Female athletes are
far more likely than males to suffer serious knee injuries
Female athletes are three times more likely to suffer from
anterior cruciate ligament (ACL) ruptures, one of the most common knee
injuries, compared to male athletes.
The ACL (anterior cruciate ligament) is one of the four
major ligaments of the knee. It connects the front of the tibia (shinbone) with
the back of the femur (thighbone). It helps provide stability to the knee
joint. Patients with torn ACLs often experience their knee “giving out.”
Most ACL tears do not occur from player-to-player contact.
The most common causes of noncontact ACL injury include: change of direction or
cutting maneuvers combined with sudden stopping, landing awkwardly from a jump,
or pivoting with the knee nearly fully extended when the foot is planted on the
ground. [1]
Dr. Pietro Tonino, Loyola University Medical Center
orthopedic surgeon, and other orthopedic surgeons are seeing a significant
number of knee injuries in female athletes, ranging from middle school to the
pros. Tonino is a sports medicine specialist who has performed thousands of
knee surgeries. [2]
Doctors aren’t certain why female athletes are more prone to
ACL injuries. One reason may be related to how they jump, Tonino said. Due to
the shape of the female pelvis, females tend to land from a jump with their
knees locked. This puts added pressure on the knee. Females also tend to be
more knock-kneed — with knees close together and the ankles far apart.
Minor ACL tears can be treated by nonsurgical means. But
significant ACL tears require surgery. An orthopedic surgeon removes a tendon
from the patient’s knee and uses it to replace the torn ligament.
“Unfortunately, a reconstructed knee will never be as good
as the God-given knee,” Tonino said. “So we should be doing all we can to
prevent these injuries in the first place.”
But Dr. Tonino suggests that doing preseason conditioning
could prevent many of these injuries and using proper landing techniques after
jumping.
“All female athletes, starting in adolescence, should learn
appropriate training techniques,” according to Karen Sutton, MD, assistant
professor, Yale University Department of Orthopaedics and Rehabilitation. “This
includes the appropriate way to land from a jump, increasing the strength of
muscles that could have a protective affect on the ACL—core, gluteal,
quadriceps and hamstring muscles, as well as working on the body’s reaction to
change of direction and change of speed.” [3]
I have my own theories on why ACL injuries are more prominent
in female athletes including the female athlete triad* but there is one aspect in
particular that I want to focus on given the context of this article. My theory
simply stated is that young female athletes “train to play but they don’t play
to train.” In other words they play their sport but don’t take part in any
off-field conditioning to prepare for the demands of that sport. And if they do
any off-field conditioning it is entirely inappropriate and likely a modified
version of a bodybuilding workout or a men’s strength and conditioning program.
I had a meeting a few weeks ago with a group of coaches/PE
teachers and an athletic trainer from a local high school. The discussion
turned to the topic of female strength and conditioning. This past winter I worked
with the soccer program at a local high school. My emphasis with their
programming was to reduce their risk of injury by focusing on body control and
equipping them with a superior set of brakes (ability to reduce force and
control momentum). The athletic trainer told me that there was only one
significant knee injury (ACL) all season across the three teams (Freshmen, JV
and Varsity) and it was the result of a girl being clipped from behind by an
opponent. This injury rate was a significant reduction from previous seasons.
According to the trainer when I first started working with
the girls they were skeptical because they weren’t “sore” and “exhausted” after their workouts. Eventually they
bought in only after they started to feel the benefits of having more control
because they were stronger and moved more efficiently. In America we have this
“old-school” mentality when it comes to sports training that it has to be super
intense and induce extreme sweating and/or vomiting. That “feel the burn” bodybuilding
mentality will make athletes tired but it won’t necessarily make them better
and more durable.
My bottom line when working with athletes is did they stay
healthy? If so then it gave them the opportunity to improve their skill and
performance through their ability to consistently practice and play their
sport. Athletes should not be trained to make them a champion in the weight
room. The training programs ultimate appraisal is does it help them stay on the
field/court and do they play better? If the answer is yes then the program has
accomplished what it was designed to do.
It can be tempting to throw advanced training protocols at
kids to impress parents, boosters and coaches but the vast majority of kids
aren’t prepared for it. Kids need to master the basics when it comes to
off-field/court/ice training. And just when you think they have it figured out…
A growth spurt slams their body into a state of confusion or they may have just
experienced their first relationship issue and can’t sleep at night. This is
probably not the ideal time to hit them with a “butt-kicker” of workout. Less is often more effective (quality
over quantity) for young athletes and if we can equip them with a superior set
of brakes (physically, mentally, and emotionally) they will have far more
control over where they are ultimately headed.
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