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

So You Made a Resolution

How many of us have made to lose weight by exercising more.  A great way to better yourself and improve your health.  We are half way through January and are starting to reach the point where people are faltering with that resolution.

One of the keys to maintaining a lifestyle change such as working out is to ease into it.  Not only will it easier to have this change be a lasting one, it will be more beneficial to the body.  When you push yourself too fast to soon you put yourself at risk of injury and not maintaining your exercise program which can lead to fluctuating weight.  We are going to focus on the injuries that can occur by doing to much to soon.

There is an increased risk of musculoskeletal injury when taking on a new exercise program to quickly.  Moderation is a key when starting out or changing your exercise program.  The exertion that you are putting on your body is more than it is used to which can lead to injury.  Typical injuries that you may experience when starting out with an exercise program are muscle soreness, muscle strains and depending on your choice of exercise you may see ligament sprains.

Muscle soreness is typical with physical exercise and typically is called DOMS - delayed onset muscle soreness.  DOMS is normal with workouts, and occurs one to two days after exercise.  If the pain is severe or lasts for longer than two days, you have progressed from normal muscle soreness to muscle damage.  If the pain is so severe that you our unable to complete daily tasks such as walking or lasts longer than the normal two days, you need to make a change to your program.  This also applies to any time you make a change to your work out.  For treatment of DOMS the best way to reduce pain is to continue with moderate exercise.  Stretching, cryotherapy and massage therapy have not shown to be beneficial in the reduction of pain from DOMS.  One of the best ways to deal with DOMS is to alternate your work out, by giving the muscle groups a day or two of rest before training them again, you allow the body to heal/repair from the prior work out.

Muscle strains occur when the muscle is taken beyond its normal capacity be it load capacity or range of motion.  These typically occur when using too much weight or performing a move that requires flexibility that you have not gained.  If you have taken up strength training, yoga or classes such as Zumba, you may be more prone to a muscle strain if you do not pay attention to your body.  Slow and easy is the best rule of thumb when starting a strength program. When doing exercises that involve flexibility or doing a movement that goes beyond your norm, pain is your guide.  If the movement hurts, stop.  Find a way to modify the movement, but continue to work on building towards completing the movement properly.

A ligament sprain can occur during weight lifting, running, or during activities such as Zumba, dance, soccer or even yoga.  You typically will not see them if you are cycling, running on a treadmill, rowing or using an elliptical machine.

As part of a complete exercise program, you need to have a flexibility and propioception portion.  A full body stretching program will help alleviate any muscle imbalances caused by improper posture.  Propioception is knowing where you body is in space.  By working on balance and proper positioning you reduce the chance of injury. Think of a volleyball player coming down from a block, if as they land their ankle starts to roll, an athlete with propioception training body will notice this and activate the muscles to avoid the injury.

Setting the goal and resolution of losing weight is an admiral one that will only be of full benefit if you are able to continue with it and avoid injury.