GIRLS, DISRUPTED
Conditioning to avoid an ACL injury.
Since the introduction of Title IX, female participation in athletics has been steadily increasing. While this is great news for the world of sports, it's not so great for the participants' knees. Female athletes are between six and nine times more likely to have a noncontact anterior cruciate ligament (ACL) tear than male athletes of the same age. This injury commonly results in knee surgery and a subsequent 6-9 month rehabilitation period.
Why are female athletes more prone to injure the ACL? Over the last decade, that question has been everywhere, including the New York Times [1].
Some hypotheses:
• Female knee bones are shaped differently.
• Hormonal differences.
• Strength differences.
• Females have a wider pelvis.
To date, the most commonly held belief is that most females use their hamstrings differently than males. When jumping, landing and cutting (sharply changing direction), girls tend to have less use of their hip muscles, causing increased use of the knee joints. Females also tend to land and cut in a more upright position, which can place the knee in a vulnerable position.
Decreased use of the hips causes the upper leg bone, the femur, to rotate inward, while cutting and landing involve putting the foot on the ground. If the lower leg stays still while the upper leg rotates inward, twisting occurs at the knee, placing the ACL and cartilage at greater risk for injury. We have observed that the knees of active girls and women tend to twist inward upon landing and during cutting to the opposite side of the planted leg (for example, the right knee twists inward when planting the right foot and cutting to the left).
No other examined variables have shown to be significant contributors. The good news is, girls can be trained to improve strength and control the hamstrings and hip muscles to limit the knee twisting that makes them susceptible to injury.
For several years physical therapists, athletic trainers and strength and conditioning specialists have been helping female athletes overcome their strength and control deficits with some specific exercises and training. Some specific exercises for ACL injury prevention can be found at: http://aclprevent.com/pepprogram.htm.
The principles of these exercises are to teach control of the knees and prevent twisting. They include strengthening exercises like lunges and squats with the knees in good alignment, sprinting and cutting drills, and plyometrics, which include controlled jumping and landing. The most important aspect of this training is how it's done, not how much can be done. Understand the significance of each movement and have someone analyze your progress and weak points.
Pay particular attention to keeping the shoulders over the knees, and knees over the toes. When observed from the side, the shoulders should always be over the toes and not behind them. The back should stay flat and still, without rounding forward. The knees should not extend past the ends of the toes or move inward. Likewise, the feet should not turn out.
This type of training should be done 2-3 times per week, and only take about 20 minutes. In fact, the drills most appropriate for ACL injury prevention can be incorporated into warm-ups for nearly every sport, especially those that pose the most risk like basketball, soccer, volleyball and field hockey.
The costs of injury -- rigorous rehabilitation, decreased opportunity for recruitment, a year out of competition -- make prevention a must for any lady looking to take the field.
Other Trusted Sources:
Arthroscopy.com
Atlantic Coast Conference
