NY Times Magazine article on the young female athlete and ACLs/knee injuries

[Pequenita]

Thought this story was an interesting read. I feel like when I had my first ACL-related injury as a 16-year-old, no one I knew had a clue as to what the injury was. Now, it seems like everyone does...or maybe I just wander in different circles now.

Anyway, the story focuses on a high school female soccer star, Title IX and its potential impacts on the "increase" of ACL tears among women, ACL injuries and the "game" sports (ie, soccer, basketball, lax, etc.) and the usual discussion on the disparity in percentage of females who suffer ACL and other knee injuries as compared to males.

 

[pinto]

Really interesting, thanks.

I was on the beginning edge of the big soccer thing back when I was younger. Even then, I had several friends who did their ACLs. Of course, at that time it was a year off minimum. They'd put you in a CAST after the surgery, so your leg was completely shriveled up when the knee healed.

I myself dislocated my knee 8 times, but no ACL injuries. (Where's the knock-on-wood smiley?) I've had three knee operations and a big toe joint replacement.

I really identified with the sentiments about playing through pain ... it's just what you do. In fact, up to a point, and depending on the injury/pain, I play better when hurting. It gives me a focus and anger that actually help my performance.

But a couple of months ago, the joint replacement sort of opened my eyes. The doctors kept asking what I had done to injure my toe so badly at my age, and why didn't it hurt more? (I had not gone in for a replacement ... just an osteotomy because of a lot of stiffness ... when they opened it up, there was zero cartilage.) I don't know the answer, except that you just get used to it.

I turned 40 in January, and decided it was time to stop playing when something hurts. Duh. But it makes it very difficult to compete ... you can't just quit during a match if something starts to hurt.

My kids are also in the soccer world, although we are monitoring their participation and their coaches and making sure that they are playing other sports to keep their bodies (and souls) well-rounded. My kids both have long legs with small muscles, like I do, and I just am waiting for the inevitable.

I'm also glad that the author pointed out that much of the kids sports stuff is not necessarily parent-driven. Yes, it happens, but as anyone knows, it's not that easy to make your kids do things they don't want to do.

 

[BackCountryGirl]

Boy, that article rang true for me. I did my ACL in when I was 18, during my freshman year at West Point in a gymnastics gym class. I had surgery and was in a long ast for 12 weeks. Fortunately, the medical center was fantastic at doing these surgeries (I swear there was at least 3 to 4 among the corps of cadets each week) and the rehab department was well-ahead of it's time. After all, the army had a vested interest in making us all we could be. It is interesting to read in the NYT article that there are ongoing studies of cadets and middies who get ACL injuries. The hardest part was dealing with several years of stiffness and having to change the way I played sports and the sports I played. I got into biking, swimming, and nordic skiing as a result of the injury, which has turned out to be a good thing. So, 30 years later, the repair has held up really well. I think that young girls who play sports need to have balanced training regimes that focus on all aspects of conditioning -- muscle strength, flexibility, and cardio. Sometimes, these girls on elite travel teams have little time to appropriately train.

 

[MaineSkiLady]

A (female!) orthopedic surgeon in my region (who is also the director of the clinic at Sugarloaf), Dr Nancy Cummings, has addressed this specifically:

"Body1: Your CV mentions ACL injuries in young female athletes as one of your major research interests. Can you tell us more about this topic?

Dr. Cummings: A female basketball player has four times the risk of her male counterpart of tearing her ACL and it tends to happen in a non-contact type fashion. I’m interested in the factors that make it so much more common in young women, and have worked with local basketball teams to improve jumping and landing techniques.

A few years ago, I heard at the AOSSM (the American Orthopedic Society for Sports Medicine) about how men and women land differently when they jump. So I asked my four-year-old and six-year-old to jump, and my daughter landed with stiff knees and my son landed with flexed knees. Our neuromuscular wiring may make us that way. . . So we’ve been training young female athletes [to land better] in hopes of preventing the injury. If you start at the 5th and 6th grade level, hopefully, by the time the athletes are starting college, you won’t see all five starters with scars on their knees from reconstructive ACL surgery."

