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.
How To Warm Up Correctly Before Playing Different Sports
July 10, 2024
When you see professional athletes gearing up to race or getting ready to take the field, you’ll notice that they’re always in motion. That’s because they are warming up in preparation for going all out.
And there’s a good reason why you’ll never see a pro go straight from the bench into a full sprint. “You need to allow your muscles to gradually accept the demands of your activity,” says Jennifer Burnham, a certified athletic trainer at Henry Ford Health. “Otherwise you risk causing an injury.”
Why You Should Warm Up
As the name implies, a warmup is a series of movements designed to warm up your muscles. “You want to increase blood flow to your muscles and loosen up and lubricate your joints,” says Burnham. “And you need to do it gradually, so that your body has time to adapt to the increasing intensity.”
Warming up involves more than just stretching. According to Burnham, studies have actually shown that holding a static stretch when muscles are cold can decrease performance. “Instead, before activity you want to do a dynamic warmup that incorporates movement as well as some gentle stretching."
Your warmup only needs to take 5 to 10 minutes. When deciding what to do, think about the movements you’ll be doing in your activity and which muscles and joints are most involved. Then choose movements that slowly get them warmed up and primed for more intense action.
How To Warm Up For Different Activities
No matter your sport, the warmup before your workout should include some exercises to activate and engage your core (the abdominal and back muscles). “Waking up those muscles helps decrease injury potential,” says Burnham. She suggests incorporating bridges and mini squats (no deeper than 45 degrees) into your warmup routine. To do a bridge, lie on your back, knees bent, feet flat on the floor. Tighten your stomach muscles and squeeze your butt as you lift your hips up to form a straight line from knees to shoulders.
The rest of your warmup can be more specific to muscles and movements of your planned activity.
Running
Before a run, or even a jog, you want to warm up all the muscles and joints from the waist down.
- Rotate your hips (lift your knee up and do some circles in both directions to move the joint) and ankles (circle one foot at a time both clockwise and counter-clockwise).
- Get powerful muscles like your glutes and quads ready with high knees and butt kicks.
- Walk on your toes and then on your heels to warm up shin and calf muscles.
- When you’re ready to run, start off slowly and gradually increase your speed.
Racquet sports
You still need to warm up your lower body using the same moves as the running warmup. But you’ll want to add in others specific to the upper body movements of tennis, pickleball or other racket sports.
- Warm up shoulders with big arm circles both forwards and backwards
- Circle your hands in both directions to get wrists ready for action
- Lunge forward and rotate your upper torso to increase your spine mobility
Basketball, soccer and football
You want to make sure your lower body has time to adapt to the demands of sports that require bursts of sprinting and quick shifts of direction. Your warmup should gradually increase in speed and intensity as you move your body in all directions:
- Side shuffles while swinging your arms (shuffle in both directions)
- Grapevines in both directions
- Skip forward, lifting knees high, then skip backward
Swimming
Prepping your body for a swimming workout means warming up your arms, shoulders and upper back.
- Circle arms backwards and forwards
- Use a light resistance band to do shoulder rows
- Use a light resistance band or light dumbbell and lift straight arms up to shoulder height in front and to your sides
- Start with an easy tempo freestyle swim before going into more dynamic strokes like butterfly
Jennifer Burnham is an athletic trainer who sees patients at the Henry Ford Center for Athletic Medicine in Detroit.
To find a sports medicine provider at Henry Ford Health, visit henryford.com/athletes or call 313-651-1969.