More women and girls than ever are participating in competitive sports. But emergency department statistics indicate that female athletes are more susceptible to tears of the anterior cruciate ligament (ACL) than males are.
In fact, female athletes tear their ACLs at an alarmingly higher rate — 2 to 8 times more frequently — than male athletes. For example, according to the National Institutes of Health, the incidence of female to male ACL injuries is 3.5 times greater in basketball and 2.8 times greater in soccer.
How Do ACL Injuries Occur?
The ACL is one of the main ligaments that stabilizes the knee joint. It connects the femur (thighbone) to the tibia (shinbone).
A non-contact ACL tear usually happens when an athlete makes a rapid but awkward stop in anticipation of a lateral movement.
ACL injuries tend to happen when athletes are decelerating, changing directions, or landing. During these maneuvers, female bodies may move differently than male bodies, putting them at a higher risk of injury.
The hamstring muscles in the back of the leg and the quadricep muscles in the front work together to move the leg. When you bend your leg, the hamstring muscles contract, and the quads relax. Conversely, when you straighten your leg, the quads contract and the hamstring muscles relax.
Female athletes can take steps to strengthen their hamstrings and use different body mechanics to get back to playing after an ACL injury.
The same steps that can help them recover from an ACL injury can also help prevent the injury altogether.
“ACL prevention, especially in young female athletes, is important because of the high risk of ACL injury women have compared to their male counterparts,” says Bryson Lesniak, MD, an orthopaedic surgeon specializing in sports medicine at UPMC. “Research has shown the use of proven ACL prevention programs can significantly reduce the risk of injury and keep young women out on the field/court.”
During evaluations through the ACL Program at UPMC Sports Medicine, athletes are asked to stand up on a box and jump down and land, or jump down, land, pivot, and run.
Oftentimes, when women and girls jump down, they tend to land knock-kneed with straighter legs, while men and boys land with knees straight out and more bend in the legs. But when female athletes are taught a different way to land on their feet, we can treat the movement that’s putting them at risk.
How Can Female Athletes Prevent ACL Injuries?
One way for female athletes to reduce their risk of ACL tears is to build and maintain leg strength year-round — not just during their sports season. Exercises the UPMC ACL Program recommends include:
- Quad sets.
- Straight leg raises.
- Backward leg raises.
- Hip abduction.
- Squats.
- Wall sits.
- Reverse lunges.
- Bridges (short leg and long leg).
- Planks and side planks.
“An ACL prevention program can help prevent injury and reinjury after a reconstruction,” says Dr. Lesniak. “There are several evidence based formal programs that can be followed with a performance trainer or coach, or even as a home program. It is important to note that these programs can minimize risk but do not entirely remove the risk of injury to the ACL.”
Early sports specialization can increase the risk of girls and women sustaining ACL injuries.
“The best advice is to not specialize in a single sport but rather play a variety of sports,” says Dr. Lesniak. “In addition to that, incorporate ACL prevention exercises into your normal work-out routine.”
Playing different sports at a young age diversifies the training of both the muscles and the brain, which helps the athlete grow stronger all over.
Top 3 Tips for Preventing ACL Injuries
There are steps you can take to reduce your risk and help to prevent ACL injury:
- Become a multisport athlete.
- Respect the three Rs: rest, recovery, rehydration. No one can train seven days a week — not even the pros, so make sure to give your body time to rest and recover.
- Enroll in an ACL injury prevention program or go online for a good app. Spend a few minutes per day doing prevention exercises, such as the Nordic hamstring curl.
The Nordic hamstring curl is an eccentric hamstring curl, which means that the hamstring muscle gets longer but stays active during the exercise.
To do the Nordic curl, kneel down on a mat and have your partner hold your ankles down on the floor. (If doing this curl on your own, put your ankles under a loaded barbell or other immovable object.)
Keeping your body straight, lean forward from the knee (not the hip) toward the floor as close to the floor as you can without using your arms or hands. Move slowly and with control. Only put your hands out in front of you on the floor when you can no longer hold yourself up with your legs.
Then, push yourself back to the starting position and repeat. Count how many you can do and try to add a rep each time you do the exercise.
