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.

ACL tears in athletes

“I heard it go ‘pop,’” an athlete says with dread.

That sickening sound and a sudden pain in the knee point to the culprit: an ACL tear. Sports that demand sudden stops and quick lateral movements like football, soccer and basketball are hotbeds for ACL tears. Here’s what an athlete needs to know about recovering from this common sports injury.

About the injury

The anterior cruciate ligament (ACL) is one of four main ligaments in the knee that connect the femur above the knee to the tibia below. Injuries to the ACL can happen to anyone, but they are common among competitive athletes in their late teens to mid- to late twenties. As more young people are participating in sports with higher levels of athleticism, the injury is on the rise. According to the American Academy of Orthopaedic Surgeons, the annual incident rate of ACL injury is about 200,000 with 100,000 ACL reconstructions performed a year.

How it happens       

ACL injuries often occur when an athlete makes a quick stop, plants his or her foot and then changes direction. The abrupt change of speed combined with an abrupt change in direction stresses the ACL, which can tear and make a popping sound. Pain and swelling sets in quickly. Athletes will generally opt for reconstructive surgery of the ligament to maximize their ability to resume competition.

The road to recovery

Orthopedic surgeons thread in a new tendon to replace the torn ACL that is taken from the patient’s hamstring or from a cadaver. A patient will usually be on crutches for the first couple of weeks after surgery. The rehabilitation plan is dependent on the extent of injuries sustained during an ACL tear; it’s not uncommon to also experience damage to the meniscus. Therapy starts with very limited weight-bearing exercises that will slowly increase over time.

Strengthening the quadriceps is the primary goal of first 6 weeks of therapy. This helps provide stability to knee. The physical therapist will then move to short arc exercises, straight leg raises, hip strengthening and some balance exercises.

During the first 6 weeks, the goal is to increase range of motion — helping a patient go from zero to 135 degrees of flexion.

At the 8 to 12-week mark, the healing process is well underway with the reconstructed tendon tightening down as it should. Balance and biomechanics become key therapy priorities. Patients also progress into plyometric training, working their way up to light jogging and mild ladder drills at about the 10-week juncture. After 12-16 weeks, patients get into heavier plyometrics with the intention of soon getting back into their chosen sport. The therapist observes movement and watches for any signs of instability or imbalance.

Listen to your PT

Throughout therapy, it’s critical that a patient stick to the prescribed home exercise program to supplement therapy sessions. It’s also important a patient understand that the adage “no pain, no gain” does not apply to ACL recovery.  Take it slow and allow the ligament to fully heal in place. Patience goes a long way in preventing future injury.