Girls are two to six times more likely to tear an ACL - What Female Athletes Need to Know
By Colette House
It’s the season ending injury no one wants to have. An ACL tear possibly means reconstructive surgery. It means at least six months of rehabilitation. It means an increased risk for a second tear in the same knee or the opposite one. For many girls, an ACL tear means deciding between pursuing a sport competitively and retiring.
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Dr. Cynthia LaBella, sports medicine physician at Lurie Children’s Hospital, says it’s more common for girls to end their careers, choose a different sport, or not pursue moving to the next level of their respective sport after suffering an ACL tear. Reasons vary, but LaBella says it could be because they’re afraid of getting injured, feel like they’ve lost too much time in recovery, or have found other interests to pursue.
Is there really a gender gap between male and female athletes and ACL tears?
High school female athletes are two to six times more likely to tear an ACL than their male counterparts. Read on to understand risk factors and learn about ways to strengthen and protect knees!
Why are girls more likely to tear an ACL?
The gender gap has intrigued researchers for years. Studies have been done exploring the effect of hormones on the ligament itself as well as whether females naturally wider pelvises create an angle between the hip and knee that results in more tears. Those studies did not produce conclusive results, leading researchers to examine the differences in neuromuscular activation between boys and girls.
"Said quite simply, girls just use their muscles differently when they're playing sports than boys do," says LaBella. "The way girls tend to use their muscles is less protective for the knee than the way boys tend to use their muscles."
For example, LaBella said girls tend to use their quadriceps a lot more than their hamstrings when they jump, whereas boys tend to use both muscle groups evenly. When athletes use both muscle groups evenly balanced forces act on the knee. If they’re not used evenly the imbalance puts athletes at a higher risk for a tear. A trained eye can spot when girls are using their muscles unevenly, particularly if girls land on stiffer knees or their knees collapse inward then they land.
Additionally LaBella points to a theory that shows that girls rely on their bones and ligaments to stop the motion on their joints rather than using their muscles to control joint movement. LaBella says this dynamic is what leads girls to land in what’s commonly referred to as a “knock kneed” position [girls landing with their knees collapsing inward] which increases the risk of a tear.
Finally, researchers identified that girls tend to have a dominant or stronger leg whereas boys have a tendency to have equal strength in both legs and girls exhibit less core stability making it harder to stabilize their truck over the top of their leg and knee. if they land from a jump on a single leg.
"So it's not so much hip width of presence of hormones; it's really dynamic and how girls use their muscles when they do these sports maneuvers. That's where a lot of the evidence points to as to why girls are at a higher risk for ACL injuries than boys," says LaBella.
Puberty’s role in ACL tears
One aspect researchers can agree on is that puberty plays a role in girls’ increased risk of tears. LaBella says when researchers look at the way girls and boys jump and land before puberty they look the same, but when puberty hits they begin to see differences. With puberty, boys get a big burst of testosterone, which increases muscle size and strength. Not only do boys experience a growth spurt at this stage, their muscle mass increases as well, helping them control their new body size. Not so for the girls.
“Girls do not get a big burst of muscle. They’re kind of left with their pre-pubertal muscle strength and size to control this new body height and limb length, and wider hips.”
Just because girls don’t receive a natural increase in strength doesn’t mean it can’t be trained. LaBella says girls can definitely increase their strength and improve muscle firing patterns. They might just have to train a bit harder to do so.
Preventing ACL tears
Girls definitely have resources available to them to decrease their risk factors for ACL tears and improve their strength and overall athletic prowess. LaBella stresses the importance of finding a good pre-season conditioning program, preferably one that lasts at least six weeks. These programs should help athletes build overall strength and conditioning and improve muscle coordination.
Components of successful ACL prevention programs
1.) LOWER EXTREMITY STRENGTHENING. LaBella said exercises such as squats, planks, and lunges strengthen hips, hamstrings, and quads – all necessary in helping the knees function properly.
2.) PLYOMETRICS. Repetitive jumping exercises help athletes build power. With the oversight of a trainer LaBella says girls can understand when they’re jumping and landing in the correct position.
3.) SUPERVISION. LaBella said the most successful programs incorporated a trainer or coach that watched the girls and coached them on proper mechanics, especially when it came to the landings of plyometric exercises.
“Strength and conditioning is very very important, especially if you’re playing a sport that puts a lot of stress and demand on the knees like basketball, soccer, or volleyball,” says LaBella.
What is my ACL?
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