More than ever, girls and women are becoming active on the workout circuit and competing in organized sports. With this has come a significant rise in the number of injuries to the knee, particularly the anterior cruciate ligament (ACL).
The typical cause of the injury is a rapid but awkward stop and anticipation of a lateral movement. While itï¿½s not known exactly why this happens, many theories exist on why women are suffering this injury more often than their male counterparts.
One of the countryï¿½s top sports medicine specialists, the University of Kentuckyï¿½s Dr. Mary Lloyd Ireland, cites a survey of 80 male and 64 female basketball players who participated in the 1988 U.S. Olympic tryouts. Of the male players, three suffered single-knee ACL injuries, while 13 female athletes had ACL injuries, all occurring while playing basketball.
In addition to being a team physician for the U.S. Olympic team at the 1992 Games, Ireland has herself competed as a world-ranked swimmer in the breaststroke. She has given lectures on gender-specific injuries to organizations like the National Strength and Conditioning Association, and feels that the ACL question is a complex one with no simple answer.
ï¿½There are certain structural differences between men and women that could explain some of the disparity in ACL injury rates,ï¿½ explains Ireland. ï¿½Women have a physiological laxity in and around the knee compared to males.ï¿½
One difference that may contribute to ACL injury is technique. Ireland has found that male basketball and soccer players typically land using both legs, which absorbs impact. Females just as typically favor a one-leg landing, which may put additional strain on the knee.
Technique and training
ï¿½We need to teach our female athletesï¿½when they are young, as theyï¿½re forming their athletic habitsï¿½how to leap and land without hurting themselves,ï¿½ says Ireland. ï¿½Young female athletes should be taught to ï¿½jump straight as an arrow and land light as a feather,ï¿½ with hips and knees in a bent position, landing on both feet.ï¿½
Women should know the risks for ACL injury, especially when participating in ï¿½cutting sports,ï¿½ such as basketball, soccer, and volleyball. Properly strengthening the knee and the muscles surrounding it will benefit the female athlete.
Ireland says that with an informed approach to exercise and weightlifting, women can reduce their chances of suffering an ACL injury. She recommends multi-joint, compound free-weight exercises over isolated movements. Squats are superior to leg extensions, particularly for those who experience any pain on or under the kneecap while doing leg extensions.
ï¿½No doubt about it, proper weight training tightens the knee area,ï¿½ says Ireland. ï¿½Squats to parallel are wonderful for the knees, assuming theyï¿½re done correctly. The motion should be controlled and careful throughout the entire exercise.ï¿½
Ireland also points out the benefit of balanced muscular training.
ï¿½The hamstrings, lower back, and hips all need to be trained diligently to achieve strength parity,ï¿½ says Ireland. ï¿½Try to balance strength among the muscles in and around the knee.ï¿½
Prevention and surgery
The UK Sports Medicine program is working on an ACL ï¿½prehabï¿½ program for soccer, which includes routine exercises to do during warmup and on the playing field. It is all about proper landing techniques and getting into a safe position with knees and hips bent.
Despite the best prevention efforts, sometimes injuries do occur. At one time, a knee injury spelled the end of an athletic career. Fortunately, thatï¿½s no longer always the case. UKï¿½s talented staff of orthopedic surgeons in sports medicine can perform many innovative function-preserving knee-repair techniques, including anatomical reconstruction of the ACL. The relatively new ï¿½double bundleï¿½ ACL repair technique shows great promise at returning athletes to their pre-injury levels of performance.