This post was contributed by a community member. The views expressed here are the author's own.

Local Voices

Are you or a loved one at risk for a major knee injury?

Revolution Physical Therapy – ACL tears Disproportionate rates between genders

We have been seeing a lot of ACL tears lately and we felt that talking about this unfortunate and unnecessary injury would be the best topic for this blog post. Please feel free to ask questions on this topic or any other.

Females tear their anterior cruciate ligament (ACL) up to 10 times more than their male counterparts from non-contact injuries and these injuries are almost entirely preventable!  This means that they are just running along, cutting, pivoting, and/or landing and BOOM! They are on the ground.

There are approximately 22,000 ACL injuries in female athletes each year from high school to collegiate sports. 1 in 10 girls that compete at the collegiate level in any sport (not just jumping, cutting and pivoting sports) will tear their ACL prior to graduation. That is CRAZY! Especially when it can be prevented.

Find out what's happening in Cranberrywith free, real-time updates from Patch.

The knee is a hinge joint that primarily opens and closes like a door.  It also has 6 degrees of freedom meaning it can move forward and back (bending or flexion and extension), side to side and rotate each direction. However and most importantly, almost all of the motion is front to back bending with no rotation. The joints in which most of the rotary motion occurs are at the ball and socket joint of the hip and the pseudo ball and socket joint of the ankle.

The Cause: Suboptimal Biomechanics

Find out what's happening in Cranberrywith free, real-time updates from Patch.

While obvious that female and male bodies differ they also demonstrate different landing and decelerating movement patterns as well. Females have a tendency to land and decelerate without using their hips properly, keeping their feet flat and their heels hitting the ground, ultimately creating excessive torque at the knee.

As a female hits puberty the long bones, the femur (thigh bone) and tibia (shin bone), of the leg grow and with this growth they begin to ascend into their taller adult skeleton. However this occurs with an increase in estrogen and a decrease in testosterone. A boy typically sees a significant spike in testosterone as their limbs begin to grow. Testosterone increases the ability to develop more muscle tissue and control the movement of the now increasing long levers of the tibia and femur which already produce tremendous torque at the knee in every human.

When the hip and knee joint are not controlled during dynamic movements, the excessive rotational torque is distributed to the knee tearing the ACL. There are 2 and sometimes 3 bundles to the ACL which are actually twisted and run at an angle. It is designed to resist some rotational and angular forces but easily tears when in the position of dynamic knee valgus. You can see this in the image above with opposite side hip drop, thigh bone and knee medially deviating and rotating internally. This is often associated with pronation of the foot and ankle or collapsing of the medial arch of the foot.

Another reason for this is that girls also demonstrate less of an ability to fire their hamstrings at high speeds. During slow speeds they are equal to boys but at faster speeds they become deficient. The hamstrings resist anterior tibial translation. This is the forward movement of the tibia or lower leg bone. The ACL also resists anterior tibial movement and tears with this excessive forward movement. The Lachman Test, pictured above, is the standard for testing the ACL in which anterior force is exerted manually on the tibia by a clinician to assess integrity of the ACL.

The hamstrings are a two joint muscle, acting at the hip and knee.  When the hamstrings contract, they exert a posterior pull on the tibia which allows the knee to flex or bend as pictured above. Females typically tear their ACL during high velocity movements such as decelerating, cutting and landing from a jump. This suggests that the nervous system is not sending the appropriate message to fire the muscles to stabilize the knee quickly enough.

Fortunately, movement and coordination are easily trainable.   Research demonstrates that when an appropriate screening is performed to identify high risk athletes, they can train to avoid these injuries. Most ACL injury prevention programs have success rate greater than 90%!. Which begs the question, if we screen for scoliosis in most 7th graders, why not for risk of ACL injuries?

Females having different bodies than males can benefit from and need specialized training. At the very least, they need to be screened to determine if they have high risk biomechanics. It is our belief that female athletes are the most neglected population in the country. How can we allow 22,000 of our sisters, daughters, cousins, nieces and friends to experience this nearly preventable injury each year?

Revolution Physical Therapy has an answer for our young women. We are now offering a free screening for any female who would like to know if they are at risk. If you are a female athlete playing sports involving cutting, pivoting and jumping without the appropriate training, you are at a high risk  of having a season or career ending knee problem. Thousands of college bound females lose their scholarships every year from indifference, denial and neglect.. Time to make a change. Join the Revolution!

We’ve removed the ability to reply as we work to make improvements. Learn more here

The views expressed in this post are the author's own. Want to post on Patch?