ACL Injuries & Females
The risk that females have of injuring their Anterior Cruciate Ligament (ACL) will always be of concern no matter if you are a player, coach or spectator of the game. We all want to see players injury free and seek the best information for how to keep players healthy while on the pitch. Fact not fiction: females are more prone to ACL injury than their male counterpart, according to research studies in the last 10 years.
Here are prevention tips on how to reduce the risk of knee injuries for soccer players from John Gallucci Jr., MLS Medical Coordinator and medical analyst for coverage of the 2015 FIFA Women’s World Cup.
The prevalence of Anterior Cruciate Ligament tears in athletics has become an epidemic, especially when we are talking about the female athlete population. It has become common place to cringe when we, as athletes, parents, coaches or health care professionals watch a female athlete go down holding their knee.
In the United States alone, studies have shown that upwards of 80,000 high school aged, female athletes will suffer from an ACL injury, with most of those injuries occurring in soccer and basketball.
But why do females suffer close to 10 times more ACL injuries than males?
Why Are Women More Likely to Tear Their ACL?
Although science has yet to prove one theory over another, there are several factors that this prevalence can be attributed to:
Greater Q angle: Women have a greater Q angle, or angle at which the femur meets the tibia, than men due to a woman’s wider pelvis that begins to develop during puberty to accommodate for child birth.
- This greater angle leads to the femur facing inward while the tibia is trying to maintain its’ forward facing position. Genu valgum, or knock knees, that develops from the greater Q angle places a concentrated force on the ACL during each twist and turn at the knee leading to increased risk of anterior knee pain and ACL injury.
- Another factor is the biomechanical differences in running and landing techniques (i.e. knees falling in) due to muscular imbalances and increased body weight.
Puberty: Before the onset of puberty, the playing field is equal when it comes to knee injuries in boys and girls. So what happens during and after puberty that leaves girls so susceptible to injuries?
- Testosterone Production- We all know that as a young male goes through puberty their body is producing the hormone testosterone, which is not only responsible for a deeper voice and facial hair but is also responsible for their increase in height, weight and muscle mass to support their newer, bigger body.
- Females, although they produce small amounts of testosterone during puberty, it is not nearly enough to keep up with the demand from the growing muscles. This can leave females with muscular imbalances, in particular between the hamstrings and quadriceps and increased risks of knee pain and ACL injuries.
Weight Differences: During puberty, males and females will gain lean muscle mass but unfortunately females will retain and gain body fat while males will lose body fat.
- This addition of muscle mass and body fat will place additional weight on the female body’s joints, which if they are not strong enough can lead to strain and/or failure like an ACL tear.
Female Hormones and Menstruation: Studies have shown that female hormones produced during the menstrual cycle- estrogen, progesterone, relaxin- allow for greater flexibility and laxity of muscles, tendons, and ligaments.
- If the soft tissue structures surrounding the knee are lax, a tremendous amount of stress may be placed on the ACL when trying to compensate for the other structures.
- This stress can lead to failure of the ACL especially during a females “time of the month.”
As a female, how do I know I am at risk?
A simple test that can be performed by the athlete and monitored by their coach or parent is a two-legged jump test. The athlete begins by standing on a step or bottom row of a bleacher and will be instructed to jump off and land on their two feet. No instruction should be given in terms of how they should land other than on their two feet.
If the athlete is strong in their core, hips and thigh muscles they will land with their feet slightly apart and their knees will be slightly bent and facing forward.
If there is muscular weakness or imbalance the athlete will land the jump with one or both knees falling or facing inward and will be less stable overall.
If We Can’t Prevent the Injury, Can We Reduce the Risk?
Absolutely! Over the past 10 years, a tremendous amount of focus has been placed on ACL injury reduction programs. Although we are now much more knowledgeable and we have seen great advancements, there is no possible way to fully prevent an ACL injury.
However, it is encouraging to know that through the development and implementation of stretching and strengthening programs focusing on the lower extremity, such as the Lower Extremity Strengthening System (L.E.S.S) offered at JAG Physical Therapy or the Santa Monica ACL Injury Prevention Program, we can reduce these incidents by more then 50-60%! These types of programs are evidence based and consist of lower extremity and core strengthening exercises, lower extremity stretches, and instruction in proper mechanics during running, jumping and landing.
These programs, or one’s similar, are being offered at local gyms and physical therapy clinics and can be seen being implemented into warm-up routines at many schools and athletic clubs.
Let’s take responsibility now that we know that the science and help is out there and make sure all athletes, especially the females, have access to programs like these so they can reduce their risk of injury and continue to play the games they love!