Girls and the Terrible, Horrible, No Good, Very Bad ACL Tear

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Proper training is a main component of prevention.

With the start of school just around the corner, parents are thinking about practices, uniforms, games, and scheduling.

But injuries are a low priority on the list (which they should be; we don’t want to think about the possibility of our children getting hurt).  However, after a long summer of fun in the sun, and probably a lack of training, sports injuries are going to be a reality.

We often associate ACL tears with boys who play football and basketball. Not often are we thinking of cheerleaders and dancers, volleyball and field hockey players, or cross country runners…especially when these athletes are girls.

Female athletes have a higher risk for ACL tears compared to their male counterparts.
Female athletes have a higher risk for ACL tears compared to their male counterparts.

Girls, especially during the teen years, are more susceptible to ACL injuries simply due to body type, an increased quadriceps to hamstrings weakness ratio and hormones. We cannot alter hormones, but we can strengthen the muscles surrounding the knees and teach good body mechanics to reduce the likelihood of an ACL injury.

Helping young people understand what the ACL is (1 of 4 major ligaments in the knee that provides stability) and how to prevent an injury (strengthen, improve balance, and proper techniques) are the first steps to prevention. But it can’t end there. Coaches and parents need to play an active role in prevention as well.

The main suggestions to girls to focus on during ACL prevention would be:

  1. “Soft knees” during landings
  2. General hamstrings strengthening to improve the ratio of quadriceps to hamstrings weakness (girls tend to be more weak in the hamstrings)
  3. Avoidance of a ‘knock-kneed’ position – females in general tend to have wider hips than men. When we stand with our feet together, the angle created between the hip and the knee is higher for girls – when bending knees to initiate a jump or when landing, don’t allow knees to touch
  4. Improve balance
 Physical therapy is an important step in recovery from an ACL injury.
Physical therapy is an important step in recovery from an ACL injury.

Below are some specific examples of exercises and activities that will aid in reducing the risk of an ACL injury.

  • Land softly on the way up and way down during box jumps (or when dismounting from a stunt or saut de basque move)
  • Position the knee into an outward stance during dynamic movement patterns or jumps to strengthen the outer hips & improve “knock-kneed” positions by performing squats with a theraband around the outer thighs and keeping the tension throughout the movement.
  • So much of sports is balance. Any kind of liberty or arabesque stunt in cheerleading requires significant balance. Do things in training to improve or at least maintain balance: Stand on 1 foot on an unlevel surface (foam, BOSU, etc), stand on 1 foot and perform calf raises, stand on 1 foot then extend foot to the side into a lunge and then return to standing on 1 foot
  • The increased hip/knee angle can lead to patellar (knee cap) tracking issues – focus on keeping alignment between hips, knees, and feet
  • Do a quarter squat and then walk both forward and sideways – this will train the muscles and joints to be in a flexed position when both feet are planted on the floor
  • Use strap around knees/thighs and keep taught for up to 1 minute – this will help to keep the knees from touching during activities
  • Plyometric lunges and squats will incorporate the strengthening, soft knees, and balance/control

Most ACL injuries are due to non-contact events, meaning they are not caused by one athlete colliding with another; the injury often results from an awkward landing, a pivoting motion of the knee while the foot is planted, or hyperextension of the knee.

Parents, coaches, and athletes all need to be aware and diligent in avoiding ACL injuries with our young, female athletes.

Like this post? Check out these from the experts at Tidewater Physical Therapy, Inc.

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