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Brooke de Lench
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How Can We Reduce The Number of Knee Injuries In Female Athletes?

Submitted by Brooke de Lench on Sat, 05/31/2008 - 23:36.

The New York Times recently ran a thought provoking story by Michael Sokolove called The Uneven Playing Field . The long and short of the article was that the bodies of female athletes, especially their knees, are taking a beating playing sports.

I can speak personally about the knee injuries girls are now experiencing in epidemic proportions. Thirty six years ago, I tore my right knee cartilage playing college lacrosse. Two surgeries and three years later I tore my Anterior Cruciate Ligament (ACL) and fractured my tibia during a squash match, which required major reconstructive surgery. By the age of thirty I could no longer enjoy a game of tennis, a day of skiing or regular hikes without enduring some lingering pain. By thirty-five I no longer tried to run after my young triplet sons or jog with my dog. My knees were shot. Recently I exploded my ACL. Three consults later the general consensus was that I need a total knee replacement. I do not wish this on anyone and in the months to follow will ask each of you who have been affected to join in my national discussion.

There are three things we should do about sports safety. First, parents need to consider their child's full life cycle and be reminded not to sacrifice their child's long term health and well-being for short term athletic success. Second, youth sports safety reforms and comprehensive risk-management programs are sorely needed. Third, the United States needs to view youth sports safety from a child's rights perspective. As a society, we owe children playing sports, as in all other areas of their life, a duty of care. Best practices need to be identified, and child protection programs implemented to combat the physical, emotional and sexual abuse of our children in sports, as is done in Great Britain.

What can parents do to make youth sports safer? Three years ago I interviewed Holly Silvers, a physical therapist and the director of research at the Santa Monica Orthopaedic and Sports Medicine Research Foundation who co- designed the PEP program, an ACL injury prevention program in Southern California. The program utilizes a customized series of warm ups and stretching, strengthening and balancing exercises.

If more schools spent more time teaching girls the importance of strengthening their bodies and learning the importance of cross training & balance exercises I believe we would begin to see a drastic reduction in severe knee injuries among girls.

Do you have any ideas or thoughts on ways to reduce the epidemic of knee injuries among female athletes?

Please share your ideas with us.


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Safety Always First

Submitted by Kirk Mango on Wed, 06/04/2008 - 22:54.

Great point, "First, parents need to consider their child's full life cycle and be reminded not to sacrifice their child's long term health and well-being for short term athletic success." Never ever should winning or athletic success be placed above the long term health and safety of a child. I agree wholeheartedly that parents need to always keep this as priority one and run from coaches who do not do the same. I practiced this myself as an athlete, prioritized it as a coach, and insisted on it as a parent (which my kids hated because of their competitiveness).

Kirk Mango
Author: Becoming a True Champion

Brooke, there is no doubt

Submitted by John Dee on Tue, 08/19/2008 - 04:11.

Brooke, there is no doubt that girls are more likely to have serious knee injuries than boys, it's a proven fact. I'm not sure I totally agree with your assertation to just about forbid kids to play sports because of the potential of knee injuries. We have a generation of young people who are the heaviest ever due to lack of exercise,and you are pushing them to the sidelines.
Girls have more knee injuries because of their build. Yes, some stretching and muscle training may help some, but girls are still going to have more knee injuries. It's just the way they are wired. Also remember that many of the girls that have knee injuries, like you, were in an active sport where cutting and quick movements were necessary (basketball and lacrosse).
I have two kids who are active in sports. If one has a serious knee injury, knowing of today's great advances in therapy and rehabilitation, it would be very difficult to tell them they should not play basketball anymore because they may injure their knee again or they may not be able to walk very well in 40 years? Who knows what medical advances will bring in another 25 years? Brooke, if you would have injured your knee today instead of 36 years ago, you'd have a much different result.

There are several reasons for females having more knee injuries

Submitted by Kirk Mango on Wed, 08/20/2008 - 04:03.

Yes, girls are much more susceptible to knee injuries than their male counterparts. This became vividly apparent for me when looking at my daughters club soccer team (ACL injury is very common in soccer) during high school where 6 of 18 had torn their ACL' s and 4 of those tore both at some point in high school. My daughter was one of the 6 (and then blew out her ankle senior year).

In the process of finding a good orthopedic surgeon for her I started filtering through the research on this most common occurrence with girls. There are several research based theories that seem to indicate a multitude of possibilities.

1. Q Angle - the angle between the knee and the hip is much more pronounced in maturing girls than it is in boys. As girls mature and their hips widen for bearing children the angle between these two joints becomes greater thus putting the knee at risk to injury. Boys tend to have narrower hips and straighter more vertical lines between these two joints.

2. Muscle Contraction - Several pieces I read demonstrated how female athletes seem to have less neromuscular control than their male counterparts. They tended to use their quadriceps when landing, cutting, turning, jumping, etc. while their male counterparts had a better more evenly distributed use of both the quadriceps and the hamstrings. Anatomically, the quadriceps puts more pressure on the ACL while the hamstring tends to stabilize the joint. Basically, girls where much harder on their feet contracting the muscle that put the ACL at higher risk, without enough use of the hamstring for stabalization, than did the boys. This factor can be diminished with proper training.

3. Muscle Imbalances - Other information I came across pointed to the more common strength/endurance imbalances between the hamstring (stabilizer of the knee) and the quadriceps found in girls compared to boys. I would tend to think that this is due a lot to #2 above. Again, this puts the knee, and ACL, at greater risk to injury. This aspect can also be diminished through proper training.

4. Intercondylar Notch - It was also found that the notch where the ACL passes seems to be much smaller in girls than boys not allowing for the freedom of movement necessary in many aggressive cutting/jumping type sports. Basically, that this smaller notch increased the risk for an ACL tear in girls.

5. Hormones - The hormones responsible for the menstrual cycle also increase and decrease laxity of the ligaments in the joints of the body at different times of the month. This one is a little sketchy but is out there as a possible risk factor for ACL injury.

In addition, there is solid research that demonstrates the ability for girls to decrease their risk of knee injury through "proper" and "preventative" conditioning/training but a person has to be committed to such a program. I am also convinced that proper rest and nutrition can only help reduce this risk further. Something many pre-teens and teens seem to have much difficulty with.

Well, those are the things I found regarding more knee injuries in girls after my daughter had the issue with her ACL.

Lastly, my oldest had two serious injuries in high school, one being the ACL, the other her ankle. The ACL took 6 months post op to recover from and 1 year for her to be back at 100%. The ankle injury took about 8-10 months to recover from and most of her college career to reach prior levels of ability. The only thing I would have wished for is that she had listened to me in 8th grade when I told her that if she continued to want to play at the level she was playing at, and with reckless abandon, that she will need to spend some time on proper conditioning/training for injury prevention. Even though I absolutely hated, and stressed over, the fact that my daughter had to have two major surgeries to correct athletic injuries, I still truly believe in the benefits of sports participation for both girls and boys. To me, the advantages (and what can be gained intrinsically if the right lessons are taught) far outweigh the risks.

Kirk Mango
Becoming a True Champion