NOVEMBER
13, 2000 VOL. 156 NO. 20
On
Bended Knee
More girls
are tearing ligaments in their knees. Here's what they can do to prevent it
BY
IAN K. SMITH, M.D.
Grizzled old
jocks sitting around the training room comparing war stories and showing off
battle scars are as familiar in organized sports as jockstraps and body odor.
Today, however, with female sports participation at an all-time high (2.5
million high school girls and 145,000 college women will compete this year),
the athletes telling war stories are more likely to have smooth faces and wear
sports bras. The injuries have also changed. One in particular has sports
doctors worried.
It's a knee
injury--damage to the anterior cruciate ligament, or ACL. As increasing numbers
of young women lace up their cleats and head out onto the field, more are
showing up in infirmaries and operating rooms with a partly torn or completely
ruptured ACL. This is a lot more serious than an ankle sprain or a jammed
finger. The ACL is the knee's most important stabilizer and if severely injured
can require surgical repair and cause permanent, perhaps career-ending damage.
Several studies
have shown that women are considerably more vulnerable than men to ACL injury.
By some estimates, they suffer this injury two to eight times as frequently as
men. For years, doctors thought this had something to do with weakness in the
joints and ligaments. The evidence, however, doesn't support the notion. What
research has shown is that there are inherent anatomical differences between
male and female athletes--differences in pelvic width and alignment of the leg
bones--that make women more likely to injure their ACL. Unfortunately, these anatomical
features can't be modified.
But if you are a
female athlete, you don't have to take knee problems as a given. There are
several things you can do to reduce your risk of ACL injury. One is strength
training. The muscles around the knee--in particular the quadriceps (front leg
muscles) and hamstrings (back leg muscles)--play a critical role in keeping the
knee stable during athletic performance. Strength in the hamstrings has been
shown to protect the ACL from excessive strain; women, however, tend to be
stronger in the quadriceps, creating an injury-prone imbalance.
Research has
also shown that women jump and land differently than men do. This is critical
because a high percentage of ACL injuries occur during these moves. Women are
less flexible in the hip and knee joints and tend to land in a position of
extension rather than the preferable flexed position. Special jump training
involving wall jumps and single-leg hops strengthens leg muscles and can create
more favorable body mechanics.
Finally, women
can protect their knees by improving their balance. This can be done by
building up the muscles surrounding the knees. These muscles serve as shock
absorbers, reducing the force that eventually gets transferred to the ACL and
protecting against excessive rotation at the knee joint. Working on balance
boards for as little as 20 minutes a day over a period of six weeks can improve
coordination of the hamstrings and the gastrocnemius muscles in the calves,
protecting the ACL during athletic twists and turns. Training properly and
developing physical conditioning will not only help level the playing field for
female athletes but also keep them on it longer.
Dr. Ian is a
medical correspondent for nbc's Today show. E-mail: ianmedical@aol.com. For more on knees, try orthoinfo.aaos.org END
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