Source: https://knee1.com/hero/hero.cfm/63/1

 

[SlopeDiver]

acl injuries suck... so many of my friends have had them

 

[Pequenita]

A followup: the author to the NY Times Magazine article has published another adaptation of his book, "Warrior Girls: Protecting Our Daughters Against the Injury Epidemic in Women's Sports," published this week by Simon and Schuster, in today's Washington Post. Here's a link to the article.

 

[Skimom]

Thanks for the info. My DD is 14, and very athletic. I would hate to see an injury sideline her. I've never given it much thought, but will now pay attention to this.

 

[Deedee]

I found the story fascinating. I had a complete tear of my left ACL 3 years ago while skiing in Vail and in fact was operated on by Dr Jo Hanafin, who was quoted in the article. She is a specialist in women's knees, head of Women's Sports medicine at the Hospital for Special Surgery in NYC. She also has an office in Greenwich, CT. I highly recommend her to any woman with knee problems or in need of surgery. (She also does many knees of NYC Firefighters who are on their knees alot she told me...) My surgery was a success, done March 30, I was back teaching the following December. and yes, women's knees go 5 x or more often than men she tells me, for all the reasons in the article. So we need to train more specifically to strengthen our legs and core to support our knees.

 

[altagirl]

It seems like most of that injury prevention is for basketball/soccer/etc. where there is jumping involved. I've seen all the Vermont ski safety stuff on body positioning, but it seems like it would be a little different for other sports? (I know some ski-related torn ACLs are from jumping, but the large majority seem to be twisting injuries).

 

[Pequenita]

(I know some ski-related torn ACLs are from jumping, but the large majority seem to be twisting injuries).

I agree; I do know women skiers who have ruptured their ACLs by landing jumps straight-legged, but my guess is that there are two primary types of skiing-related ACL injuries: the backwards twisting fall that starts by being too far in the back seat and then losing balance and the all-out catastrophic tumble that sends the legs spinning every way... although, even then, I'd be willing to bet that the skier lost her balance initially by falling backwards despite the forward momentum... The former makes a good case for maintaining the "athletic stance" of bent knees, forward lean, etc., if only to protect the knees if you fall.

I think it'd be interesting to learn how women skiers actually injured their knees -- you know, more than just saying, "While skiing."

 

[altagirl]

Yeah, my first one was the classic rearward twisting fall. I was way too sore and tired to be skiing, went to turn in the bumps and caught my ski tail (back on straight skis) on a bump and my inside ski didn't turn and I did. Felt and heard the pop as it twisted and fell backward...

My other knee was while mountain biking and was really weird. I was in the middle of a DH race, landed a jump just fine and then put my outside foot down as I wobbled in the loose sand after landing and it gave out and I felt the pop. (Which is really weird because normally the problem is that you plant your foot and twist and I was in loose sand...) I jumped back on my bike (thinking I didn't really need an ACL to ride a bike, right?) and kept going. A couple hundred yards later I dabbed on a rock and my knee gave out even worse - like my ankle was coming in towards my chest as everything collapsed and at that point I couldn't even get up - just crawled off the course. Bleh.

My surgeon couldn't even give me much of an explanation for that one, other than maybe it was partially torn from all the wear and tear over the years and that was just the last straw. He also said I have "narrow notch syndrome" and drilled out the intracondylar notch during reconstruction so the ACL has more space in the joint - basically it had been rubbing on the bone all along, I guess.

 

[overthehilldiva]

Interesting. I think I fell forward but I was trying to save a fall coming off some ice and I was wobbly, leg twisted. I didn't hear the pop but it felt just like I'd hyperextended it.
Jane

 

[Deedee]

I was doing some small bumps on a mugul field, was in the process of turning my skis left and heard a loud "pop" and fell face into the snow uphill, my upper leg and body twisting uphill, my skis and lower leg still downwardish, across the hill. My left upper leg did a complete 180 degree twist on itself, as I had 2 small fractures as a result of the bone on the upper right side (thigh) hitting the lower left bone (tibia?)(I forget the names). I found it interesting. But it was definitely a twisting turn, not jumping.

