Female Athletes and ACL Injuries

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Female Athletes and ACL Injuries

Recently, ACL injuries among female athletes, and not surprisingly, the prevention of these injuries has been receiving a great deal more attention.  In 1972, before Federal legislation was enacted called Title IX, which ensured that schools that received Federal funding would offer equal opportunities to both sexes, including competitive sports, there were less than 300,000 high school girls participating in sports.  By the 2005-2006 school year, that number had risen to almost 3 million high school female athletes, over 1000% increase.  With greater female participation in sports at all levels of competition, we have also seen a higher rate of injury.  Each year the number of women participating in sports continues to increase, the levels of competition increases, and not surprisingly, the number of injuries continues to increase.

An ACL injury can be devastating to an athlete.  These injuries almost always require surgery to repair and usually take at least 4 to 6 months of rehabilitation before returning to a competitive level.  Athletes may be faced with the prospect of being sidelined for an entire season of play, long-term rehabilitation, possible loss of a scholarship money, higher rate of re-injury, permanent functional impairment and limitations, and also the increased potential for early-onset osteoarthritis in the injured knee.  Additionally, the estimated cost of these injuries, from the injury to the surgery and rehabilitation are staggering.  It is estimated that the average ACL injury to an adult with surgical treatment will cost $18,000-25,000 from the time of the injury through completion of rehabilitation.

For multiple reasons, women are at a greater risk of ACL injury than their male counterparts, experiencing ACL injuries at a four to six times higher rate than males.  Some of the factors that put the female athlete at a higher risk cannot be changed, but several of the causes can be changed, reducing the risk of ACL injuries among female athletes. 

There are several predisposing factors that make women more at risk than men that can not be changed.  These factors include things such as hormone levels, joint laxity, limb alignment, muscle strength, slower neuromuscular activation (reflex time), and smaller ligament size.  During menstruation, there are higher levels of estrogen which affect ligament strength and stiffness, resulting in decreased protection of the ACL.  Women generally have a wider pelvis than men, which increases the angle of the thigh bone to the knee (Q-angle) and results in more pressure on the inside joint surface of the knee and abnormal limb alignment, which increases the vulnerability and stress to the ACL .  Women also have slower neuromuscular activation which is the unconscious activation of muscles crossing the knee joint in response to sensory stimulation, which slows the ability of muscles to protect the ACL.

Factors that can be changed, resulting in decreased risk of ACL injury include muscle imbalance, muscle weakness, training shortfalls and technique.  Women tend to have stronger quadriceps muscles than hamstring muscles.  The hamstring is the natural protector of the ACL, so if it’s weak, it’s unable to do its job efficiently.  Also muscle imbalance that is present between the right and left leg is problematic.  The hamstrings, gluts and hips are often weak in women.  Again, these are the muscles that take some of the pressure off of the ACL and with strengthening will decrease the risk of ACL injury.  Athletes also need to be trained in proper landing techniques, decelerating techniques, and techniques for changing direction (cutting).  These techniques are very important since the ACL is the primary knee stabilizer during each of these movements.  70%-80% of all ACL injuries are non-contact injuries and occur during these movements without any exterior forces.

At Gateau Physical Therapy and Sports Medicine, we are excited to provide an ACL Injury Prevention program that targets the female athlete.  We will work with the athlete to dramatically decrease their risk of injury, emphasizing leg strength and muscle balance, core stability, instruction in proper technique and improved mechanics during multi-directional movements, jumping, and landing.  While reducing the risk of ACL injury, these techniques have been found to also be helpful in enhancing the athletes overall sports performance.  Contact our office at 301-862-5177 with any questions or for more information.  Also, you can visit us on the web at www.gateaupt.com.

Submitted by Ellie Sweum, Physical Therapy Assistant

Gateau Physical Therapy and Sports Medicine