Brief Overview

After reviewing a good deal of research on this topic, I have highlighted the key issues surrounding the female athlete and ACL injuries.  Conclusive data is beginning to suggest that a change in training regime could potentially reduce ACL injury in female athletes. Some experts argue that most ACL injuries may be sport-specific instead of sex-specific and the extrinsic factors such as training and conditioning and socialization into sport should be the focus of more study.  Research is also showing that the intrinsic factors (anatomical differences) can be controlled with a female specific training and conditioning program.

Why are women more susceptible to ACL injuries?

• Girls generally become involved in athletics later in life than boys.


• Females are entering the athletic arena without an extensive history of athletic participation and without a high level of training or conditioning as compared with males.  Training histories are almost always very different from the histories of male athletes.  For example, young boys can start playing youth football at the age of 5; the girls are standing on the sidelines cheering.  Girls are late with coaching and late with conditioning or participation in contact sports.


• Different social expectations are placed on young boys’ participation in sports, compared to the social expectations placed on young girls.  Girls are still pushed to pursue feminine activities like dance, cheer and synchronized swimming.  These expectations result in different degrees of conditioning in girls and boys.


• Girls are less understood and less well studied compared to boys, especially in the areas of performance factors, repetitive stress and acute injuries.  Further research about hormonal causes needs to be done with female athletes who have been participating in a training regime designed to prevent ACL injuries.  Also, future studies must account for the subjects training history and first involvement in sporting activities.


• There are anatomical differences between men and women; however, these differences can be irrelevant when female athletes take on a different training regime.


• Female athletes tend to be “ligament dominant.”  This suggests that a woman doesn’t support her landing with her knee musculature but rather she lets the knee go out until the ligament picks up the slack.  Training and conditioning can resolve ligament dominance.  


• Girls and women have been subjected to the “male” model of training and conditioning, however, this model may not be the appropriate model, given the very different training histories of men and women earlier in life.


• Girls/women are playing sports with boys/men and possibly not with a competitor of comparable strength, size and skill level.

How can we prevent ACL injuries in women?

• Take a more proactive approach to training to prevent injury.  Start conditioning programs earlier in a girls’ sports career.


• Sports-specific conditioning.


• Need exercise programs that balance the hamstring to quadriceps strength ratio while increasing dynamic joint stiffness thus reducing strain on the ACL.  Train for sound muscular structure to support the knee.  Develop proper landing technique.


• Training programs must account for neuromuscular insufficiencies and develop proper technique to significantly decrease the ratio of ACL injuries in female athletes.  Teaching women proper technique for planting, cutting and pivoting has shown an 89% decrease in ACL injuries.  Plyometric training decreases possible factors and the rate of incident four-fold.


• Interventions that improve muscle firing patterns around the knee and specific landing and stopping techniques have been shown to reduce the risk of non-contact ACL injuries.


• Proprioceptive training programs are a key to preventing ACL injuries

To find related articles, go to: Reasons Why Women Should Train Differently Than Men, or ACL Injuries

REFERENCES

1. Arendt, Elizabeth and Griffin, Letha 2000. “Musculoskeletal Injuries,” Women in    Sport: Vol VIII of The Encyclopedia of Sports Medicine. Barbara Drinkwater, ed. Oxford: Blackwell Science. 37-61.


2. Croissant, Jennifer, Schmit, Emily, 2007. Misplaced Focus: Assumptions about Sex Hormones and ACL Injury in Female Athletes, Journal of Interdisciplinary Feminist Thought. Women and Science. Vol. 2/Issue 1/Article 2.  Retrieved from: http://escholar.salve.edu/jift


3. Griffin, Letha Y. et al (2000), “Noncontact Anterior Cruciate Ligament Injuries – Risk Factors and Prevention Strategies,” Journal American Academy Orthopedic Surgery. 8(3):141-50.


4. Hewett, Timothy (2000). “Neuromuscular and Hormonal Factors Associated with Knee Injuries in Female Athletes: Strategies for Intervention,” Sports Medicine. 29(5): 313-327.


5. Holschen, Jolie, C (2004), “The Female Athlete,” Southern Medical Journal. 97(9): 852-857.


6. Hutslar, Jack (1999). “Youth Sport Participation in the Triad,” Sport Scene: Focus on Youth Programs. North American Youth Sports Institute. 15(2). Available at http://www.naysi.com/sport_scene/sport_scene15_2.htm#Youth%20Sport.


7. Mees, Patricia (2003). “The Ripple Effect of Title IX on Women’s Health Issues: Treating an Increasingly Active Population,” The Physician and Sports Medicine. 31(4). Available at http://www.physsportsmed.com/issues/2003/0403/spotlight0403.htm.


8. Metz, Guillermo (1999). “Restoring the Balance: A jump-training program that focuses on controlled landings, strengthening the hamstrings, and proprioception show promise at preventing ACL tears,” Training and Conditioning. 9(3): 10-19. Available at http://www.momentummedia.com/articles/tc/tc0903/restorbal.htm.


9. Schnirring, Lisa (1997). “What’s New in Treating Active Women,” Sports Injuries SourceBook. Heather Aldred, Ed. Detroit: Omnigraphics. 261-270, 1999.


10. White, Klane et al (2003). “EMG Power Spectra of Intercollegiate Athletes and Anterior Cruciate Ligament Injury Risk in Females,” Medicine and Science in Sports and Exercise. 35(3): 371-376.


11. Wojtys, E.M., L.J. Huston, T.N. Lindenfeld, et al. (1998). “Association between the menstrual cycle and anterior cruciate ligament injuries in female athletes,” American Journal of Sports Medicine 26(5):614-619.