Knee Injuries and the Female Athlete

Knee injuries, particularly damage to the anterior cruciate ligament, are most commonly seen in female athletes. This has been observed more in recent years, possibly as a result of the increase in popularity and participation levels in women’s sport. Increased participation has heightened appreciation of health and medical issues specific to the female athlete. Studies comparing male to female susceptibility to injury of the ACL have shown women to have considerably higher rate of injury. Studies have shown that ACL injuries occur roughly 4 times as often in sports such as; basketball, gymnastics and football where quick turns and pivoting are required. Orthopaedic doctors, physio therapists and sports coaches have suggested many possible reasons why women are more susceptible to this kind of injury. The anterior and posterior cruciate ligaments cross each other and act as the primary stabilizers of the knee. Together they maintain the rotary stability of the knee and prevent the lower leg (tibia) from moving either too far forward or backward. The posterior cruciate ligament (PCL) is the larger of the two ligaments which may be part of the reason why the anterior cruciate ligament (ACL) in general, is torn more often. There are many different factors that could be influential in what causes women to damage their ACL more often. Some are based on anatomical realities such as a narrower femoral notch, increased between the quadriceps muscles and the patella tendon (known as Q angle), looser ligaments (increased ligamentous laxity), inadequate strength, and impaired cognitive coordination. Extrinsic factors such as techniques and skill of the player, improper footwear, and the playing surface may also contribute to injury rates. A narrower femoral notch (the space at the bottom of the femur through which the ACL runs) in women is being suggested as a culprit in ACL injuries. It is possible that the tight fit may cause a "shearing" effect on the ACL by the femur. The angle between the quadriceps muscle on the front of the thigh and the patellar tendon at the knee is greater in the female due to her wider pelvis. Therefore, a women’s knee is made with a naturally greater angle between the femur and the tibia predisposing it to greater stress. And further, aggravating the tendency to injure the knee is the more pronated or flattened foot that is created by this increased angle. Strength training for women is critical with an emphasis on being in shape before they play their sport. Women tend to be generally more flexible than men, but a program that consists of strengthening and stretching is essential for all athletes involved in sports. Non-competitive balance and agility training may enhance proprioceptive function and help to reduce the rate of injury as well. Boys have historically been trained from an early age to use their body in sports activities. Their training includes footwork drills, eye-hand coordination skills, catching and throwing balls which develop their neuromuscular systems. Girls are not exposed to this early motor learning at a young age, putting them at a distinct disadvantage when they decide to get involved in sports at school. Especially if they want to play competitively where there is a higher level of play and greater stress on their body. Studies have shown that intensity is a factor in injury of the ACL. Injuries were seven times more likely to occur during games than practices. However, physical contact with other players appears to be unrelated in the occurrence of injury. The ACL is most often injured with an abrupt change of direction or a jump and usually with an activity they have done many times before. The athlete will describe having "felt a pop", swelling within a couple of hours and knowing there is something wrong with their knee. If the injury is less severe, the athlete may not know they have been injured. Over time they may describe their knee as being unpredictable, giving way sometimes or a having an unsafe feeling with rotational movements. Years ago an ACL injury could have been an end to the career of a professional athlete. In recent years, doctors have learned more about surgical techniques, while coaches and physical therapists are learning more about rehabilitation. Furthermore, rehabilitation methods have become more aggressive thus shortening the length of recovery periods. It’s an exciting time in women’s sports! Participation in physical education for girls is essential for their development. Women should be encouraged to play, but play smart and listen to their bodies. Find out more about coping with and ACL injury here.