 

[overthehilldiva]

I was on a trail I'd skiied 100s of times, coming off a stretch that's like a chute, almost always icy. I think that because I knew that, I tightened up up, came through the ice fine then hit a pile of soft stuff, caught a tip of something, then tried to save the fall. I've had a ski house near there since 1982 and I've skiied that trail in all conditions, usually icy and never had a problem before. Someone helped me up by releasing the ski, I put it back on and skiied down to a mid mountain lodge. I knew I had a problem when I took off my skis an my leg buckled and I found myself sitting on the ground.
Jane

 

[itri]

It seems like most of that injury prevention is for basketball/soccer/etc. where there is jumping involved. I've seen all the Vermont ski safety stuff on body positioning, but it seems like it would be a little different for other sports? (I know some ski-related torn ACLs are from jumping, but the large majority seem to be twisting injuries).

Actually the most commonly reported mechanism of injury for soccer (and basketball) ACL tears is that the athlete planted their foot and went to pivot and go another direction and the knee popped and gave out. Even most of the football ACLs I saw when I was working (as a high school certified athletic trainer) were from that mechanism, although there were certainly a handful that were contact-induced. It was pretty much always a dead giveaway if you saw the athlete plant to pivot and just fall down without anyone anywhere around them.

The programs do focus a lot on jumping, but part of the reason behind that is because learning to correctly land those jumps, in addition to helping prevent injury from jumping, helps strengthen the muscles (usually hamstrings) that are usually weak, contributing to injury. Plus, the enhanced body awareness and core strength learned from those activities crosses over to many others.

 

[snowski/swimmouse]

I'm learning from you guys (wow) and hoping I never need the info!

 

[num]

Since we're comparing notes, I'll add mine. I blew my acl out in a forward, tumbling fall.

Actually, maybe that should be a poll. I wish we didn't have enough divas who could answer it, but it seems we do.

 

[Lisamarie]

A few years ago, I heard at the AOSSM (the American Orthopedic Society for Sports Medicine) about how men and women land differently when they jump. So I asked my four-year-old and six-year-old to jump, and my daughter landed with stiff knees and my son landed with flexed knees. Our neuromuscular wiring may make us that way. . . So we’ve been training young female athletes [to land better] in hopes of preventing the injury. If you start at the 5th and 6th grade level, hopefully, by the time the athletes are starting college, you won’t see all five starters with scars on their knees from reconstructive ACL surgery."

The reason we tend to land with stiff knees is because our hamstrings are usually much weaker than our quads. As such, when the correct response to a landing would be to flex the knees, which is a function of the hamstrings, they are alas, too weak to do so.

Sadly, the current fitness scene is so yoga obsessed, that female athletes are making themselves even more prone to injuries. Keep in mind that when you over stretch a muscle, you actually weaken it, so all of those yoga poses that involve wrapping your legs around your head are an ACL injury waiting to happen.

To prevent ACL injuries, women need to get rid of some of the "OM" and add a bit more groan, as in weight training and plyometrics to their workouts.

 

[altagirl]

I know when I had my first knee injury, my quads were probably stronger than my hamstrings, but basically that was just because I was doing SO much weight training and that's really where the focus just happened to be. I was in the Army and doing the same weight training as the guys - which involved a lot of leg extensions and such for whatever reason. I certainly wasn't doing any yoga at the time.

Honestly - at that point - no one had ever told me to worry about strengthening my hamstrings or what that would do for me. I had huge muscular legs and couldn't have imagined that I was at risk for a knee injury.

 

[Lisamarie]

The leg extension alone might have done you in, whether you were male or female. The shearing forces on the knee can be deadly. Also, since the leg extension isolates the quads, it contributes to the genetic muscular imbalance.