Female Athletes And The ACL Tear

Dr. Jordan Metzl: "When I see young athletes who tear their ACL, one of the first questions their parents ask is: What could we have done to prevent this? The answer: everything."

Over the course of the past 8 years, I have spent countless hours working in high school weight rooms. One thing became apparent early on: the athletes participating in strength training were predominantly male. This is not to say that females do not lift, they do. Just not as many of them. And this article is not saying the males do not get injured. They do. In the United States alone, there are over 100,000 ACL tears per year. Some of these are not preventable. They just happen. But others can be prevented. Out of those 100,000 ACL tears, roughly 30,000 of them are high school age females! That is  nearly one-third of all ACL tears. If you want to reduce the incidence of ACL tears, this is the population that needs special attention

The stories are unfortunately very common. They often start like something like this: She had been at practice when she planted her foot, twisted her knee and went down in a heap. You ask the athlete what happened and their response was "I felt a pop,". One of the saddest things I see with female athletics is that poor girl who has to walk around with the bulky knee brace because she just tore her ACL. Research shows that many of these injuries are preventable with proper training. Yet, most coaches  do not take time to practice injury reduction routines. The best way to win games as coach is to keep your best players on the field. When the best players are hurt, your team's chances of winning greatly decrease. So why not take some time to hopefully prevent injury?

Keep in mind, no matter what we do as athletic trainers, sport coaches or as strength and conditioning coaches, we can't prevent injury, we can only reduce the incidence. For a coach or trainer to not implement something like this is doing your child an injustice, It could become quite expensive too. ACL ruptures can cost somewhere between $17,000-$25,000 per injury. This is on the conservative side too. Aside from the financial cost, there is a potential loss of entire seasons of sports, scholarships, lowered academic performance, long-term disability, and significantly greater risk of osteoarthritis in that given area. The truth is that surgery can restore knee function, but it does little to diminish the risk of arthritis 15 to 20 years down the line. Kids who tear their ACL today are often left with 60-year-old knees when they're 30. If you are in a position of power to implement injury reduction programs, here is a quick way to do it

Five Ways to Implement an ACL Injury Reduction Program:

1. Active Warm-up. This is all about getting the body prepared for the activity they are about to embark on. Muscle tissue gets warmed up and you slowly start incorporating movement skills that may show up during the training session. So, if your sport involves lateral agility, take some time to walk-through skills like a lateral shuffle. This also provides a great time to coach up proper movement. 
2. Power and Stability / Eccentric Strength. Most sports have a power component. Throwing, kicking, running, jumping, lifting, etc. You need to display power and but also need to develop stability. You can do this with eccentric training. Developing eccentric strength will greatly improve your landing and cutting skills. When thinking about eccentric strength, think about doing a squat. Go ahead, try it out right now. As you set your feet, slowly lower your body into a deep squat. Take about 8-10 seconds to get to the bottom. As you fight gravity, your body is working on improving eccentric strength. Your muscles are slowing your body down in an efficient manner. This is opposed to violently dropping into a deep squat. Developing these skills will enable you to slow your body down, so you can re-accelerate and go in a different direction.
3. Strength Development.  Developing a balanced strength & conditioning program is paramount to athletic success. It doesn't have to be fancy, just master the basics (push/pull/squat/deadlift) and have symmetry in your program. This means for every push, have a pull, for both the lower and upper body. There also needs to be an emphasis on single leg strength. Almost everything done in athletics is off of one leg, therefore strength and stability on one leg needs to be trained and developed. I have written about this in the past, check out this link for more information.
4. Change of Direction Concepts. Once your strength is developed, learning how to stop and start may just save your knees from a lifetime of discomfort. When viewing ACL tears in females, one of the following usually happens: As the at-risk female athlete lands, her knee buckles inward; The injured knee is relatively straight while landing or cutting; Most if not all of her weight is on a single lower extremity; Her trunk tends to be tilted laterally.​ Take the time to review body mechanics. Those four areas can be trained and improved upon. If you aren't comfortable teaching them yourself, find someone who is. 
5. Change of Direction Conditioning. Once you teach the mechanics, it is time to condition those mechanics. Everybody can practice proper form when they are fresh and it is early in the competition. You have to be able to repeat those same mechanics over the course of a game as mental and physical fatigue set in.

Oh yeah, there is one more thing to avoid: playing one sport all year long. This leaves no time for muscles and joints to recover from the microtrauma that occurs during practice and play. This also narrows down the athletes skill set. The more you do something, the more efficient you get at that given task. This sounds like a good thing and it probably is in a controlled environment. But athletic competition is not a controlled environment. They can be hectic and chaotic. Preparing your body for the unknown in athletics can be paramount to keeping you on the playing field and out of the training room!

Chris Fluck

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