Parents of middle school and high school athletes know that various sprains and strains are a common part of sports. Anterior cruciate ligament (ACL) injuries, however, can sideline athletes for an entire season and require aggressive rehabilitation to regain a competitive status. What are ACL injuries, why are they more common in female athletes, and what can be done to reduce their risk in both sexes?
The ACL connects the thigh bone (femur) and the shin bone (tibia) and helps stabilize the knee when you make quick stops or pivoting motions. When the ACL tears, an athlete’s agility is greatly reduced. Surgery is usually performed to reconstruct the ligament.
Beginning several years ago with Title IX, the federal statute assuring equal athletic opportunities for women, with men, in colleges and high schools, a disturbing trend started to appear. Women athletes, especially in basketball and soccer, were nearly twice as prone to ACL ruptures as their male counterparts.
Many studies have been performed to analyze this phenomenon, and the most common theories include:
- Anatomical differences in the ligament between men and women.
- Hormonal fluctuations in women that may make the ligament more susceptible to damage.
- The tendency of women to play sports in a more upright position than men.
- General lack of proper training programs for women to protect the ACL.
To develop strategies to reduce ACL injuries in all athletes, one must understand the delicate muscle balance, in strength, between the front thigh muscles (quadriceps) and back thigh muscles (hamstrings). It is recommended that the hamstrings be 60%-80% as strong as the quadriceps. Training programs that focus on strengthening techniques should take this balance into consideration for both males and females.
In addition, flexibility of the legs and trunk should be emphasized. A regular program of slow, careful stretching promotes flexibility. This helps to protect the knee and improves overall agility. The force and stress on the ACL from twists, sharp turns and tensing spread nicely through a well-toned, flexible body, which is highly desirable, because the effect is “softened.”
Last, specific exercises should focus on rapid muscle recruitment and jumping skills. Becoming proficient at safe take offs and landings, controlling impact and building proprioception, which is an awareness of joint position during quick motions, all assist in decreasing injuries.
Studies show that training techniques aimed at achieving these objectives significantly reduce injuries in athletes of all ages. Youngsters and teenagers are particularly susceptible to ACL damage because their bodies are still growing. A teen may look like a young adult, but inside of the body there is still much development underway. Coaches, in particular, should understand the immediate and long-term physical consequences of everything they ask their athletes to do.