The Female Knee Creates the MVP Most Vulnerable Player

1
The Female Knee Creates the MVP(Most Vulnerable
Player)

• Anastasia N. Fischer, MD
• Nationwide Childrens Hospital
• Dept. of Sports Medicine

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What well cover today

• ACL tears are a relatively common injury in
  female sports
• Girls are more prone to ACL tears than boys
• Why?
• What can we do
  about it?

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ACL Injuries in Girls

• 38,000 estimated female ACL injuries each year
• Estimated 2,200 at the collegiate level
• May be 4 times as high at HS level (8000-9000!!)

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ACL Injuries in Girls

• Increased Participation in sports (Title IX)
• Female basketball players are 2x more likely to
  suffer an ACL tear than their male counterparts
• Female soccer players are 4x more likely to
  suffer an ACL tear than their male counterparts

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Why?Theories To Explain Gender Differences

• Anatomical Differences
• Biomechanical Factors
• Hormonal Influences
• Neuromuscular Differences

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Anatomic Differences

• Women tend to have a more knock-kneed leg
  alignment
• The femoral notch, in women tends to be narrower

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Biomechanical Differences

• Compared with men, women
• Have less muscle mass
• Are slower at the rate of muscle force
  development (ms)
• Have a stronger, quicker reacting quadriceps
  relative to hamstrings
• Tend to be more upright when landing
• Tend to be quad dominant

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Hormonal Influences?

• Increased risk of ACL tears during ovulatory
  phase of menstrual cycle
• Decreased risk of ACL tear during follicular
  phase of menstrual cycle
• Recent studies are conflicting , these results
  are not widely supported

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Neuromuscular Differences

• Ligament Dominance
• Knee ligaments rather than knee muscles absorb
  the landing forces during sports maneuvers
• Quadriceps Dominance
• Quads react more quickly to forces than the
  hamstrings
• Leg Dominance
• The non-dominant knee
  is at greater risk because
  its weaker

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What does this all boil down to?

• 4 out of 5 ACL injuries occur from a non-contact
  mechanism - very often during deceleration
  activities, (i.e. landing from a jump or planting
  and cutting) and are due to being in the
  position of no return

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Biomechanics
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Biomechanics
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How Can The Incidence of ACL Injuries Be Reduced?

• ACL injury prevention programs have demonstrated
  a reduction in the rate of ACL injuries in 14-18
  year old girls by 74-83!!
• Helping to change the position of the knee when
  landing or cutting and pivoting
• Decreasing landing forces on the knee when
  landing from a jump

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Strategies to Avoid Injury

• Avoid vulnerable positions
• Increase flexibility
• Increase strength
• Increase balance through agility training
• Include sports specific exercises into the
  training program

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Injury Prevention Protocol

• A 3 phase program done three days / week
  beginning six to eight weeks prior to the season
• Technique phase teach proper jump technique -
  Learn to stick and hold landings
• Fundamental phase continue to build strength,
  power and agility
• Performance phase focus on increasing maximum
  vertical jump height and sports specific training

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Technique Phase

• At the start proper landing form must be
  reinforced
• The athletes should be taught to land on the
  balls of the feet with the knees flexed and the
  chest over the knees
• Verbal cues
• Sit back
• Land soft toes-gt heels
• Legs are shock absorbers (instant recoil for next
  jump)

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Technique Phase

• Focus in this phase must be on perfecting the
  technique of each exercise
• Athletes need immediate feedback
• Wall jumps
• Squat jumps
• Broad jump and hold

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Fundamental Phase

• Training should focus on strength and balance
• Exercises should include dynamic, multi-planar,
  sport-specific movements that are a challenge to
  the proprioceptive system

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Fundamental Phase

• Strength exercises must also include the core
• Critical for body control
• Progression must be slow and methodical with
  enough recovery time
• Balance activities should be progressive
• Single leg passing (bounce -gt chest -gt OH)
• Single leg woodchops
• Multidirectional lunges
• Single leg jump and hold
• Power skipping

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Performance Phase

• Practical application
• Training skills should expose the athlete to
  movement patterns that generate greater dynamic
  knee control
• Agility drills should be progressed when the
  athletes can maintain good static body control

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Performance Phase

• Exercises should progress from previous phases
  and should now focus on power and agility
• Power drills include advanced plyometrics and
  explosive movements
• 180 Deg jumps
• Barrier hops
• Scissor jumps
• Power skipping gt maximize height
• Box drop jumps gt plant and turn
• Medicine ball vertical throws

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Injury Prevention Protocol

• Optimally, after the training program, the
  program should be performed at least 2-3 times
  per week during the season
• Program consists of a warm-up, stretching,
  strengthening, plyometrics, and sport specific
  agilities
• The coaches and athletic trainers need to
  emphasize correct posture, straight up and down
  jumps without excessive side-to-side movement,
  and reinforce soft landings

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Preventative Training Programs

• Nationwide Childrens Sports Medicines
• Personal Best Injury Prevention Programs
• ACL Bootcamp
• Shoulder Stability/Throwing Program
• LEAPS and BOUNDS
• Age appropriate specific to their developmental
  level
• Sport specific
• Basketball
• Soccer
• Baseball/Softball
• Volleyball

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Conclusion

• The research and development of training programs
  to prevent ACL injuries is evolving rapidly
• More attention needs to be placed on implementing
  these programs to younger athletes during their
  developmental years

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References

• Gilchrist J, etal. A Randomized Controlled Trial
  to Prevent NoncontactAnterior Cruciate Ligament
  Injury in Female Collegiate Soccer Players. Am J
  Sports Med. 200836(8)1476-1483.
• Meyer GD, Ford KR, Hewett TE. Rationale and
  Clinical techniques for Anterior Cruciate
  Ligament Injury Prevention Among Female Athletes.
  Journal of Athletic Training. 200439352-363.
• Mandelbaum BR, Silvers HJ, et al. Effectiveness
  of a Neuromuscular and Proprioceptive Training
  Program in Preventing Anterior Cruciate Ligament
  Injuries on Female Athletes. Am J Sports Med.
  2005331003-1010.
• Olsen OE, Myklebust, et al. Exercises to Prevent
  Lower Limb Injuries in Youth Sports Cluster
  Randomized Controlled Trial. British Medical
  Journal. 2005330449-452.