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

Working with High Performance Minor Athletes - Part 2

Please check out part one of Working with High Performance Minor Athletes

It does not matter if the athletes are male or females, hormones are going to effect your interactions with them each and every day.  They effect their moods, their body, how they recover from injuries both physically and emotionally, how they react to their teammates, training partners and coaches.  I will break the myth right now, it is not only girls who cry and not only boys who want to hit things.  If you are dealing with young elementary aged children, they are still learning how to deal with disappointment, loss and success.  As the athletes grow older they are starting to discover who they are, and are having more expectations put on them.  Their role in sport can start to define them, if this role is suddenly changed, they may find it hard to cope.  You typically become their ally or enemy. If this role change occurs due to an injury, they see you as an enemy because you are what is holding them back.  If it is a coaching choice that changes their role you become the ally, they see you as someone to turn to who understands what is going on.  Typically at this age their relationships with their parents are changing and they may not feel they can go to them, you become their constant who they can trust.  It is this trust that will help you get through the enemy stage.  If you have built the trust when the time comes for you to remove them from play you remain their ally.  When removing an athlete from activity be prepared for anything.  As I said earlier girls hit and boys cry, you are messing with their identity in their minds, and they each have their own way of showing it.

At times you feel like a glorified babysitter.  You are the first one there, the last to leave, you pick up after the athletes, find out who's parents are always late, and do the room checks because the coaches are having strategy sessions.  Due to all this you become the gate keeper, you learn which athletes like to toe the line, which ones like to step over the edge a little and the ones who will ask you later "what line?"  Many coaches like to think they have their finger on the pulse of their athletes, but truly it is the Athletic Therapist.  We see all, here all and usually end up cleaning up the mess.  With minor aged athletes you try to help them keep the messes to a minimum, you become the teacher again in guiding them as to right and wrong.  You would be amazed at what these young minds can come up with to do on road trips.

For everyone involved in minor sports at a high level, we all must remember that these athletes are still kids.  Even as an Athletic Therapist it is hard.  We are trying to give them the structure and guidance they need to succeed.  Nutrition plans, treatment schedules, and expectations of how to act in the clinic or treatment room.  Let the kids be kids.  They will try to eat poutine before a game, use your athletic tape for their sticks and you will go through about ten sets of nail clippers each season.  It all becomes worth it though when they do something to show they have been listening, or when the truly show they care by carrying the treatment table and medical kit.  No matter the age of your athletes it is important to treat them all with respect and have their long term health and wellness in mind, because at times you will be the only one worrying about that.

Please follow us on Twitter @EliteInjuryMgmt  and our webpage at www.eliteinjury.com