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D.I.S.C. Health Tip of the Month - November

by Staff Writer / Los Angeles Kings
By Dr. Gary Brazina

Board Certified Orthopedic Surgeon D.I.S.C. Sports and Spine Center

Dr. Gary Brazina, a board certified orthopaedic surgeon and sports medicine specialist offers important information to women to help them prevent ACL injuries and tears.

Recent studies from multiple centers have shown that women have a significantly higher risk of tearing the anterior cruciate ligament and then in non contact sports.  Studies have shown that women participating in female sports have from two to 10 times greater risk of injuring the ACL in sports that require landing and cutting such as basketball, soccer, and volleyball.  Female skiers have also shown to be at increased risk of ACL tears at a far greater rate than men.

For women, most anterior cruciate ligament injuries occur in the noncontact sports, when the athlete is decelerating, landing from a jump, or makes a pivoting move.  The exact reason why women have this increased risk has not been clearly defined  However, recent studies suggest that there is an in balance between the neuromuscular response.  Athletic equipment, training techniques, hormonal and anatomic differences have all been cited as potential causes of the increased risk for ACL tears.

Since title IX has been in place a greater number of females are participating in high school and collegiate athletics.  And we as orthopedic surgeons are seeing an increased number of girls requiring anterior cruciate ligament surgery.

New studies say just that training can decrease the incidence of an ACL injury in the female athlete by 50%.  There is strong evidence demonstrating that "neuromuscular training" is a safe effective method to reduce ACL injuries in both men and women.

Women appear to have several factors, which put them at risk:
  • They are ligament dominant: this means that when the athlete pivots the knee ligaments become stressed.  Long before the muscles fire to control knee motion.  The lack of dynamic muscular control increases torque across the knee and leads to tearing of the ACL.
  • Women appear to be quadriceps dominant.  They activate their knee extensors (the quadriceps muscle) , predominantly over their knee flexors (hamstrings).
  • Studies have shown that women have a tendency to have an imbalance between their legs such that one is significantly stronger and more coordinated than the opposite limb.
  • Studies have also shown that the female athlete is trunk dominant with poor control of the upper body mass

Training techniques, must address all four of these deficiencies.  Hamstrings strengthening and core strengthening is vital.  The trainer and coach must look for leg to leg imbalances and leg dominance.  Weakness of the hamstrings as compared to the quadriceps and weakness of core muscles that prevent the athlete from controlling the trunk and developing inertia in the trunk all lead to increased risk for ACL injuries and can be addressed in training.

All training programs must include:
  • A strong warm-up program with at least 15 minutes pregame.
  • Plyometric/jump training that emphasizes body posture and trunk control through core strengthening
  • Task specific training can be used to strengthen the core
  • Progressive resistance exercise training, that is strength training is vital and should be balanced between quadriceps and hamstring strength
  • Aerobic, sport specific training, as well as sports skills need to be continually developed.
  • Pre-season training is vital: with the least 6 to 8 weeks of preseason drills.
  • Evaluation of sports equipment equipment to determine if it is designed for the female athlete should be utilized.

While no one factor can completely eliminate the risk of a tear cruciate ligament tears in the young athlete, awareness by the coaching and training staff and the development of an ACL tear prevention program through proper training will go a long way to prevent injury.
Gary Brazina, M.D. Having spent his career at the forefront of his field, Dr. Gary Brazina is dedicated to providing his patients with the best quality care, the newest surgical techniques, and the latest protocols in conservative care. First and foremost, his emphasis is always on the patients’ individual and specific needs. His specialties lie in arthroscopic surgery and sports medicine. With over 20 years of surgical experience, he has treated some of the top athletes in the nation. Dr. Brazina is a Fellow in both the American Academy of Orthopedic Surgery and the American College of Surgeons.
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