Sports Training Articles

Girls face higher knee injury risk
Strengthening muscles could protect ACL
(USA Today, Kathleen Fackelmann)

Muscular changes that take place during puberty put female athletes at higher risk for an injury to the anterior cruciate ligament (ACL), an injury that has sidelined scores of female soccer and basketball players in the last decade.

Other research had shown that female athletes are at greater risk of an ACL injury. But a new study is the first to suggest when and how that risk comes about.

The findings, from a study published this month in the Journal of Bone & Joint Surgery, along with additional research by the same team of scientists, suggest that female athletes can be taught early on to strengthen muscles that control the knee and avoid costly ACL injury.

Girls who blow out an ACL often must have an expensive operation to repair the tear and then must work out to gain enough control to get back on the playing field. The operation and rehabilitation can cost $25,000.

"It's close to a billion-dollar problem in girls and women in the USA," says Timothy Hewett, lead researcher on the latest study and director of the Sports Medicine Biodynamics Center at the University of Cincinnati.

Even after girls have recovered from the acute injury, the changes in the joint may set the stage for osteoarthritis of the knee, he says.

Compared with guys, female athletes run an eight-times-greater risk of tearing the ACL, a fibrous band that connects the shinbone (tibia) to the thighbone (femur). Basketball, soccer and other sports that require cutting moves or jump shots can put an athlete at risk.

For this study, Hewett and his colleagues brought 181 middle and high school athletes into the lab. They had the players, male and female, go through the moves that often trigger an ACL injury. The team recorded those movements on camera and used a computer to analyze the pattern of play.

The team measured the amount of inward collapse of the knee and found that girls had more problems with control of the knee joint.

Starting at puberty, boys and girls undergo a growth spurt. Bones get longer and body weight increases. That makes it harder for athletes to control tricky moves. But boys also get a testosterone-driven boost in muscles around the knee, an advantage that could mean they're better able to control their landing after a jump shot, for instance.

For girls, knee muscles don't get much stronger even as body mass increases, Hewett says. Rather than move in one direction like a hinge, a girl's knee may move all around during crucial moves, which can put a lot of stress on the ACL and lead to an injury, he says.

Girls that land off-balance - or in a position where the knees come close to touching - after a jump shot are at high risk of tearing the ACL, says Kathy Weber, a sports medicine expert at the Rush University Medical Center in Chicago.

"You can see it happening," she says, noting that girls also have more trouble controlling their landing because of anatomical differences, such as wider hips.

But girls can reduce their risk of an ACL tear by strengthening muscles that help control and stabilize the knee joint. Girls who do the work will get a big payoff.

"They'll be a more powerful athlete, and they'll be safer," Hewett says.

SPI Philosophy

Developing the Sports Performance Foundation: Building a Better Athlete

This section is to educate you on the proper way to train your high school aged athlete. By following the suggestions throughout this narrative, you will:

1. Enhance each athlete's performance, thus enhancing our "team's" performance
2. Reduce the risk of significant injury
3. Build self-esteem and confidence in each athlete

How many of us have heard the phrase, "you are only as strong as your weakest link"? This phrase holds the key to training your athletes. In order to build a stronger, bigger, faster, stable, balanced athlete, you must train their weakest links! Many of you are asking: "what are the weakest links in my athletes?" The answer is their foundation!

The foundation of all athletes begins at the joints where movement occurs. Ankles, knees, hips, core (abs, obliques, and low back), shoulder, and neck are the primary joints that athletes stress during sport performance. You must analyze the movement patterns that a particular joint was designed for and train the body specifically to that movement. Simultaneously, an evaluation of opposing movements must be done to ensure proper muscular balance and strength. Modern training for ultimate athletic development must be based on training movements, not muscles.

What happens when you build a house on a poor foundation? It will eventually crumble and collapse. The same thing happens with the human body. We must build a solid foundation to support the super structure of an athlete. A strong, stable foundation must be prepared and maintained before any other training protocol begins.

Once the athlete has strengthened their foundation, it must now be trained specific to the sport activity. Each athlete will need training specific to their age, sport, position, playing time, and injury status. Additionally, sport performance factors including power, strength, speed, agility, coordination, quickness, balance, flexibility, local muscular endurance, and cardiovascular endurance must be addressed. Throw in proper hydration, nutrition, and sleep (rest and recovery); you now have all the ingredients for developing each athlete to their full potential.

Sport-specific, individualized programs must be used when conditioning the athlete. Even athletes with outstanding natural physical and psychological abilities in a sport can use sports performance conditioning to take those abilities to higher levels of performance. This also enables the athlete to prevent injury and enhance their ability to recover from small injuries which will contribute to success and a long career. Physical conditioning is no longer about running and lifting weights. It is developing a sport-specific performance strategy and teaching the athlete to integrate them during competition that dictates the degree of success.

Every coach and athlete knows that success and recognition in athletic competition doesn't just happen. They are the result of an honest commitment to excellence and hard work. A synergistic approach from coaches, strength and conditioning specialists, athletic trainers, parents, and athletes can go a long way to enhancing individual and team performance. Developing the sports performance foundation will allow for the systematic application of functional exercise in performance, fitness, and sport-specific neuromuscular facilitation.