ACL TEAR PREVENTION IN FEMALE ATHLETES

Nicole PecoraroOctober 21, 2012

THE ANTERIOR CRUCIATE LIGAMENT Two bands

Anteromedial band is tight in flexion Posterolateral band is tight in extension

Courses from femur to tibia Prevents anterior translation of the tibia on the

femur Provides passive stability to the tibiofemoral joint

STABILIZERS AROUND THE ACL

Muscles Quadriceps Hamstrings Popliteus Gastrocnemius Pes Anserine group

Gracilis Semitendinosus Sartorius

Other Ligaments PCL MCL LCL

Joint Capsules Anterior capsule Posterior capsule

HOW IS THE ACL TORN?

Large valgus or varus force while the foot remains planted in the ground

Hyperextension of the knee Patient will typically hear popping sound and feel

and tearing sensation

WHY ARE FEMALES AT A HIGHER RISK OF TEARS?

ACL tears occur 4-8 times more frequently in females Four primary factors

Neuromuscular differences How muscles contract and react Less force and torques can be generated in the hamstrings and

quadriceps muscles in females Anatomical differences

Females have wider hips resulting in a larger Q angle Women rely on the use of their quadriceps muscles heavily, adding a lot

of stress on the knee, whereas men rely more on their hamstrings. Hormonal differences

Ligaments tend to be more lax in females due to hormones Bio-mechanical differences

Increased knee abduction and valgus torques in females Females have a higher lateral trunk motion

Majority of the body’s weight is shifted onto one leg Foot remains planted in surface and is displaced from the center of mass

HOW CAN YOU REDUCE THE RISK OF INJURY?

Strengthen muscles Particularly hamstrings, gluteal, and core

muscles Correct any abnormal movement

patterns in their gait These could be adding stress to the joint

Exercise programs that include stretching, strengthening, coordination and plyometrics

PREVENT INJURY & ENHANCE PERFORMANCE(PEP)

The PEP Program has shown to reduce injury up to 41% in female athletes Study done by the NCAA including 1,435 Division 1 female athletes Designed by physical therapists at the Santa Monica Orthopedic and

Sports Medicine Group

Addresses potential deficits in neuromuscular coordination and strength in the stabilizing muscles around the knee joint

5 parts Warm-up Strengthening Plyometrics Agilities Stretching

Approximately 15-20 minutes

WARM-UP 1½ minutes Promotes blood

circulation to the muscle tissues Reduces risk of injury

Example: Jog from line to line(cone to cone)  Make sure the

athlete’s hips/knees/ankles are in  straight alignment  

STRENGTHENING

3 minutes Strengthening the

muscles surrounding the knee will make the joint more stable

Example: Walking Lunges Strengthens the

quadriceps muscles

PLYOMETRICS

2½ minutes Improve power, strength, and speed

through explosive exercises Proper, soft landings are crucial

“softly accept your weight on the balls of your feet slowly rolling back to the heel with a bent knee and a bent hip”

Example: Scissors Jump Increases strength and power of vertical jump

AGILITIES

3 minutes Each of the 3 activities has a different

purpose Example: Lateral Diagonal Runs

Purpose: Increases dynamic stability in the ankles, knees, and hips.

Prevents a “knock knee” position from occurring which puts the ACL in a vulnerable place

STRETCHING

5 minutes Improves or

maintains mobility and range of motion

Reduces stiffness in joints and post-exercise soreness

Example: Figure-4 hamstring stretch

ADDITIONAL INFORMATION

Video by the NCAA on the PEP program Demonstrates some of the exercises http://www.youtube.com/watch?v=t_yz7yW

Lo5o

The entire PEP Program http://smsmf.org/files/PEP_Program_04122

011.pdf

REFERENCES

APTA. (2008). PTs: Appropriate exercise can help prevent ACL injuries in females. Retrieved 10/12, 2012, from <http://www.apta.org/Media/

Releases/Consumer/2008/9/25/> Hewett, T. E., Myer, G. D., Ford, K. R., Paterno, M. V., & Quatman, C. E.

(2012). The 2012 ABJS nicolas andry award: The sequence of prevention: A systematic approach to prevent anterior cruciate ligament injury. Clinical Orthopaedics and Related Research, 470(10), 2930-2940.

Neumann, D. A. (2012). Kinesiology of the musculoskeletal system (second ed.). St. Louis, Missouri: Mosby, Inc.

Noyes, F. R., & Barber Westin, S.,D. (2012). Anterior cruciate ligament injury prevention training in female athletes: A systematic review of injury reduction and results of athletic performance tests. Sports Health, 4(1), 36-46.

The Santa Monica Sports Medicine Research Foundation.The PEP program: Prevent injury and enhance performance. Retrieved 10/12, 2012,

from <http://smsmf.org/files/PEP_Program_04122011.pdf>