Why Do Female Athletes Suffer More ACL Injuries Than Males?

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


Looking for a Recovery Beverage? Try Chocolate Milk

When it comes to choosing a post-workout recovery beverage, experts suggest ditching the usual sports and protein drinks in favor of a childhood favorite—chocolate milk.  Chocolate milk has all of the nutrients the body needs to recover from an intense workout.   And according to Cornell University researchers, chocolate milk just might be the new gold standard for post-workout recovery nutrition.

Here’s what makes chocolate milk such a great choice:

  • The sugar and carbs in chocolate milk replace glycogen that was burned as energy during your workout and provide a good instant source of energy
  • Protein, calcium, and vitamin D in the milk help burn fat and build muscle
  • Water rehydrates
  • Even the youngest athletes like the taste

While sports drinks like Gatorade and Powerade are great for hydration and electrolyte replenishment, they don’t do much for building muscle or glycogen repair. 

Chocolate milk is ideal for endurance athletes or athletes who are working out intensely for an hour or more.  If you are more of a low intensity athlete, it’s probably okay to follow your workout with water and a healthy snack or meal.  Although, chocolate milk is still a smart choice for those just staying in shape, particularly if you are on the go after your workout and don’t have time to sit for a meal.  

Parents can pick up a supply of pre-mixed 8 ounce bottles to keep on hand for car rides home from practice or to the next activity.  Athletes have a tendency to under-consume during the day prior to working out and over-consume post-workout.  Drinking chocolate milk allows most athletes of average weight and size to replenish most of what they lost during their workout. 

Researchers have determined that the ideal protein supply for building muscle is 10 to 20 grams, with athletes consuming half before and half after a workout. 8 ounces of low-fat chocolate milk contains 8 grams of protein and has a perfect fat-carb-protein ratio.  Since excess protein gets stored as body fat, there is such a thing as too much of a good thing.  That said, athletes who are bigger and have more muscle mass might require an additional supply of protein.

Athletes should look to consume 8 oz. of low fat chocolate milk within 30-60 minutes of completing their workout.

Fueling your recovery is as important as the effort you put into your workout.  Studies have shown that combined with working out, chocolate milk may just be the perfect muscle-building beverage.  

So now we’ve got to ask, GOT CHOCOLATE MILK?

Raising Girls and the Benefits of High School Sports

If you are planning on raising a confident, well-adjusted daughter who’s healthy, happy, and motivated be sure to know about the benefits of playing high school sports.  While there’s no special manual or “How to” book you need to read - you just make sure she plays sports, particularly in high school. 

Some of the Benefits to Girls Playing High School Sports

The nonprofit group Ruling Our Experiences (ROX) recently surveyed over 10,000 girls in 5th through 12th grade.  They found that girls who play sports exhibit more confidence, have a more positive self-image of themselves and their bodies, stronger relationships with other girls, and report lower levels of sadness and depression when compared to those who don’t participate in sports.

While these results aren’t surprising, they do confirm what many parents, coaches, and administrators have suspected for years.

Benefits are Farther Reaching Than Just Fitness

The benefits of playing sports go far beyond simple fitness and into the realm of mental health.  Girls who spend a lot of time on social media are 5 times more likely to report that they are sad or depressed nearly every day.  More time practicing and playing games leaves less opportunity for social media and results in improved mental health for athletes.

Female high school athletes have stronger relationships as well, and are significantly more likely to talk about serious issues with their friends, get along with other girls, trust other girls, and have healthy ways to manage stressful situations. 

Why Sports Matter in High School and Beyond

Studies show confidence declines sharply from 5th to 9th grade.  Interestingly, this is the same timeframe that many kids quit sports.  The National Alliance for Youth Sports reports that approximately 70% of kids in the U.S. stop playing organized sports by the age of 13.  But there are positive benefits to be had if you can keep your daughter “in the game”. 

The ROX study also showed that when compared to girls who do not play sports, female high school athletes are:

        14% more likely to believe they are smart enough for their dream career

        11% more likely to say they are happy the way they are

        16% less likely to say they want to change their appearance

And playing sports helps grades too.  61% of high school girls who have a grade point average above 4.0 play on a sports team.

Lastly, if you’re looking to raise daughters who will speak up for themselves and have the confidence to pursue their dream profession, playing sports will help that happen too.  Female athletes have increased career and leadership aspirations.

High School Sports Matter for Girls

In short, girls who play sports did better on nearly every index metric in the study versus their non-sport playing counterparts. There are clearly some significant overall benefits that girls enjoy as a result of being involved with a sports team with the most positive outcomes from sports participation at the high school level.

You can download the full report here.

