Human Performance and Rehabilitation Centers, Inc.

Are young female athletes at greater risk for ACL injuries?

Young female athletes are five times more likely to sustain an ACL tear than their male counterparts. This is especially common in explosive multidirectional sports like soccer or basketball. It’s important for girls to learn how to jump and land properly in order to prevent an ACL injury from occurring.

Female athletes from about 14-18 years of age are at greater risk than boys of injuring the anterior cruciate ligament (ACL). This is largely due hormonal changes. An increase in estrogen during puberty causes relaxation of the ligaments and the natural widening of the hips causes changes in biomechanics. A female athlete is likely not conscious of these new structural changes as she continues to snag rebounds or bolt across the soccer field. She may inadvertently land or stop stiff-kneed or in a locked position, and she might have a greater tendency to internally rotate the knee due to weakness of the developing outer hip.

In addition, a female athlete may be accustomed to using only the quadriceps instead of her developing hamstrings to control movements. All of these factors can put the ACL at risk.

It’s important to teach young women early on how to adjust the way they run and jump in competition in order to prevent an ACL tear. A physical therapist can screen an athlete to evaluate body mechanics, potential weakness and faulty movement patterns. Prevention is key. And it’s time well spent since a young athlete who has suffered an ACL tear is 70% more likely to suffer a re-injury.

Here are some strategies:

  • Young athletes should be in shape for the demands of their chosen sport. This includes both cardiovascular capacity and muscular strength. During fatigue or exhaustion, even a small weakness or poor body mechanics can become a bigger problem.
  • A good strengthening program will encourage better hamstring-to-quad strength ratio, which will help reduce reliance on quads only.
  • Good lateral hip strength and hip abduction control will help maintain proper knee position so that a girl doesn’t experience what we call a valgus collapse, or the extra internal rotation of the femur and the knee falling inward.
  • Proper proprioception is key. When the foot hits the ground, the knee should be properly positioned over it. This allows for strong core-hip stability during lunges, running and multidirectional activities.

Physical therapists don’t just treat patients after an injury. They also work with patients to prevent one from occurring.

Achilles Tendon Injury

The Achilles tendon is an essential part of daily life. Spanning from your heel bone to your calf muscle, this band of tissue allows you to participate in everything from competitive sports to recreational activities, or just simply getting around. While the Achilles is the strongest and thickest tendon in the body, it can also be vulnerable to injury.

How Achilles tendon injuries happen

Athletes certainly experience their fair share of Achilles tendon injuries, but so can the average person. A variety of issues can cause the tendon to partially tear or even rupture. These include an abrupt and incorrect stepping down movement, wearing high-heeled shoes over the long-term, contact injuries or overuse. A tear can occur anywhere along the tendon from the heel to the calf. Injuries are more common in middle-aged individuals, and generally effect men more often than women.

How to recognize a tear

Partial tears, which are vertically or horizontally oriented along the tendon, are much more common than ruptures, or complete tears. You can usually feel a tear when it happens. It will cause the area around the Achilles to feel sore, tender and it may cause swelling. When a patient experiences a complete tear, normal walking is instantly compromised since the tendon is severed and essentially rolls up like a Roman shade. A rupture will require surgery and follow-up physical therapy.

Treating a partial tear or a post-op rupture

A full recovery from an Achilles injury demands patience. Rest is key. If surgery is not indicated, some patients benefit from wearing a boot to keep the tendon in a neutral position. If surgery is indicated, the patient will be referred to physical therapy typically around the 6th post-operative week, but will remain in a boot until 12 weeks post-op, on average.

During therapy sessions, a PT will manually stretch the tendon to bolster blood flow and to improve the relationship between the tendon and the heel bone and/or the calf muscle. The PT will also issue home exercises to encourage healing while minimizing inflammation. When the patient is ready, the PT will introduce gentle exercises like seated calf raises and exercises using therapy bands to increase blood flow. Next, the therapist will guide the patient through a progression of walking activities and dynamic stretching like lunges and standing calf raises with the goal of an eventual return to the individual’s desired level of activity. Another important part of therapy is restoring – or improving – a patient’s sense of balance, so a therapist may also deploy exercises that improve biomechanics. As the patient builds strength and flexibility, it will be possible to once again run and jump.

Continued maintenance

A home exercise program is a key part of helping a torn Achilles tendon heal throughout therapy. Wearing proper footwear is also important. While active adults are always eager to jump back into their former routines, it’s crucial that they practice patience and allow the Achilles tendon to heal fully to prevent re-injury.