A female soccer player is bringing the ball down the field in a high school match. Her opponent leaps to block a pass, and as the defender lands, she hears a "pop," followed by a telltale pain in her knee. Just like that, she's torn her anterior cruciate ligament (ACL), and she'll need surgery and six to nine months of rehabilitation before she can return to the field.
ACL Tears Among Female Athletes
While athletes in soccer, basketball, baseball, and a number of other sports commonly injure their ACLs, the greatest number of ACL injuries occur in females between the ages of 15 and 19. According to the National Institutes of Health (NIH), young female athletes are two to eight times more likely to tear this ligament than their male peers.
What Is the ACL?
What exactly is this critical ligament, and why is it so vulnerable to injury? Ligaments are fibrous connective tissue that attach one bone to another. They usually hold joints together and keep them stable.
When it comes to the knee, four ligaments hold the joint in place, each playing a key role. Two -- the medial and lateral ligaments -- are on either side of the knee, while the posterior cruciate ligament and ACL run through the center of the knee. The ACL is therefore key to keeping the knee stable.
How Does the ACL Get Torn?
Nearly 80 percent of ACL injuries happen when an athlete is stopping suddenly, jumping, or changing direction. These injuries usually occur without any contact from another player.
However, this doesn't explain why females are more prone to tears than their male peers. Numerous researchers have sought to understand why young women are more at risk of this damage, and there are quite a few opinions. Most theories focus on two areas: landing techniques and the differences in women's bodies.
Poor Landing Techniques
In the Journal of Athletic Training, researchers point to the "knock kneed" landing position of many women as a risk factor for ACL tears. According to the research, women's knees tend to bend inward toward each other during landing -- women are 3.6 times more likely than men to land in this manner. NIH notes that flat-footed landing (versus landing on the balls of the feet) could also contribute to the knee buckling and tearing the ACL.
Another study found that female athletes tend to keep their trunk and hips in a more erect posture than men while running and jumping, and this could contribute to females' higher propensity for ACL injuries.
Differences in Physique
Some research has also suggested that women's wider hips make it more likely that their knees come together after jumping. Without belaboring the differences in body type between men and women, the American Academy of Orthopaedic Surgeons pointed to a difference in knee structure that was not entirely gender-specific. When the upper part of the shinbone at the joint is shorter and more rounded, the individual is more prone to ACL injury. In the study, most women -- and many of the men -- with ACL injuries had this irregularity.
Preventing ACL Injuries
Most athletes are able to return to activity after an ACL injury, but the recovery process is not easy. With the right exercise program, however, athletes can reduce their chances of an ACL tear while improving their performance. The Osteoarthritis Action Alliance has compiled one such exercise regimen.
Most exercise programs designed to reduce ACL injuries emphasize the following:
- Stretching of the hip and leg muscles.
- Warming up with a mild jog, side shuffle, arm swings, or leg swings.
- Strengthening with push-ups, curl-ups, squats, and lunges.
- Practicing plyometrics -- also called jump training -- such as double- and single-leg jumps, ladder drills, running, and cutting.
- Seeking feedback from a trainer or exercise coach to ensure these preventive measures are being performed properly.
If you know a young female athlete who might be at risk for ACL injury, what are you waiting for? Get them to work on strengthening their lower body and softening those landings. If they get moving on preventive measures, they'll be best positioned to make the most out of their young athletic lives.