Females and ACL Sprains

In a continuation of our female athlete series we will focus on their predisposition to of suffering ACL sprains.
To start a quick overview of the role of the anterior cruciate ligament (ACL) in the body and why it is important to athletes.  The cruciate ligaments in the knee form an X the ACL starts in the front of the knee while the PCL starts in the back, together they prevent back and forth movement of the knee.   ACL sprains can typically without contact.  A quick deceleration, hyper-extension and typically with a change of direction.
So if we all have ACL why are female athletes more prone to suffer an injury. There are both intrinsic and extrinsic factors.

Intrinsic factors include:

Alignment
Large Q Angle
Q angle is the angle formed by a line drawn from the ASIS to the central patella and a second line drawn from the central patella to the tibial tubercle. In females the average angle is 17 degrees compared to males at 14 degrees.  The increase in this angle puts more stress on the structures of the knee and comes from females typically having wider hips.

Hyper-extension
The alignment of the femur onto the tibia can predispose females to hyper-extension of the knee putting them in a position that is already causing stress on the ACL.  Any further extension pushes the ligament beyond its tensile strength.

Hormones
There are studies showing that joint laxity increases during the pre-ovulatory phase of the menstrual cycle.  The sex hormones estradiol, estriol, and progesterone all rise in this stage causing an increased laxity in the joint.

Extrinsic Factors:

Strength
Females have a tendancy to have a low hamstring to quad strength ratio, meaning their quadriceps are stronger than their hamstrings.

Shoes
The type of shoes and surface playing on can increase the likely hood of an ACL injury.  The proper type of footing is required.  Wearing outdoor soccer cleats during indoor season will more than likely place a female in danger of suffering an ACL sprain.  This is caused by the cleat getting caught on the playing surface causing torsion of the knee.

Combined Factors:

Propioception
This is the body knowing where it is in space.  An example of this is being able to touch your finger to your nose.

Sport Specific Skills
Having the appropriate skills needed to compete at the given level of competition goes along way towards injury prevention.

Prevention:

The use of ACL prevention programs has shown to decrease injuries up to 88%.  These programs typically are around 15-20 minutes long.  They will consist of a dynamic warm up, the use of plyometrics and propioceptive exercises.  These programs can be used as your teams warm up.  The strength portion focuses not only on the lower leg but strengthening the core as well.

Females are 2 - 10 times more likely to suffer an ACL injury compared to their male counterparts.  Intrinsic factors can not be changed, however extrinsic factors such as strength, propioception, and the type of shoes being worn can be dealt with either by implementing an ACL prevention program or by being aware what shoes are appropriate to the surface that participation is occurring on.

Please follow us on Twitter @EliteInjuryMgmt and check out our website www.eliteinjury.com

References used for this post:

William Romani, Jim Patrie, Leigh Ann Curl, and Jodi Anne Flaws. Journal of Women's Health. April 2003, 12(3): 287-298. doi:10.1089/154099903321667627

Clin J Sport Med. 2009 Jan;19(1):3-8. doi: 10.1097/JSM.0b013e318190bddb.

Mandelbaum BR1, Silvers HJ, Watanabe DS, Knarr JF, Thomas SD, Griffin LY, Kirkendall DT, Garrett W Jr.Am J Sports Med. 2005 Jul;33(7):1003-10. Epub 2005 May 11.

http://www.aaos.org/news/aaosnow/nov10/research3.asp

Dr. Connie Lebrun, Considerations for the Female Child Athlete

Female Athlete - Their Why

The why.  This is extremely important to all who participate in sport.  It is what gives athletes their drive and purpose.  They why can change from beginning to end but performance can be effected if it is not truly from within.  With the female athlete, their reasons to start participation vary especially from their male counterparts.

Friends are one of the greatest reasons for females to start sport participation.  The adage if your friends jumped off a bridge would you?  Holds true in this case.  Many young female athletes either start participating in sport as a group of friends or because their friends are already involved.  Compared to their male counterparts females are not inclined to join a sport group or team by themselves.  They also are more likely to quit if they no longer have friends at sport or if they become bullied in any way.

Both male and female athletes feel a lot of pressure from family to participate, the female athlete however more so.  Females see it as a sense of duty to their family to participate, whether they are happy or not.

Females will choose to participate in sport as a means of exercise and weight loss, especially as they grow older.  This is one of the main reasons for females past their teenage years to restart or start participation in sport.

Another difference between males and females is the desire to compete.  Females will continue in sport participation not due to the competitive drive of beating their opponents but the internal drive of accomplishing the task and improving themselves.  This is one of the main points that keep females involved.  They want to continually improve themselves.  The sense of accomplishment over weighs that of besting their opponent if there is one.

One thing that everyone involved with female athletes needs to keep in mind is that their is a higher drop out rate compared to males.  We need to remove boundaries that interfere with female participation in sport.  Be it gender biases, the emphasis on the body or sport stereotypes, we need to encourage females to participate in sport.

Intro to the Female Athlete

The female is a complex being turn that female into an athlete and you have made her even more complex. The female athlete provides many challenges to the coach, parent and athletic therapist.  To fully understand the female athlete will take more than this one post.  Today will be an overview of future topics and if you feel I am missing one or want me to talk about something specifically let me know as not all athletes are the same.

Female Athlete Triad, simply it is the combination of disordered eating, amenorrhea, and osteoporosis.  It is a vicious cycle that starts with disordered eating and progresses.  No sport is exempt from this as it is typically seen as an aesthetic or performance sport issue.

Anterior Cruciate Ligament Sprains, this ligament helps prevent anterior translation of the tibia relative to the femur.  In more simplified terms it stops the lower leg from moving forward compared to the upper leg.

Disordered Eating,  detrimental effects on energy levels do not require an athlete to have a diagnosed eating disorder such as Anorexia Nervosa or Bulimia Nervosa, the slightest change in energy intake for the athletes energy output will place unnecessary strain on their body.

Physical characteristics, the differences between males and females can predispose females to injuries that their male counterparts may not experience.  These characteristics may also predispose the athlete as to what sport or position they may participate in.

Why the participate?  The reason for female participate in sport varies depending on the individual however there are some constants.  Friend participation both effects the reason to start sport participation as well as when females decide to no longer be involved.

One of the new areas of study on the female athlete is in the area of concussions.  Still in its infancy we are learning a great deal about how females react to a concussive injury and if there is differences from their male counterparts.

As a parent or coach it is important to understand how to deal with the female athlete.  Learning how to deal with them will give both you and them an advantage on their path to success.