If you’ve spent any time around a high school turf field or visited a physical therapy office recently, chances are you’ve seen more than one female athlete recovering from an anterior cruciate ligament (ACL) injury. Record numbers of girls are participating in varsity sports since Title IX was passed 46 years ago. With close to 8 million girls joining a high school sports team during the 2016-2017 school year, according to a survey conducted by the National Federation of State High School Associations (NFHS), more athletes are at risk. It’s been reported that female athletes injure their ACLs up to 8 times more often than male athletes. The question is why? Medical experts have identified several factors that put female athletes at greater risk: anatomy, musculature, range of motion, and hormones.
Anatomy or Body Differences: Quite simply, men and women are built differently. Women have a wider pelvis than men, a smaller ACL, and a smaller intercondylar notch. A wider pelvis can affect knee alignment, making females more prone to being knock-kneed, where the knees point inward, placing additional stress on the ACL. This added stress can increase the risk of ACL injury, particularly when landing from a jump. The intercondylar notch is the groove in the bottom of the femur where it meets the knee. A narrower notch may restrict movement of the ACL, especially during twisting or change of direction movement.
Differences in Musculature: Hip, buttock, and leg muscles in women are not as strong as those in men, which directly affects the biomechanics of how they move and react. Women also tend to use their quadriceps (muscles in the front of the thighs) more for stability. When changing direction or landing from a jump, this causes the knee and ACL to absorb more force instead of it being absorbed by surrounding muscles.
Greater Range of Motion: Women tend to have greater range of motion in their knees and hips. Knee laxity (or looser knees), greater hip rotation, and knee hyperextension make ACL injuries more likely in females. Knee hyperextension, or how far the knee can be stretched or straightened, can result in a backward curve of the knee even when the leg is straight. This makes it harder for the hamstrings to help protect the ACL, and injury more likely.
Hormones: Some studies have suggested that changing hormone levels play a role in ligament laxity and that during their menstrual cycle and ovulatory phase, women have a greater risk of injuring their ACL. However, it is unclear exactly how hormones affect the ACL.
The good news is that with proper training, female athletes can decrease their likelihood of ACL injury. Many sports, such as soccer, have introduced even the youngest athletes to training programs that take all of these factors into account and work to strengthen the quadriceps, hamstrings, and other muscles that support the knee, hip adductor, and gluteus muscles. Some teams work on ACL-focused exercises during both their pre-practice/game warm-ups and post-practice/game cool down. Doing a routine of squats, jump squats, lateral hops, step -ups, hamstring curls, and focusing on core strength can help female athletes to decrease their risk and keep them off of the injured list.
An athlete’s rehabilitation and recovery from any sports-related injury can be a lengthy, difficult process. Injured athletes must identify further risk factors, retrain sport-specific movement patterns and regain self-confidence to fully recover and prevent further injury.
API’s Return to Play program bridges the gap between therapy and a successful return to athletic competition in a safe, controlled environment. Specializing in sports-related injuries including ACL reconstruction, shoulder injuries, and concussions.
For more information on API’s Return to Play training programs, contact Sean Doyle, Sports Performance Director at (410) 923-2100 or send email to ben@athleticperformanceinc.com