On your knees.

Since my bike accident last month, I’ve been thinking a lot about knees. My right knee suffered quite a hit: a gaping laceration that measured 6 inches across and perhaps 3 inches from top to bottom. Luckily, only a small part of my patellar ligament was damaged. It’s still pretty stiff, and my range of motion is somewhat limited. The good news is that there’s quite a bit of time before ski season, and I should be fine by then.

All the same, it’s given me a new appreciation for knee injuries. Up until now, I’ve been pretty injury-free. But it seems that a number of women on TheSkiDiva.com haven’t been that lucky, particularly with regard to their ACL’s. The ACL, or Anterior Cruciate Ligament, is one of the four major ligaments in the knee. It controls how far forward the tibia moves under the femur. (The tibia is the larger bone beneath your knee; the femur is your thigh bone). And it’s the first ligament that tightens when the knee is straightened. If the knee is forced past this point, that’s when trouble begins.

Knee joint anatomy

Knee joint anatomy

According to my research, female athletes are nearly three times more likely to suffer an ACL injury than men — a huge difference.

Which leads to the following question:

Why?

Oddly enough, no one seems to know exactly, though there are a number of theories. I’m no doctor or medical authority, but they seem to boil down to the following:

• Reduced muscle strength: Women have less muscle strength than men, so they rely more on the ACL to hold the knee in place. This can make the ligament more prone to rupture.

• Knee alignment: The Q angle, or the angle in which the quadriceps meet the femur, is greater in women than it is in men. Because of this, any twisting action can exert greater force on the ACL than it does in men. This, again, can cause it to rupture.

• Hormones: Yes, yet another thing we can chalk up to these buggers. On the up side, hormones can give women’s ligaments and joints greater flexibility. On the down side, if the other ligaments and muscles around the knee are so loose that they can’t absorb stress, then even normal loads or forces may be transferred directly to the ACL. And this can make it, yes, prone to rupture. Some studies even show that the knee can become even looser than normal at specific points within the menstrual cycle, making ACL ruptures even more common.

• Delayed response: It’s also been determined that women’s muscles that stablize the knee may take a millisecond longer to respond than men’s, and that this small difference could lead to an injury.

So what’s to be done? Is there anything, apart from not skiing (heaven forbid), that you can do to keep your ACL injury-free?

The good news is yes. Studies show that improving muscular power and strength can help. These are two different things. Strength refers to the amount of force that can be applied to a muscle, and power to the combined factors of speed and strength. Weights and resistance training are good for the former, and plyometric exercises for the latter. Plyometrics are designed to produce fast, explosive movements in which the muscle is loaded and unloaded in rapid sequence.

My advice: if you want to begin any kind of program to help your ACL, consult a good physical trainer. Start your training well in advance, and your knees will thank you next season.

I hope I haven’t jinxed myself by posting this. I’m a little superstitious, and I wouldn’t want to attract the evil eye. All the same, and not being one to take chances, I hope you don’t mind if I include the following picture. Maybe it’ll help.

 



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