When does the risk for ACL injury occur in young female athletes?

Anterior Cruciate Ligament (ACL) knee injuries, in twisting and cutting sports, has become well recognized and documented in the medical literature and in physical clinics throughout the country. ACL injuries are four to six times more frequent in female athletes than in male athletes playing the same sports.

The ACL ligament is one of four ligaments that are responsible for holding the thigh and leg bone together. It is believed that the difference in neuromuscular control, or the way our muscles contract and react, is one of four primary factors contributing to why women are more susceptible to knee injuries than men. Other discrepancies are anatomical (women are structurally different with a wider pelvis creating “knock” knee), hormonal (women’s hormonal makeup affects the integrity of the ligament, making it more lax) and bio-mechanical (the positions our knees get in during cutting and jumping).

Seventy percent of all ACL injuries occur without contact. Most ACL injuries occur at foot strike with the knee close to full extension during quick deceleration or landing maneuvers.

With this near epidemic of ACL injuries in female athletes, the National Athletic Trainers’ Association has advocated prevention programs to diminish the risk of injury. There is highlevel research evidence supporting prevention programs that focus on neuromuscular control, balance, coordination, flexibility and strength can reduce the risk of ACL injuries.

But when should these programs be started to best prevent injury?

A recent research article has determined that most ACL injuries occur after age 12. Due to the fact that girls mature faster than boys, the authors advised that prevention programs should start at age 12, if not earlier (BMJ Open Sport Exerc Med 2016). Being that there are some technical aspects to the prevention program, such as proper landing technique, I believe it is reasonable to start the program as soon as the young athlete can comprehend basic movements and control of their body (possible as early as 7 or 8 years old). The trainer, coach or parent may need to make modifications in the program to meet the developmental needs of the child. Also, it is important to remember that running and jumping are part of normal healthy child development. There is minimal risk of injury when youth exercise programs are properly developed and closely monitored by trained adults.

Please go to my website (mishockpt.com) to download my free ACL and lower extremity injury prevention program. This program is for parents and coaches of young athletes to perform prior to practices or games in hopes of preventing or minimizing the risk of this devastating injury.

We can help! If pain is limiting you from doing the activities you enjoy, give Mishock Physical Therapy a call at (610) 327-2600 or email your questions to mishockpt@comcast.net. Also, visit our website to read more physical therapy related articles, learn more about our treatment philosophy, our physical therapy staff and our six convenient locations in Gilbertsville, Skippack, Barto, Phoenixville, Limerick and Stoww at www.mishockpt.com. Our mission is to exceed the expectations of our patients by providing excellence in care and service. We are here to serve you! Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania.