Monday Medical: Reducing ACL injuries in girls and women
Ski season is in full swing, which means skiers need to be aware of the possibility of ACL injuries. Especially women.
“Women are four to six times more likely to tear an ACL based on their structural anatomy and strength imbalances,” said David Grinnell, a physical therapist and board certified orthopedic specialist at SportsMed at Yampa Valley Medical Center.
The ACL, or anterior cruciate ligament, is one of four main ligaments in the knee that connect the upper leg bone, or femur, to the lower leg bone, or tibia, and help the knee work as a hinge.
There are several reasons women are more susceptible to ACL injury. First, women have a proportionately wider pelvis than men, which can set the femur at a greater angle from the hip to the knee, making it easier to stress the knee.
Second, women are usually a little weaker in their glutes than men, which can cause instability in the hips and knees.
And finally, women may have a smaller notch in the upper leg bone through which the ACL passes, which makes it easier to pull or tear the ligament.
ACL injuries are often due to a cut and pivot motion, in which a person decelerates and changes direction quickly. That can happen on the soccer field, the basketball court and while skiing.
“The foot is locked in place while skiing, so during a fall, there can be extreme flexion, hyperextension or rotational forces on the knee,” Grinnell said. “It can happen in fluffy powder if you fall and twist the wrong way or on an icy run.”
Major ligaments, such as the ACL, are worth protecting.
“If a ligament is sprained, it’s stretched, so it doesn’t go back like a rubber band,” Grinnell said. “It has that laxity forever, and your body ends up relying more on muscles to compensate, making further injury more likely.”
A tear to the ACL can require surgery and a year or two of rehabilitation. That may be enough to end an elite athlete’s career, or, at the very least, it can make it more difficult to compete in the future.
But there are ways to reduce the risk. Grinnell was recently certified in Sportsmetrics, an ACL injury reduction program for girls and women, and will will offer the program at SportsMed in 2017. The goal is to teach people how to jump correctly, which builds strength and technique in a way that reduces the chance of ACL injury.
The six-week program starts with simple exercises, then becomes progressively more difficult. By the end of the program, patients have learned optimal biomechanics, or how to better stabilize and use their muscles properly.
“Visually, they see their jumping mechanics improve significantly,” Grinnell said. “People who go through the class have less of a chance of having ACL tears or injuries than people who don’t.”
Sportsmetrics can be beneficial to anyone — from an elite ski racer to someone who hits the slopes for fun.
But even if you aren’t able to follow the program, there are steps you can take this winter to reduce the likelihood of an ACL injury. Grinnell recommends skiing less aggressively and within your ability level, taking a ski fitness class, building balanced strength and being aware of changing weather conditions on the slopes that can put different torques on skis.
“Do as much as you can do to get correct muscle groups working and learn these correct jumping techniques,” Grinnell said. “That can result in optimal performance and greatest reduction of possible injury.”
Susan Cunningham writes for Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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