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ACL Injuries in Female Athletes

Injuries to the Anterior Cruciate Ligament (ACL) have a higher prevalence in women than in men. In fact, female athletes are 2 to 8 times more likely to have an ACL injury when compared to their male counterparts (1). While there are biomechanical factors affecting ligament laxity and dynamic stability of the ACL (1), many of the injuries could be prevented by multi-component exercise programs (2). One of the big issues with this is that, historically, women have had limited access to weight rooms and quality exercise programs.

There are a few factors that cause the limited access to weight rooms and strength training. One of them being the stigma that lifting weights will make you look bulky. This isn’t true in the slightest. If your goal is to get the bulky look, there are ways to train to get that look, but if you are following a well regimented program, your body will reflect what type of exercise you do, over time. This means that athletes training for their respective sports will, generally, have a body type that is sports specific and position specific. The best example I can give for this is a long distance track or cross country runner. At high levels, every one of these athletes are extremely lean, with a low body fat percentage (male and female), and yet they still weight train (or should weight train). The second factor is that not all schools have strength coaches, and for those that do, some don’t give female athletes the time of day. This is the biggest shame of all because this leads to negative experiences for the athletes as well as setting them up for higher injury rates when they are on the competition floor. I know from personal experience that female athletes do usually come second to the male athletes when it comes to time allowed in the weight room, especially to the more glorified American sports like football and basketball.

Strengthening the muscles and tendons surrounding the knee is the best way to decrease ACL injury risk. This means that lots of exercises that target the quadriceps, hamstrings, and adductors should be used in workouts, as well as those that target other parts of the leg (i.e ankles and hips). Strengthening these muscles, through the use of squats, deadlifts, and accessory movements, will help to stabilize the knee joint. Not only that, but these movements will train the body to move safely and efficiently. As discussed in the previous newsletter the body is a series of joints that are connected very much like a chain. If there’s any broken pieces to this chain, such as an immobile hip or ankle, then there will be extra strain placed the knee joint itself, which will cause instability and set an athlete up for failure.

A few studies have found that by using a structured warm-up program, the rate at which ACL injuries occur dramatically decreases. The first one used movements that simulated those that would be performed during a game scenario, such as jumping and cutting, balancing exercises, and strength exercises (4). The second study did something similar with their warm-up for young female soccer players. They had the athletes perform a “warm-up”, followed by light stretching, strengthening, plyometrics, and agility portions prior to them playing (5). This study found a staggering 88% reduction in ACL injuries (they were also able to replicate this the following year with a 75% reduction).

Recently, Andrew and I have begun training the CY Select girls AAU basketball team. We train all of their teams, ranging in age from 2nd grade up through high school. While it is still early and we have not been training these ladies for very long, I would expect to see the impact that we are making them show up on the court. Whether they realize it or not, they will be able to run faster, change direction with more power, and jump higher. But most importantly, their bodies will be better prepared to help prevent injury occurrence during their season.

Can injuries be completely eradicated from sports? No, absolutely not, but strength training helps to lower injury rate and keep athletes healthy (3). This is why it is so important that females get in the weight room. With the injury rates of ACL and other injuries being much higher in females than males, I would be willing to bet that a lot of that stems from not strength training. As female access to proper strength training programs become more significant, it will be interesting to see how injury rates, especially ACL Injures, will change in the coming years.

1 Hewett, TE . Neuromuscular and hormonal factors associated with knee injuries in female athletes: strategies for intervention. Sports Med. 2000;29: 313–327.

2 Kay M Crossley, et al. Making football safer for women: a systematic review and meta-analysis of injury prevention programs in 11,773 female football (soccer) players.

4 Olsen OE, et al. Exercises to prevent lower limb injuries in youth sports: cluster randomized controlled trial. BMJ. 2005;330(7489):449.

5 Mandelbaum BR, Silvers HJ, Watanabe DS, et al. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. Am J Sports Med. 2005;33(7):1003–1010.

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