Preventing ACL Injuries in Female Athletes
Sports Medicine doctors and researchers don't know why women who compete in sports like basketball and soccer are more likely than their male counterparts to suffer anterior cruciate ligament (ACL) injuries.
But they know they can do something about it.
"There is a much higher incidence (for severe ACL injuries) in women who play basketball and soccer than men," says UW Health Sports Medicine researcher Dr. Bryan Heiderscheit. "But we can reduce ACL injuries and knee pain by undergoing a structured strength and conditioning program that focuses on how to move properly."
Call it confronting the devil you know. The reason for the frequency of serious ACL injuries for women who participate in sports that require a lot of cutting and jumping continues to elude the sports medicine field. One theory points to differing hormones prominent in the preovulatory phase of the menstrual cycle. Others refer to natural differences in anatomical structure.
In the end, no definitive conclusion has been reached. But while the cause is something of a mystery, mounting research suggests the effect can be mitigated through training.
In fact, a study published in the British Journal of Sports Medicine states, "We know that there can be a quantifiable reduction in the risk of ACL for athletes, particularly women, who complete a well-designed injury prevention programme."
Want to set up an ACL-friendly training?
Creating a Training Program
So what does such a program - or programme, if you're a fan of the King's English - entail?
One component is learning how to move in a way that protects rather than exposes the knee, so when an athlete is digging in for a soccer tackle or planting on a drive to the hoop, she doesn't do so in a harmful way.
"With accelerated movement, where you have to change direction quickly, you put a lot of load on the leg," Heiderscheit.
When Sports Medicine professionals like Dr. Heiderscheit say "load," read pressure. The requirements of soccer and basketball put a lot of pressure on the knee, and it's exacerbated by an athlete's inefficient pattern of movements. Tightening up those movements can decrease the chances of ACL injuries.
The British Journal of Sports Medicine article calls it learning proper "dynamic loading of the tibiofemoral joint." Translated, it means learning how to cut properly, and UW Health Sports Medicine athletic trainers and physical therapists can show you how to do it without putting your knees at undue risk. Exercises like lunges and lunge jumping progressions, when done under the supervision of a Sports Medicine provider, can mimic the movements of cutting and teach the athlete to move correctly.
The Perils of Jumping and Landing
Jumping - so common to volleyball as well as soccer and basketball - presents another risk. Actually, the jumping isn't the risky part. It's the landing that can cause trouble. But when athletes land with their trunk properly in line with their foot, knee and hip, their injury risk decreases significantly.
UW Health Sports Performance strength and conditioning specialist Alison Regal works with athletes on refining that landing technique.
"Typically when teaching landing mechanics, there are four main things to look for," she says. "Do they land softly? Are they landing in that athletic position, with their hips back, like sitting in a chair? Is their back straight? And can they keep their knees in line with their feet?"
Single and double leg box jumps and "bounding" exercises ingrain these principles in the athletes' muscle memories. After enough work, they translate seamlessly from the practice field to competition.
The Right Type of Strength Training
The final element is strength training. Strength is obviously an important factor generally for athletes. But in reference to ACL injuries, athletes need to be strong in the right way. Regal often emphasizes the "posterior chain" - the glutes and hamstrings.
"I teach exercises that challenge the neuromuscular system to increase brain-body connection for proper movement," she says, and adds that movement versatility is an emphasis. "We work the transverse and frontal plane, as opposed to just working movements in the sagittal plane."
The saggital plane divides the body into symmetrical right and left sides, and exercises like lateral squats and lunges and rotational step-ups work "across" that plane.
Female athletes who combine those three elements - learning how to cut, learning how to land, and appropriate strength training - are taking the steps they can to reduce their risk of ACL injuries.
Date Published: 04/22/2016