Women & ACL Injuries: Know Risks, Steps for Prevention

August 10, 2021

Whether you’re a casual jogger or elite athlete, you’re at risk for an injury to your anterior cruciate ligament (ACL). If you’re a woman, you are at even greater risk for these injuries.

But there are steps you can take to prevent them.

“Among athletes, women are more than twice as likely to have an ACL injury than men,” says Nithin Natwa, M.D., a sports medicine specialist and primary care physician at Henry Ford Health System. “Once you have an ACL injury, you are at greater risk for having further soft tissue injuries in the future. That’s why it is important to prevent these injuries and follow your treatment plan if injured.”

What Is An ACL Injury?

An ACL injury is a strain or tear in the ACL, one of the four major ligaments that support the knee so it can flex and bend. The ACL is a strong band of tissue that helps connect your thigh bone (femur) to your shin bone (tibia). “An ACL injury usually occurs without contact when you turn suddenly while running or land off-balance on one leg. These actions overload the knee joint and cause the ACL to be torn,” says Dr. Natwa.

In the United States, 100,000 people have ACL injuries each year. Anyone can experience an ACL injury, though athletes participating in sports like football, basketball, soccer and gymnastics are at highest risk. And summer is a peak time for outdoor sports injuries.

Seek immediate care if you have any of these signs of an ACL injury:

• An audible “pop” in the knee

• Intense knee pain and rapid-onset swelling (within hours)

• Loss of range of motion

• An unstable feeling or locking of your knee

The most common treatment for ACL injuries is surgery followed by physical therapy. After treatment, you can expect to return to normal activities in 6 to 9 months. However, peak athletic performance can take up to two years.

Why Are Women At Higher Risk For ACL Injuries?

According to Dr. Natwa, the differences in athletic training techniques for males versus females have left women at greater risk for ACL injuries. “There has been more emphasis on overall conditioning and mechanics for boys participating in sports compared to girls,” he says.

As a result, women are at greater risk for ACL tears and sprains due to:

Differences in neuromuscular control: Without conditioning from an early age, women may not have the same ability to land and perform athletic motions that men do. For example, women are at higher risk for an ACL injury after landing from a jump.

Strength imbalance for muscles that support the knee: Female athletes tend to have more defined quadriceps muscles but weaker hamstrings than men, putting them at greater risk for injury.

According to Dr. Natwa, there are many theories about women’s risk for ACL injury that lack scientific evidence, including:

Width of the pelvis: Some people have suggested that the wider width of a woman’s pelvis puts more pressure on the knee joint and increases the risk for injury. However, this difference has not been shown to impact a women’s risk for ACL tears or sprains.

Knee anatomy: The ACL runs through a section of the femur called the intercondylar notch. Women tend to have a narrower notch than men. Regardless of gender, individuals who possess smaller notch dimensions appear to be at greater risk for injury than individuals with larger notches.

Hormones: Men and women have different hormone levels. But there is currently no concrete evidence that female hormones place women at higher risk for ACL injures.

Steps To Prevent ACL Injuries – Conditioning Early, Often

“The best way to prevent ACL injuries is to begin and maintain regular conditioning exercises at an early age,” Dr. Natwa says. “The more frequently you engage in proper exercises, the lower your risk for injury.”

Consult with a sports medicine specialist, physical therapist or athletic trainer to develop a training routine to prevent ACL and other injuries. Your training program should include exercises that:

Strengthen the muscles that support your knee: Add strength training to build up your calves, hamstrings and quadriceps muscles. These muscles help stabilize your knee as you move. By strengthening these muscle groups evenly, you can lower your risk for injury.

• Improve overall neuromuscular control: Focus on adding neuromuscular exercises that train your nerves and muscles to react and communicate. For example, you may work on your balance by standing on one leg or sit upright on an exercise ball for short periods of time. And core exercises can strengthen the muscles that support your abdomen and back and help improve your posture as you move. These moves can strengthen your joints and help you learn appropriate balance and technique.

“Exercise really is the best medicine. It can improve your balance and agility as you participate in a sport or prevent injury as you move through your daily activities,” says Dr. Natwa. “Consider adding these exercises to your wellness program.”

Dr. Nithin Natwa is a sports medicine doctor who sees patients at Henry Ford Macomb Health Center in Chesterfield and Henry Ford Macomb Orthopedics and Wound Care in Clinton Township.

Want to learn more? Henry Ford Health System sports medicine experts are treating the whole athlete, in a whole new way. From nutrition to neurology, and from injury prevention to treatment of sports-related conditions, they can give your athlete a unique game plan. To find a sports medicine physician at Henry Ford, visit henryford.com or call 1-800-436-7936. 

Hastings' Life-Saving Response Reinforces Vital Importance of Being Prepared

By Geoff Kimmerly
MHSAA.com senior editor

August 23, 2022

HASTINGS – Preseason silence, mixed with anticipation, made Hastings High School’s gym feel especially pristine last week.

Mid-MichiganThe raucousness is returning soon as the school’s volleyball teams are into their first matches of a new season, with winter sports bringing everyone inside in a few months. This is a place where big-game memories are made – but one from a scrimmage June 14 certainly will stick with many who were at Hastings High that day.

That evening, Potterville junior Da’Marion Hicks was playing in a basketball scrimmage when he suffered a heart attack due to a valve that later required open-heart surgery.

During a period of just a few minutes that could have meant his life, Hastings staff, students and a doctor who fortunately happened to be watching his son’s team from the stands, responded to assist Hicks before it was too late. In fact, he’s expected to be cleared to return this upcoming basketball season.

It’s a situation everyone hopes will never happen, but very occasionally it does. And when it did this time, Hastings – with crucial assistance coming out of the bleachers – showed what can be done to assure a best-possible result.

