By Andrea Downing Peck
FEMALE ATHLETES HAVE an unwelcome
advantage over their male counterparts in one
statistical category: the number of anterior
cruciate ligament (ACL) injuries.
ACL injuries typically occur when an athlete stops and changes directions suddenly or
lands a jump, making the knee injury most
common in sports such as soccer, basketball,
football and volleyball. An estimated 300,000
ACL injuries occur annually in the United
States, with girls two to eight times more
likely to rupture this ligament, which connects the thigh bone to the shinbone and stabilizes the knee joint. A torn ACL usually
requires reconstructive surgery and a six- to
12-month recovery period before an athlete
can return to his or her sport.
The exact reason women and girls are
more prone to ACL injuries remains elusive.
While anatomical differences between men
and women often are cited—for example,
women have a wider pelvis, meaning the
angle of a female’s thigh bone puts more pressure on the inside of the knee—researchers
are zeroing in on a handful of neuromuscular
factors to explain why women and girls may
be more at risk for non-contact ACL injuries:
; When cutting, running and jumping,
women and girls exhibit less upper-body control, putting more stress on the knee joint.
; Women and girls rely more on the leg’s
quadriceps muscles when decelerating, rather
than a combination of hamstrings, glutes and
; Women and girls often land jumps in
a knock-kneed position.
; Asymmetrical leg strength makes
women and girls more likely to injure their
“There are multiple factors, and researchers have been trying to figure out what the
for your health
© CORBIS / AGE FOTOSTOCK
Acrucial matter Making ACL injury
prevention the goal
most important factor is, but we probably need a risk-ratio equation,” says Dr.
Mary Lloyd Ireland, a University of
Kentucky–based orthopedic surgeon
who specializes in sports medicine
and injury prevention. “In my opinion,
the most important factor is core stability
and being able to control your landing patterns from the abdominal, back and hip
Prevention is key
That’s where ACL injury prevention
programs come in. Prevention programs can
be particularly beneficial for female athletes
because they focus on neuromuscular
retraining and increasing core strength, agility and coordination.
“I call it driver education,” says Dr. Frank
Noyes, whose Cincinnati SportsMedicine
Research and Education Foundation has
developed a scientifically proven ACL pre-vention-training program. “That’s what
Sportsmetrics does. We don’t oversell it. We
don’t say we are going to prevent every ACL
injury, but we have statistically shown you
can reduce the ACL injury rate” among
female athletes to a level comparable to male
athletes playing the same sports.
Sportsmetrics involves 90 minutes of high-intensity strength and flexibility training, plyo-metric jumping, sport-specific agility drills and
cardio workouts performed three times a week
for six weeks. During the season, exercises are
incorporated into daily warm-ups.
Coaches, however, often are reluctant to
dedicate large chunks of time to injury prevention, so they turn to less time-intensive
options. The Santa Monica Sports Medicine
Foundation’s Prevent Injury and Enhance
Performance program is one proven option.
This strategic training program also targets
female athletes but is condensed into 20-min-
ute warm-up sessions performed two or three
times per week.
Seattle Pacific University assistant wom-
en’s soccer coach Arby Busey, who also
coaches for one of the Seattle area’s largest
says he incorporates
aspects of different pre-
vention programs into
his practices. He believes
prevention programs are
paying dividends throughout
The Costco Connection
Costco and Costco.com carry a variety of
exercise equipment, as well as medications,
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Looking at the long term
Noyes, however, is concerned that
coaches are looking for a “quick fix” and fail
to include all the components necessary for
prevention training to be effective.
“The biggest mistake we find is the inten-
sity of the jumping routines is not there,”
Noyes says. “The second thing is they don’t
have an instructor who says to the female ath-
lete, ‘Here’s how you do it.’ If you jump a thou-
sand times, but every jump is incorrect, it
doesn’t make any difference.”
There is no way to prevent all ACL inju-
ries, but Timothy Hewett, director of research,
Ohio State University Sports Medicine, is con-
fident fewer female athletes will be sidelined if
high school and youth sports programs make
prevention an integral part of training.
According to Hewett, a Costco member,
“Potentially, if we can get these programs
instituted, we have the opportunity to drop
the number of ACL injuries by 50 to 60 percent, which would be a huge reduction.” C
MAY 2013 ;e Costco Connection 83
Andrea Downing Peck is a freelance writer
from Bainbridge Island, Washington.