Preventing ACL Injuries in Female AthletesBy Robert Silverman, DC, MS, CCN, CSCS For female athletes, the key to optimal athletic health lies in preventing ACL injuries. In medical terms, the anterior cruciate ligament (ACL) is the primary restraint to the anterior displacement of the tibia on the femur at all angles of the knee flexor. This means when the ACL is injured, the shinbone can slide forward on the thighbone, causing the knee to "give way." The ACL is one of a pair of ligaments in the center of the knee joint that forms a cross or "cruciate." The anterior and posterior cruciate ligaments (PCL) both function to stabilize the knee from front to back. Let's review ACL injuries, why female athletes are more susceptible and how to help prevent ACL injuries. What Causes an ACL Injury? An ACL injury is usually caused by sudden, abrupt change in force to the knee. This can occur during an unexpected cutting move made during a sporting activity, or while landing following a jump in an athletic activity. Most ACL injuries occur in a non-contact setting and do not involve a collision with another player.1 What Does an ACL Injury Mean to an Athlete? When an athlete injures the ACL, it may mean losing an entire season of play. If the injury is severe enough, it could also lead to surgery, resulting in long-term rehabilitation, a possible loss of scholarship, and emotional and mental strain. ACL injuries also could pose a lifelong potential for arthritis in the injured joint.2 Why Do They Occur More Frequently in Female Athletes? ACL injuries typically occur at a four- to six-times higher rate in females because they are more quadriceps dominant. Another factor may be decreased neuromuscular performance and increased ligamentous laxity during menstrual cycles from the fluctuation of female hormones.3-4 A study in The New England Journal of Medicine found differences in leg ailment of males vs. females, noting females have an increased rate of knock-knee (valgus deformity5). The intercondylar notch width is smaller in females, creating less space for the movement of the ACL and resulting in increased risk of injury. Women also typically have a wider pelvis, resulting in thigh bones angling downward more sharply (Q-angle).6 This leads to increased valgus stress and potential injury. ACL Injuries and Hormones Fibroblasts lead to collagen synthesis, which enables ligaments and tendons to heal. Estrogen (especially estrodial) inhibits fibroblastic proliferation. Collagen synthesis is significantly reduced with increased local estrodial concentration. Many high-school and college female athletes take birth-control pills, which are all estrogen-based and contribute to the potential for injury. The National High School Sports-Related Injury Surveillance Study, currently in its fifth year of online data collection, has found that one ACL tear occurs every 15,000 times an athlete practices or competes. On average, athletes are eight times more likely to suffer ACL injuries in competition than practice. Data was collected from a national sample of nine girls' high-school sports, including soccer, basketball, lacrosse, track, volleyball and softball.2 Most Common Sports for ACL Injury in Practice / Competition
ACL Injury Rate Per Sport A study in the American Journal of Sports Medicine (2009)8 concluded the following with regard to ACL injury prevalence by sport:
Of clinical relevance is the conclusion that the prevention program lowered the athletes' risk of injury. A later study in the American Journal of Sports Medicine (2013)9 concluded that neuromuscular and educational interventions appear to reduce the incidence rate of ACL injuries by approximately 50 percent. How to Prevent ACL Injuries The key elements of a clinical program to prevent ACL injury include the following (see examples of each element below):
1. Dynamic Warm-Up
2. Proper Stretching (Click here to learn how to stretch properly.)
3. Strengthening (See descriptions / images of how to perform these exercises below.)
Glute-Ham Raise
Single-Leg, Stiff-Legged Deadlift
Assisted Russian Hamstring Curl
Things to look for: Brace stomach while moving forward and back. Make sure not to arch back when returning to starting position. 4. Plyometrics
5. Agility Drills
The athlete's fitness and desired level of performance will influence which of the above exercises are performed. Talk to your doctor before initiating any of these exercises to ensure proper / safe performance, particularly if you are have suffered an ACL injury of any type. References
Robert Silverman, DC, MS, CCN, CSCS, graduated from the University of Bridgeport, College of Chiropractic. He also has a master's of science in human nutrition. Dr. Silverman is a nationally known speaker and has published numerous articles, in addition to giving seminars on injury-related prevention, treatments and nutrition for various organizations and Fortune 500 corporations. He also serves as a chiropractor and sports injury consultant for basketball players, professional wrestling organizations, local, collegiate, and professional sports teams, professional triathletes, body-builders, martial artists and cyclists. To learn more, visit his website: www.drrobersilverman.com. |