Women and Sports in the United States: A Documentary Reader

WOMEN AND ACL INJURIES

y WOMEN AND ACL INJURIES Taking the Bad News with the Good Maureen Madden, PT, CSCS The Bad News The statistics are impressive. Women are two to eight times more likely to sustain an ACL tear in sports that are at the highest risk such as basketball and soccer. The incidence of significant knee injury among females is roughly five times higher per player per hour than for males. The volume of injury is significant. It is estimated that 350,000 ACL injuries occur annually in the U.S. alone. More of those injured will still be men by virtue of a greater number of male participation in sports. The data suggests that women who choose to participate in sports are taking a greater risk than men. With the help of Title IX in 1972 and the trend of adolescents to participate in a single sport year round, the number of women and the level of competition in many sports continues to rise. There is no sign of a slowdown in female athletic endeavors, nor should there be. The increasing interest and study in the causes of this disparity among men and women is helping lead to discoveries that can benefit both male and female athletes. Early research was primarily focused on the anatomical and hormonal differences among men and women. Unfortunately, the studies have not led to obvious answers or methods of injury prevention. Although differences exist, ultimately there would be no reasonable course of action available to change one’s anatomy or biochemistry for the sake of basketball . For example, there have been studies on the relationship between femoral notch width to ACL injuries with conclusions that smaller notch width (which on average is smaller in women) shows a higher incidence of unilateral and bilateral ACL tears. There have been studies about the relationship of ACL injuries in women and the menstrual cycle. Wojts et al. found that women are three times more likely to injure their ACL during ovulation (when levels of estrogen peak) than during other times of their cycle. Others along similar lines include studies showing greater joint and ligament laxity in women. However, none of these studies could conclusively find a direct relationship to increased ACL tears. Competing Bodies 125 From the Web site of The Stone Clinic, 21 March 2003, http://www.stoneclinic.com /acl_womenbadgood.htm. 126 WOMEN AND SPORTS IN THE UNITED STATES Additional anatomic differences can be more easily observed. On average , women have greater pelvis widths, a larger “Q angle,” greater hip varus, hip ante version, knee valgus and foot pronation. All combined, these biomechanics may put the ligament at a disadvantage even before any jump or landing is ever made. The exact effect that these characteristics have individually or in combination on ACL vulnerability continues to be explored, but may help identify risk factors. Again, other than possible orthotic intervention in some cases, or the unlikely result of “quitting soccer because of my Q angle,” little else can reasonably be done to influence these anatomical traits in women. The Good News The most encouraging aspect of the bad news about ACL tears is that 70% are noncontact injuries. This can be viewed with optimism because it says there may be something we can do about one aspect of the problem at a neuromuscular level, rather than hope to accomplish an impossible task by trying to control outside forces such as a tackle from another player. Since there has been no solid evidence to support the benefit of prophylactic bracing for knee injuries, neuromuscular training had to be looked at. In the neuromuscular arena, women appear, yet again, to have a general disadvantage. There have been reports of women having electromechanical delay in muscle recruitment, poor hamstring recruitment patterns , and less functional joint stiffness (the stability of the joint brought about by muscular constraints). Others have noted less hamstring and gluteus medius activation in females than males. Still others have noted the functional outcome of all these factors seems to be that women tend to use less hip and ankle musculature during sport, therefore, exposing the knee and ACL to greater amounts of uncontrolled movement. ACL injuries appear to occur most frequently during deceleration activity such as a sudden stop, change in direction, or landing from a jump. Therefore, eccentric strength and proprioception play a critical role. Both are factors that can be influenced substantially through training. The answer is not simply sport speci...