Female Atletes and ACL Injuries

Female Athletes More Prone To ACL Injuries
By Simeon Margolis, M.D., Ph.D.

One of my granddaughters is a high school long-distance runner and another granddaughter plays just one sport (soccer) almost year round. So I was interested in an article by Michael Sokolove in the May 11 issue of The New York Times Magazine titled, "The Uneven Playing Field."

The greater involvement of American women and young girls in athletics largely stems from an important federal law, Title IX, which was enacted in 1972 to guarantee equal opportunities in sports for both men and women.

The downside of such participation is that now girls, like boys, may suffer ankle, back, and head injuries. Of particular concern to young athletes, however, is a tear or rupture of the anterior cruciate ligament (or ACL), 1 of 4 major ligaments of the knee, and the one most commonly injured.

Football fans hear of ACL injuries to their favorite players, often the result of a direct blow to the knee. But these injuries can occur without any contact or unusual happenstance. For example, the ACL can be damaged when the knee is twisted on landing, or when a foot is firmly planted on the ground but the player's body is forced to rotate.

An ACL tear or rupture is not only quite painful but often ends up needing a surgical repair or reconstruction, followed by a rehabilitation period of 6 to 9 months before a return to competition.

Researchers have determined that girls rupture their ACLs 5 times more often than do boys, even when competing in the same sports — soccer, basketball, and volleyball. This difference may be due to hormonal changes at puberty, when testosterone causes boys to add muscle and grow stronger, though less flexible. By contrast, increased estrogen in girls tends to add more fat than muscle, so that their ligaments, although more flexible, are surrounded by less protective muscle.

Based on what I hear from the parents of our 12-year-old, soccer-playing granddaughter, young girls are apparently getting pressured more and more to play longer and harder, in more and more tournaments. The result is that these youngsters have too many opportunities to get hurt and too little time to recuperate from their injuries.

Just as worrisome, youngsters are urged to concentrate on one sport, so as to increase their chances of standing out. This specialization means that the same groups of muscles and ligaments will be getting the punishment throughout the year. When I was growing up, we played different sports each season, and the muscle stiffness on switching from one sport to another made it apparent that each sport puts the greatest strain on its own particular muscle groups.

What can be done to prevent ACL and other injuries in young girls?

They need:

-to start at a young age with vigorous exercise to gain muscle strength
-to be taught proper stretching and balancing exercises
-to receive less pressure from coaches and parents to spend excessive time and effort on a single sport
-to be given more freedom to try as many sports as they want, so the same group of muscles and ligaments will not be subjected to stress year after year