Fitness Quest 10: Our A.C.L. Problem in Women’s Sports

Coach Brett Klika is the Director of Athletic Performance at Todd Durkin’s Fitness Quest 10 in San Diego, CA. He specializes in youth fitness and athletic performance, overseeing a staff of 8 strength coaches developing programs for over 300 youth per week, both athletes and non-athletes. In addition to coaching, Brett currently authors for a variety of publications, produces DVD’s on fitness and athletic performance and presents around the world on topics in fitness, wellness, and sports performance. Brett can be reached at brett@fitnessquest10.com

If you’re involved in female athletics, you may have heard of the alarming rate at which women are getting injured. Of particular concern is the disproportionate number of knee injuries in women versus men.

Current statistics indicate that women tear their Anterior Cruciate Ligament 8 times more often than men do. This is the dreaded “ACL” injury we often hear about. The post-injury process for this involves surgery and a slow, painful six to nine month rehab period, which can be both mentally and physically difficult for the athlete. Research has indicated that those who have an ACL injury are statistically more likely to do it again, as well as have problems with pain and limited mobility later in life. All of the above make a strong case for creating and implementing an effective strategy for prevention.

In order to create a prevention program, however, you must find out the cause of the problem. Aye, there’s the rub. The theories as to why women get this injury more than men are varied and numerous, so much so that the attempt to create a prevention strategy has become diluted. While women continue to get hurt at an alarming rate, coaches, parents, and trainers do very little in regards to specific prevention strategies. It’s time to get our heads out of the sand, review the facts, quit clutching to cultural epithets, and stop our girls from getting hurt. The problem with prevention is not an inability of the Anterior Cruciate Ligament; it’s our inability in Applying Credible Logic. To prevent Dr. Andrews from Alabama, we need Dr. Spock from Vulcan (homage to pro-sports insiders and Star Trek fans. An unlikely pairing, I know).

Here are a few prevalent theories in regards to the increased propensity in ACL injuries amongst women (trust me, there are MANY more related to female anatomy and physiology, but these are some of the more popular):

• Women’s ACLs are smaller.
• The connective tissue softens in relation to a female’s menstrual cycle.
• An increased “Q” angle creates greater force at the knees.
• Many females lack development of the VMO muscle.
• Because of biomechanical differences in ankle, hip, and spine orientation, females tend to be quad dominant.
• Females tend to decelerate movement in a more risk-oriented manner.
• Females do not have the same lean muscle mass and strength as males.
• Overtraining causes mental and physical fatigue, reducing the neuromuscular system’s ability to control the body.

While researchers can argue about which of the above contributes to an ACL injury, it is clear that all of these factors contribute. The only speculation is to what degree each contributes to the injury. Some can be modified, some cannot. Females are different from males.Let’s apply some credible logic here. If I were 5’4” and wanted to play in the NBA, I wouldn’t spend my time trying to figure out why my chances of success are slimmer. I already know that. Nor would I spend time hanging upside down trying to get taller. I would address every logical thing I knew I could do to increase my likelihood for success. It’s the same for females and ACL injuries. A different biomechanical structure is going to create a different foundation for function. It’s not fair, I know. While you can’t change bones, you can change things like strength, coordination, fitness, balance, and neuromuscular movement patterns. If these are optimal, it is possible to minimize risk. If we could cut down the propensity of female ACL injuries to even that of two times the rate of men, that would be quite a few more girls finishing seasons and growing up to be happy, healthy, pain-free adults.

Due to our refusal to admit that women are different than men, coaches continue to train the girls like they would the boys. Even though certain biomechanical propensities create an increased risk of injury for women, they continue to reinforce these propensities through hours and hours of practice. Applying credible logic once again, if it has been found that the way women tend to decelerate increases likelihood for injury, wouldn’t you want to address this movement pattern from a biomechanical proficiency standpoint? You could, maybe, practice doing it correctly and improve the various components of the movement related to stability such as strength, coordination, balance, and power. This would suggest that a woman’s practice may have a specific component of injury prevention different from that of a manA famous study out of the Santa Monica Orthopedic and Sports Medicine Research Foundation found that with a specific protocol designed to address biomechanical and neuromuscular deficiencies in female soccer players, they were able to observe an overall injury reduction of 88%. When you work on the things that are weak, you decrease injury. I would say that’s pretty credible logic.

I’ve worked with thousands of young female athletes and have seen the knocked knees, “straight up” running posture, tight ankles, interiorly tilted pelvis, inability to use glute muscles, and straight legged stopping technique. I once worked with a soccer team in which less than half the girls couldn’t do a bodyweight lunge. Logic would dictate that a problem would arise when you throw those girls onto a field with varied playing surface, running at full speed against an unpredictable opponent. They can’t even demonstrate appropriate mastery over their body weight in a completely inert, predictable environment! Using logic as my guide, I created a program for our young female athletes that helps “un-knock” their knees, maintain a lower running stance, increase glute strength, and improve the movement pattern of deceleration. In addition, by improving their general coordination, strength, and, we decrease the likelihood that they will encounter a force that is either too great a magnitude or too high in frequency for them to control.

Even with this carefully designed program, I have seen ACL injuries. Applying it to thousands of athletes over 10 years however, I can count the number of injured girls on one hand; there have been two. One of them had a girl land on her leg while she was on the ground; the other was playing field hockey in mud and slipped. Had the thousands of girls mentioned just gone on with no logical intervention, who knows how many of them would be hobbled on crutches on the sidelines.

As you can see, due to a variety of factors, females are at greater risk for ACL injuries than men. We need to accept that fact and apply some “A.C.L.” to minimize these injuries. Coaches, parents, and trainers need to take the facts and work them. Assess what has worked for others and apply it. Address the differences in male and female athletes, don’t ignore them. Let’s make sure our female athletes can play hard, live long, and prosper!