight legs
• Cool down and stretch after exercise
These measures can help prevent serious injury and will almost certainly improve performance to boot. Sorry about the pun. I just couldn’t resist.
Reference:
Stephanie Vlach, M.S., is the Manager, Fitness Education for the Life Fitness Academy.

Personal Trainer in Charlotte, NC

Female Sports Injuries: The Creature from Jekyll Island

Majority of you reading this probably are wondering what is the Creature from Jekyll Island about. Well, yesterday while preparing for my speed camp, I was reading an article entitled The Creature from Jekyll Island, and I thought that since I had posted yesterday about the benefits of sports participation for females, why not talk about some of the injuries that most females sustain from playing sports. Jekyll Island is a real island located off of New York. It was a private island, it was a resort club, it was where the families of the very, very, very wealthy went to escape the cold winter months of New York. There you will find documents where a very small group of billionaires from New York met to establish what we now call the Federal Reserve Bank. But enough about the real Jekyll Island, I thought it would be cool to name this entry The Creature from Jekyll Island. Jekyll and Hyde is a portrayal of a split personality, split in the sense that within the same person there is both an apparently good and an evil personality each being quite distinct from each other; in mainstream culture the very phrase "Jekyll and Hyde" has come to mean a person who is vastly different in moral character from one situation to the next. So I thought since yesterday I posted about the "Hyde" or benefits of participation of females in sports, it would be rightfully deserving to post about the "Jekyll" or injuries that most females are susceptible to while participating in sports.

Female high school sports has increased 900% which equates to female participation doubling every 10 years. As stated in yesterday's blog post the benefits for female participation are numerous. Some of those benefits are:

female athletes are less likely to:

• Be in abusive relationships
• Teen pregnancy
• Chemical use
• Obesity
• Cardiovascular risks
• Develop breast cancer

however, females who participate in sport are more likely to:

• Finish high school
• Enroll in college
• Have an increase in self confidence
• Have better bone density
• More positive body image
• Learn and implement goal setting skills
• and develop team work capabilities

As discussed in a previous blog post, female athletes are more likely to injure their knees than male athletes. They are 2 to 8 times more likely to sustain an ACL injury. They are 2.5 times more likely to go down with a MCL/ LCL injury. And they are twice as likely to sustain a menisci injury. The mechanisms that causes these types of knee injuries are usually non-contact in nature. They usually come from females trying to change direction or cut on a surface, decelerate, or land from a jump.

Training programs should be designed to include prehabilitation components within it.
Within the program exercises should include:
• Stretching
• Plyometric type of exercises (type of exercise training designed to produce fast, powerful movements, and improve the functions of the nervous system, generally for the purpose of improving performance in a specific sport),
• Proprioceptive balancing exercises (the term proprioception refers to a sense of joint position. Proprioceptive training is highly common in rehabilitation of injured athletes, but it can just as easily be used to prevent injury),
• Strengthening
• Flexibility
• Incorporate some hamstring activation type of exercises
• Landing drills with the emphasis on landing on the ball of the toes
• and Deceleration training

Concussions and cervical neck strains are injuries that females sustain while playing sports with soccer having the most incidents reported. Majority of the concussions appear to be from head to head collusion with other female soccer players. At the same rate, more females are suffering worst from post concussion syndrome. Post concussion syndrome or PCS, is a set of symptoms that a person may experience for weeks.
Symptoms include:
• Dizziness
• Lethargy
• Decrease concentration
• Poor sleep
• Decrease appetite
• and Memory deficits

Some girls who play sports or exercise intensely are at risk for a problem called female athlete triad (FAT). Female athlete triad is a combination of three conditions: disordered eating, amenorrhea, and osteoporosis. Amenorrrhea is the absence of menstrual period for more than 3 months. A female athlete can have one, two, or all three parts of the triad. In 2007 the American College of Sports Medicine redefined FAT as recognizing the relationships among energy availability, menstrual function and bone mineral density, which may manifest into eating disorders, amenorrhea, and osteoporosis in at-risk female athletes. Triad disorders are thought to be most common among female athletes in sports or activities which emphasize a lean physique or low body weight, such as gymnastics, swimming, or track and field.

Our last group of injuries are shoulder and foot related. Generally females have more joint laxity than males which predispose them to injuries of the shoulder joint. At the same rate, females are 9 times more likely to develop foot disorders from playing sports. The main culprit for foot injuries and disorders are improper fitting of the shoes.

Some of these disorders are:
• Metatarsalgia-general term used to refer to any painful foot condition affecting the metatarsal region of the foot. This is a common problem that can affect the joints and bones of the metatarsals.
• Bunions
Hammertoe-twisting of the toes that are caused by high heels, narrow shoes and wearing improper shoes
• Neuromas-refers to any swelling of a nerve

In conclusion the rate of female participation is outpacing males. Injuries sustained by female athletes are unique in that they are intrinsic and extrinsic in nature. The ultimate goal is to empower female athletes, promote musculoskeletal health, and facilitate a lifelong participation way after their high school and collegiate careers are over.

Reference:
www.naot.org
Personal Trainer in Charlotte, NC