To keep a healthy knee, begin at the beginning

Anterior Cruciate Ligament (anteer-i-er croo-see-at lig-a-ment) n. – one of the four major ligaments of the knee. It connects from a posterio-lateral part of the femur to an anterio-medial part of the tibia. These attachments allow it to resist anterior translation of the tibia, in relation to the femur.

It seems like every time fans of women’s basketball turn around, another player suffers the season-ending injury known as the Anterior Cruciate Ligament (ACL) tear. And it’s no wonder, as 12 years worth of data have found that the incidence of ACL injuries for female players is twice that of males in the sport. This discrepancy is even more pronounced in soccer, where the injury ratio is four women to one man (1).

One or more factors may play a role in an ACL injury. Research has found that women tend to have stronger quadriceps than hamstrings, whereas in males, strength is more balanced between the two muscles (2). This discrepancy may explain why women tend to remain more upright during athletic participation, and thus more susceptible to injury (1, 2).

Hormones are also thought to influence ACL tear rates. Women are more likely to tear an ACL during ovulation, though doctors are not sure why (3). Other factors that can contribute to injury rates are the differences in locations of the intercondylar notches in the knees of males and females, and the wider angle of the leg bones to the knee due to wider hips in females.

University of Tennessee Assistant Athletics Director and head Athletic Trainer Jenny Moshak has seen her share of ACL injuries in her 20 years at the school. The most recent was the injury freshman Vicki Baugh sustained in the final minutes of last spring’s National Championship game. Moshak said late season injuries are common.

“There are a lot of over-use injuries, when players keep beating up the body with the same motor patterns,” she said.

Moshak said certain players seem to be predisposed to ACL tears due to a combination of biomechanical factors and personality – the “kamikazes,” she said.

“A lot of it is a biomechanical issue,” she said. “But we can correct much of that.”

One of the ways Moshak and Tennessee Head Strength Coach Heather Mason work together to do that is what Moshak calls neutralizing over-pronation of the foot. An athlete who over-pronates is given orthotics and a program to strengthen the arches of the foot. The result is improved stabilization.

Prevention and rehabilitation also involve a lot of core training, according to Moshak.

“We focus on stabilization more so than strengthening,” she said. “You have to look above and below the injury.”

Over the last decade or so, coaches on all levels have taught female players how to jump and strengthen the legs, and numerous workout recommendations to those effects abound (4, 5). But Moshak said ACL tear prevention needs to go much deeper than that, to the parents and coaches of young players.

“Today you see athletes playing one sport competitively at a young age,” Moshak said. “The bodies of these kids aren’t getting rest.

“An athlete has to get from point A to point B, and it’s up to the coach to train them properly.”
Moshak said it’s extremely important to instill the correct motor patterns for movement in athetes at a young age, when they’re forming playing habits.

“Adults oversee kids, and there’s a right and wrong way to move,” she said. “They need to learn the difference as they grow and develop.”

Hopefully, as youth basketball becomes even more specialized, coaches will focus just as much on Strength and Conditioning as sports skills. It will take some time, because even today not all high school coaches have an S and C program for their players.

But I’m optimistic that coaches of middle school and younger-aged girls will eventually focus on agility, proprioception and other crucial skills in developing players. It’s just a matter of time before the S and C industry that is now engrained in all U.S. college athletic programs trickles down to secondary schools.