Why Kids Should Play Multiple Sports

Contrary to what most adults assume, there is surprising evidence that playing multiple sports is more effective in developing successful athletes than single-sport specialization. 

One need look no further than former U.S. soccer superstar Abby Wambach who credits her participation in high school basketball with giving her the fundamentals and timing to score so many goals with her head.  Wambach points to rebounding as having the biggest effect on her heading prowess, saying learning the timing of your jump and learning the trajectory of the ball coming off the rim in basketball played an enormouw role in her ability to put balls in the goal using her head while on the soccer field.

But the pressure to specialize in just one sport and play it year-round is intense.  Gone are the days when most kids played one sport a season and switched it up as the weather changed.  Experts agree that single sport specialization has resulted in a higher incidence of overuse injuries in increasingly younger kids. 

Data suggests that specialization in a single sport is actually doing more harm than good to the long-term success of team sports.  Young athletes who participate in multiple sports have skills and pattern recognition that transfer between sports, ultimately making them better all-around athletes.

How do you combat a youth sports culture that pressures young athletes to play one sport year-round?

Although it’s easy to feel a need to keep up with the Joneses, stick to your guns and make sure your young athlete:

  • Is Exposed to multiple sports.  For an athlete to be successful, he or she must love to play.  Exposing kids to a variety of sports improves the likelihood of them discovering their passion for a particular sport (or sports), which is essential for long-term success.
  • Avoids playing a single sport competitively year-round.  The American Medical Society for Sports Medicine and the American Academy of Pediatrics recommend not specializing in a sport until age 10.
  • Focuses on skill development rather than just structured competition.  Developing fundamental skills early on increases success and ultimately an athlete’s love for sports.
  • Limits his/her training.  It’s important that young athletes don’t overdo it.  For high school athletes, training more than 16 hours per week has been associated with an increased risk of injury, so healthy limits are essential.
  • Keeps the joy in sports. Constant pressure from parents and coaches to play harder, train harder, and do more can sap the joy out of playing and lead to burnout.  Most young athletes will never make the pros, so keep your expectations (and theirs) in check.
  • Makes proper rest an important part of his/her training. Experts recommend a minimum of one day of rest per week from organized training and competition.  When asked by kids what they could do to improve their game, many professional athletes had the same answer:  get more sleep.
How to Be Your Child’s Biggest (and Best) Sports Fan

You might be your child’s biggest fan, but are you his/her best fan?  Chances are, your perspective on this is a little less than objective.  When hundreds of college athletes were asked what’s your worst memory from youth sports, the overwhelming reply was “the ride home with my parents.”  Many parents see the post-game car ride as an opportunity to offer criticism, tips, and second guess the various decisions their player made throughout the game, but this is a clear recipe for disaster.  Here are some tips for becoming your child’s #1 fan:

Don’t be the coach (unless you are actually the coach): Post-game criticism and well-meaning suggestions on the ride home can be tedious win or lose, particularly if the coach already de-briefed the team on what they did well and not so well.  Athletes overwhelmingly agree that the single best thing you can say to them after a game is “I love to watch you play.”  Your job is to provide unconditional support.  Grandparents seem to have a particularly easy time handing out genuine atta-boys, so take your cues from Grandpa.

Encourage your child to compete against him/herself rather than teammates or opponents:  Judging improvement by winning or losing isn’t fair or accurate.  Young athletes should be striving for continual improvement—swimming faster, making better passes, and correcting mistakes from week to week, not necessarily coming in first place or winning the game.  

Don’t Define Success in Terms of Winning:  Youth sports are all about skill development.  The scoreboard doesn’t necessarily reflect a victory or loss in these terms.  When your child and/or his team plays up to their potential and loses, it’s critical to focus on the performance, not the loss.  There is a difference between winning/losing and success/failure.  Make sure both you and your child understand the distinction.

Let Go:  Sports is one of the few environments where parents can be hands off.  The playing field is a great place for kids to take risks, try something new, and deal with the resulting failure or success because consequences aren’t life threatening nor are they permanent.  Good or bad, the outcome won’t require a rescue from mom or dad.  By letting go, parents allow all of the successes or failures to be their child’s alone.

Keep your emotions in check at game time:  Making grand demonstrations of displeasure over a referee’s “bad” call or when things aren’t going your team’s way is bad sportsmanship and sends the wrong message to your child. Be encouraging and positive.

Ask your child what he or she wants:  Some kids like to hear encouraging shouts from stands, but others would rather not to hear mom or dad at all.  Find out what your child prefers and honor his/her wishes as best you can.

Don’t treat your child differently after a win or a loss:  Their value is not contingent on the final outcome of the game.   Be careful that your behavior doesn’t tell a different story.

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