No One KNEE-ds a Blown Out ACL

   Women athletes in certain sports are at greater risk of blowing out their knees! 
Not politically correct you say. Go back to your anatomy and physiology textbook then.
There are physical differences between the genders. In the sports world this can lead to some significant injury observations.
   I just finished reading an interesting book called "Warrior Girls" by Michael Sokolove.
The author uses anecdotal and statistical evidence to suggest that there is actually an epidemic of severe knee injuries of elite young women in certain sports.   Sports with sudden stops and directional changes at top speed seem to pose the most risk. Soccer, basketball, and also rugby come to mind.
Teenage women on top notch competitive teams with year long league and tournament play are especially predisposed to become statistics.
   Often when these injuries occur they are noticeable with a dramatic leg plant and a loud popping noise. Sometimes it happens on an innocent looking movement. Either way leaves the casualty with pain and grief.

   The weak link in the knee is almost always the ACL  -the Anterior Cruciate Ligament!  This ligament runs at an angle across the front of the knee joint. The ACL prevents the femur bone of the upper leg from overpowering the two lower leg bones and sliding beyond the natural range of motion of the knee joint.  Once the ACL ruptures, a lifetime of trouble can ensue! Many surgically reconstructed ACL joints blow out again when the athlete returns to competition.
   Men blow out their knees too. They just do it at a lower rate. Recreational athletes are less at risk due to the slower speeds involved.  Maybe that's why I never got badly injured playing beer league hockey. I only thought that I was going fast.
Why are women at greater risk for ACL tears? There are many possible reasons:

• Hormones. Estrogen can make for more flexible joints. An overly flexible knee knee joint can be a disadvantage during a speed sport involving sudden deceleration and quick changes of direction.
• Weak core muscles such as abdominals, lower back and glutes (rear end). 
• Overspecialization in one sport at an early age. 
• Muscle imbalance in which the hamstring muscles are too weak to prevent the quadriceps muscles from dominating during running movements.
• Overly upright and erect running style. This is a cultural trait going back to the role of women carrying toddlers during the hunter/gatherer historic phase. (In Biblical time, this falls between the expulsion from Eden and the Great Flood.)
• Anatomy. The Q angle or quadriceps angle. This is a measurement of where the upper leg meets the kneecap. For childbearing reasons women often have a wider pelvis than men. This makes for a greater Q angle. The greater the Q angle, the less stable the knee. 
• More anatomy - knock knees. The opposite of being bowlegged. This can also be due to a wide Q angle. 
• Sedentary lifestyle. Many teenage athletes are inactive physically except when practicing or playing their sport. They don't develop other muscles. All of the wear and tear is on the same joints. Thank the modern tech toys for that!

Are there remedies for this epidemic of ACL injuries?  There are possible actions that may help:

• Strengthen the hamstring muscles so that they are not overpowered by the quadriceps.
• Strengthen the core muscles of the midsection including the abdominals, glutes and lower back.
• Improve running form. Athletes should learn to run with the butt low to the ground and relaxed hip and knee joints.
• Jumping drills emphasizing landing with bent knees to absorb shock.
• Play other sports or do other recreational activities to build a more balanced musculature.
• Work on balance. Balance drills train the body's proprioceptors which adjust during movement to keep in balance.
• Have a distinct off season from the sport.
• Take up a sport that doesn't require speed, deceleration or change of direction. You can also give up you favorite food and replace it with sprouts - but is this really an option?

   Wait a minute! I am always on the lookout for potential opportunities for Fitness Trainers. This is one of them. Women's soccer is very big in affluent suburbs and gentrified urban areas, Why not become go to person for knee injury prevention? Young women should be encouraged to be active and participate in sports. We also don't want them to get injured!
   You will have to ensure that your credentials and knowledge levels are up to date on current knee injury prevention science. This may require extra courses and constant educational updates on ACL prevention programs. Seek out such information and check out websites such as:

 PEP Program - SMSMF
 sportsmed.org
 sportsinjuries.org/acl-injury-prevention.aspx 
American Council on Exercise
National Strength and Conditioning Association
BioMechanics with Justin Price (I highly recommend checking out his courses)
or any other sites that you may find. Don't neglect the sports science periodicals either.
    

  If you want to specialize in working with post operative knee surgery clients tread carefully.

Knee surgery survivors would be considered a special client population. To work with special populations it would be wise to have an advanced accreditation that gives you the preferred knowledge and legal protection. Knees are too fragile a joint to risk to an under qualified Fitness Trainer going beyond their scope of practice. Do it right!

   There is a current controversy in the World Cup of Soccer for Women!
The 2015 games are to be held in Canada in stadiums with artificial turf. A number of women from other national teams have filed a suit against FIFA complaining that soccer at this level must be played on grass. One of the concerns is that turf has less give and elite athlete's knees will be exposed to dangerous conditions. It will be interesting to see how this plays out.
Then again, maybe they just fear going against the Canadian soccer women and arguably the best female athlete in the world - Christine Sinclair!

Top speed! Sudden foot plant for a kick!
A recipe for a blown out knee!

Until Next Time,.......Keep Fit

Little Bobby Strong
















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