“We debriefed after this whole thing, and we actually had six people from our school (there) trained in CPR and AED use. Enough people felt comfortable enough to take some action to cause it to have a good outcome,” Hastings athletic director Mike Goggins said. “I think more times than not in a situation like this, bad results don’t come from people trying to help. Bad results come from people being afraid to help. What was great about this situation was … lots of people took the initiative to jump in.”

As another school year begins, Hastings’ ready response should continue to reinforce the importance of being prepared for the scariest of situations. (The Grand Rapids Press spoke with Hicks as he was beginning his recovery; click here to read.)

Emergency planning for sports venues has emerged as an important topic especially over the last decade, and the National Federation of State High School Associations (NFHS) and National Athletic Trainers’ Association (NATA) detail how these should work, with the “Anyone Can Save A Life” plan provided to all member schools by the MHSAA at the start of the 2015-16 school year.

Goggins said that while Hastings doesn’t necessarily have a “formal” plan like those linked above, what his department does is “saturate” his teams’ coaches and athletes with knowledge of where to find AEDs – and Hastings also has created a setup whereby a person is never more than one minute from an AED while on school property.

That evening, four boys basketball teams were playing on adjacent courts – including Potterville against Wyoming Tri-unity Christian. Goggins himself wasn’t at the school at the time (although he quickly arrived after being notified of the situation), but the following is the collection of information he has gathered over the last two months.

  • Hicks had felt especially fatigued that evening and actually had mentioned to a few Hastings players during their scrimmage earlier that night that he was having a hard time catching his breath – definitely rare for a three-sport athlete who had run the 400 meters at an MHSAA Track & Field Finals a few weeks earlier.
  • Hicks went to his bench for a break during the Tri-unity scrimmage, and laid down. Goggins said Potterville teammates thought Hicks was just gassed, but then noticed his eyes rolling back into his head. They started yelling for help.
  • Hastings boys basketball coach Rich Long sprang into action, running over to the Potterville bench and then calling into the crowd to see if anyone with medical expertise could help a student in distress. Meanwhile, Long was joined by Hastings’ strength coach (and U.S. Marine) James Avery – who was training athletes in the weight room in the balcony overlooking the gym – and Dr. Luke Van Klompenberg, an emergency medicine physician at Holland Hospital who was there watching his son play for Tri-unity.
  • Long sent an athlete to retrieve the closest AED, located on the wall just outside the gym doors. He also sent a parent to call 9-1-1, and Saxons boys track & field coach Lin Nickels sent multiple athletes to set up a relay near the school’s doors to direct paramedics when they arrived.
  • Van Klompenberg, meanwhile, couldn’t find Hicks’ pulse, and the athlete’s breathing was shallow. Avery had begun chest compressions, the AED was used, and as the ambulance arrived Hicks was beginning to regain some consciousness. He was transported to the local Spectrum Health Pennock hospital, then to Helen DeVos Children's Hospital in Grand Rapids.

“It was one of those things where it just worked,” Goggins said. “My message, if nothing else, is we all practice it for a time that may never come – but the more you can saturate your people with the idea of A, being prepared, and B, don’t be afraid to take action … that’s really I think the key.”

Strength coach James Avery emerged from the balcony weight room to assist in Hicks’ care that evening. Beginning this year, the MHSAA is requiring all head coaches at the varsity, junior varsity and freshman levels to have CPR certification. That training almost always includes direction in the use of an AED.

Hastings has been on this track for a while. The MHSAA’s first CPR requirement for coaches was added for the 2015-16 school year, just for varsity head coaches – but Goggins made it a requirement for all of his coaches at all levels at that time.

Hastings also has taken AED prep to another level. There are 16 throughout the district – one each at the four elementary schools, two at the middle school and 10 at the high school – and they represent an even bigger investment in the life-saving technology as the district’s school board purchased those 16 a year ago to replace 12 that were nearing their expirations.

Goggins said doctors have told him that if Hicks had not received care for even 4-5 more minutes, he would not have survived because of the damage done to his heart and brain. Potterville athletic director and boys basketball coach Jake Briney said surgeons have broken things down to a 45-second window that made the difference between a good result and a sad one.

Coincidentally, Briney had scheduled a game this upcoming season against Wyoming Tri-unity Christian;  Potterville should be tough, and Tri-unity is last season’s Division 4 runner-up. But the events of June 14 will make the events of this upcoming Jan. 14 much more meaningful.

Briney said Potterville also has formed a close relationship with Hastings. Multiple Saxons administrators have checked in, including Goggins almost daily during the first weeks after the incident.

Briney is filled with nothing but praise for Hastings’ preparation. And both athletic directors noted a similar effect at their schools as another school year begins.

“It really, really made the training, made you look at it through a different lens,” Briney said.

“Our fall coaches are now like, ‘You know, if Heather (Coipel, Hastings’ trainer) wanted to stop by and run through the AED procedure again, that would be great,’” Goggins said. “(Or) ‘Where is the AED? We have one at the fieldhouse, right? Where’s the closest one for me again?’ They’re just doublechecking.”

Geoff Kimmerly joined the MHSAA in Sept. 2011 after 12 years as Prep Sports Editor of the Lansing State Journal. He is a senior editor of  MHSAA.com's editorial content and has served as MHSAA Communications Director since January 2021. Contact him at [email protected] with story ideas for the Barry, Eaton, Ingham, Livingston, Ionia, Clinton, Shiawassee, Gratiot, Isabella, Clare and Montcalm counties.

PHOTOS (Top) An AED, located just outside the doors to Hastings’ gymnasium, was used to save Da’Marion Hicks’ life June 14. (Middle) Strength coach James Avery emerged from the balcony weight room to assist in Hicks’ care that evening. (Photos by Geoff Kimmerly.)