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.
When Can I Walk Off Knee Pain — And When Should I See A Doctor?
June 7, 2022
Whether you wake up with a stiff knee, sustain an injury, or start feeling knee pain for seemingly no good reason, you might wonder what to do. Should you immediately rush off to the doctor? Can you just ignore it and hope it will get better? Can you treat it yourself? Knowing when you need a doctor’s intervention can be a tricky decision to make.
We see people at the start of injuries and after they’ve been ongoing,” says Nancy White, M.D., a sports medicine physician at Henry Ford Health. “While the sooner you see an expert, the better, there’s really no right or wrong to it. However, there are a few key signs that it’s a good idea to get it checked out.”
Dr. White recommends seeing a doctor if:
► You are waking up with consistent knee stiffness. If there’s no history of an injury involved, it could be due to osteoarthritis or rheumatoid arthritis.
► If your knee pain isn’t going away.
► Your knee is swollen and you can’t bear weight on it.
► You can’t fully flex or extend your knee.
► Your knee is warm to the touch. This could signal inflammation.
If your pain is mild — or you’re trying to decide whether to see someone — Dr. White recommends icing it on a scheduled basis. “That means two to three times a day,” she says. “Apply the ice to your knee. It will get cold. It will burn, then it will get numb. Remove the ice when it gets to the numb stage.”
She also recommends elevating your leg and putting a compression wrap or sleeve on your knee. If the pain is bad, you can try taking ibuprofen or naproxen for a few days.
Common Causes of Knee Pain
But if your knee is not getting better, it’s a good idea to see a doctor, as common causes of knee pain include:
► ACL sprains and tears. Short for anterior cruciate ligament, the ACL is one of four ligaments in the knee that allows it to flex and extend. The ACL can tear when your foot is firmly planted in place, and the knee locks and twists or pivots at the same time.
► MCL sprains and tears. Short for medial collateral ligament, the MCL connects your shinbone to your thighbone. It can tear when landing after a jump, or after an exterior blow to the knee (usually during contact sports). Luckily, most MCL injuries heal on their own.
► Meniscal tears. The menisci are your knee’s shock absorbers; they're two discs made of soft cartilage. Abrupt movements (like pivots, stops, turns, squats or lifts) can cause them to tear.
► Kneecap dislocation. A direct hit to the knee — or a sudden twist or pivoting of the leg — can make the kneecap can shift out of place.
► Patellar tendonitis. This is also known as Jumper’s Knee, as it’s a common injury in basketball and volleyball players. The patellar tendon connects the bottom of the kneecap to the top of the shinbone, and can become inflamed from overuse, excessive force or repetitive stress.
Knee bursitis. The bursa is a small, fluid-filled sac located near the knee joint. Knee bursitis occurs when the bursa becomes inflamed, often because of a knee injury or overuse from frequent kneeling.
How to Help Prevent Knee Pain
And if you want to help prevent knee pain in the future? “Exercise regularly so that you’re strengthening your quadriceps, hamstrings and gluteal muscles,” says Dr. White. “It’s also important to stretch to increase quadricep and hamstring flexibility.”
Wearing shoes with sturdy soles and proper arch support can also help ease pain and issues you may already have, says Dr. White. “I would say the top reasons people get into trouble with their knees are things they could prevent by changing lifestyle habits. This includes maintaining a healthy weight, as being overweight can also lead to increased wear and tear on the joints.
To learn more about your orthopedic condition or to find a provider, visit henryford.com/ortho.
Dr. Nancy White is a sports medicine physician at Henry Ford Health. She sees patients at Henry Ford Medical Center – Novi, and Henry Ford Medical Center — Bloomfield Township.