High incidence of anterior cruciate injuries in women athletes
Compared with males, females in certain sports are more likely to injure their knees. The most common injury of the knee in females is an injury of the anterior cruciate ligament (ACL). Ligaments are structures which stabilize joints. They are cord like bands of connective tissue and resist abnormal movements between the bones of the joints. When their endurance limit is exceeded, they fail and this leads to instability. What is the ACL? In the knee there are four ligaments binding the thigh bone to the shin bone. Two of them run within the knee joint cavity, the ACL (anterior cruciate ligament) being one of the two. It prevents the shin bone from sliding forward from the thigh bone in activities like coming downstairs. A hard twist or excessive pressure on the ACL can tear it, so that the knee gives out and can no longer support the body. Unless an injured ACL is accurately diagnosed and treated, the cushioning cartilage (the menisci) in the knee could be seriously damaged. Without this cushion, the thighbone and the shinbone would rub against each other, leading to further damage. Women and ACL injuries- The majority of ACL injuries occur in females aged 15-25. Let’s look at some statistics. • The incidence of ACL injuries among women basketball players is twice that for men. (Nearly 60 percent of ACL injuries in female basketball players occur when landing from a jump.) • Female soccer players are four times more likely to suffer an ACL tear than their male counterparts Although the reasons are not quite clear at this point of time, certain factors predispose women to increased ACL injuries. • Biomechanical. Females tend to place more emphasis on quadriceps muscles, and this may be a significant reason for increased risk of ACL injuries. Because women don’t bend their knees as much as men do when landing from a jump, the pressure on the knee joint is increased. The knee is exposed to higher forces per pound of body weight. Learning to land safely is a skill that can and should be taught early. Also, females tend to land on a flat foot rather than their toes, which can contribute to increased injury rates. • Muscle control techniques The hamstring muscles in the back of the thigh work with the quadriceps muscles in the front of the thigh to bend or straighten the leg. As one set contracts (shortens), the other relaxes (stretches). Muscles that are being stretched produce more force than muscles that are contracting. Many women athletes use their quadriceps muscles when they are changing direction rapidly. This can put enough force on the shinbone to tear the ACL if the knee isn’t bent enough. By strengthening and using the hamstrings rather than the quadriceps muscles, a female athlete could reduce her risk of an ACL injury. • Hormonal. No modification of activity or restriction from sports is recommended at any time during the menstrual cycle. A woman’s hormones do not increase the chance of ACL injury, but researchers say further investigation is warranted. • Environmental. Functional knee braces do not prevent ACL injury. Although athletic shoes may improve performance by providing good traction on certain surfaces, they also increase injury risk. • Anatomic. More data is needed to determine if ACL size is related to injury risk.
Women and ACL injuries-
The majority of ACL injuries occur in females aged 15-25. Let’s look at some statistics.
• The incidence of ACL injuries among women basketball players is twice that for men. (Nearly 60 percent of ACL injuries in female basketball players occur when landing from a jump.)
• Female soccer players are four times more likely to suffer an ACL tear than their male counterparts Although the reasons are not quite clear at this point of time, certain factors predispose women to increased ACL injuries.
• Biomechanical. Females tend to place more emphasis on quadriceps muscles, and this may be a significant reason for increased risk of ACL injuries. Because women don’t bend their knees as much as men do when landing from a jump, the pressure on the knee joint is increased. The knee is exposed to higher forces per pound of body weight. Learning to land safely is a skill that can and should be taught early. Also, females tend to land on a flat foot rather than their toes, which can contribute to increased injury rates.
• Muscle control techniques The hamstring muscles in the back of the thigh work with the quadriceps muscles in the front of the thigh to bend or straighten the leg. As one set contracts (shortens), the other relaxes (stretches). Muscles that are being stretched produce more force than muscles that are contracting. Many women athletes use their quadriceps muscles when they are changing direction rapidly. This can put enough force on the shinbone to tear the ACL if the knee isn’t bent enough. By strengthening and using the hamstrings rather than the quadriceps muscles, a female athlete could reduce her risk of an ACL injury.
• Hormonal. No modification of activity or restriction from sports is recommended at any time during the menstrual cycle. A woman’s hormones do not increase the chance of ACL injury, but researchers say further investigation is warranted.
• Environmental. Functional knee braces do not prevent ACL injury. Although athletic shoes may improve performance by providing good traction on certain surfaces, they also increase injury risk.
• Anatomic. More data is needed to determine if ACL size is related to injury risk.
Teh risk factors are thus biomenchanical, antomical and hormonal.
Prevention and treatment
Women athletes can take three steps to reduce their risk of ACL injuries. 1. Training and conditioning should be a year-round program. Skill drills and strength and flexibility exercises will enhance balance and coordination so you will be ready when the season starts. 2. Make strengthening exercises for the hamstrings and quadriceps muscles a regular part of your conditioning program. To stretch the quads, stand and use a wall or table for support. Lift one leg and pull your foot towards your buttocks. Hold for five seconds, then release the foot and stand straight. Repeat six to ten times on one side, then turn and repeat on the other side. To stretch the hamstrings, sit with one knee bent and the other leg extended, toes pointing to the ceiling. Lean forward until you feel a stretch. Hold for five seconds then return to your original position. Repeat six to ten times on each leg. 3. Practice proper landing technique (from a jump) and learn to do cutting maneuvers in a crouched posture with a slight bend at the knee and the hip. If an ACL injury does occur, it can often be successfully treated. Both operative and non-operative treatment options are available. Non-operative treatment can sometimes be used if the athlete is willing to reduce her athletic participation. A sportswoman or athlete who wishes to return to sports that involve jumping, cutting, and pivoting will probably need surgery to reconstruct the ligament. This procedure is called ACL reconstruction. It stabilizes the knee, preserves the cartilage, and enables a return to sports at the same level as prior to the surgery. ACL reconstruction can be performed arthroscopically or by an open method. After surgery, exercise and rehabilitative therapy are required to strengthen the muscles and restore mobility. After a period of nearly six months, most athletes can return to their chosen sport.