Women & ACL Injuries: Know Risks, Steps for Prevention

August 10, 2021

Whether you’re a casual jogger or elite athlete, you’re at risk for an injury to your anterior cruciate ligament (ACL). If you’re a woman, you are at even greater risk for these injuries.

But there are steps you can take to prevent them.

“Among athletes, women are more than twice as likely to have an ACL injury than men,” says Nithin Natwa, M.D., a sports medicine specialist and primary care physician at Henry Ford Health System. “Once you have an ACL injury, you are at greater risk for having further soft tissue injuries in the future. That’s why it is important to prevent these injuries and follow your treatment plan if injured.”

What Is An ACL Injury?

An ACL injury is a strain or tear in the ACL, one of the four major ligaments that support the knee so it can flex and bend. The ACL is a strong band of tissue that helps connect your thigh bone (femur) to your shin bone (tibia). “An ACL injury usually occurs without contact when you turn suddenly while running or land off-balance on one leg. These actions overload the knee joint and cause the ACL to be torn,” says Dr. Natwa.

In the United States, 100,000 people have ACL injuries each year. Anyone can experience an ACL injury, though athletes participating in sports like football, basketball, soccer and gymnastics are at highest risk. And summer is a peak time for outdoor sports injuries.

Seek immediate care if you have any of these signs of an ACL injury:

• An audible “pop” in the knee

• Intense knee pain and rapid-onset swelling (within hours)

• Loss of range of motion

• An unstable feeling or locking of your knee

The most common treatment for ACL injuries is surgery followed by physical therapy. After treatment, you can expect to return to normal activities in 6 to 9 months. However, peak athletic performance can take up to two years.

Why Are Women At Higher Risk For ACL Injuries?

According to Dr. Natwa, the differences in athletic training techniques for males versus females have left women at greater risk for ACL injuries. “There has been more emphasis on overall conditioning and mechanics for boys participating in sports compared to girls,” he says.

As a result, women are at greater risk for ACL tears and sprains due to:

Differences in neuromuscular control: Without conditioning from an early age, women may not have the same ability to land and perform athletic motions that men do. For example, women are at higher risk for an ACL injury after landing from a jump.

Strength imbalance for muscles that support the knee: Female athletes tend to have more defined quadriceps muscles but weaker hamstrings than men, putting them at greater risk for injury.

According to Dr. Natwa, there are many theories about women’s risk for ACL injury that lack scientific evidence, including:

Width of the pelvis: Some people have suggested that the wider width of a woman’s pelvis puts more pressure on the knee joint and increases the risk for injury. However, this difference has not been shown to impact a women’s risk for ACL tears or sprains.

Knee anatomy: The ACL runs through a section of the femur called the intercondylar notch. Women tend to have a narrower notch than men. Regardless of gender, individuals who possess smaller notch dimensions appear to be at greater risk for injury than individuals with larger notches.

Hormones: Men and women have different hormone levels. But there is currently no concrete evidence that female hormones place women at higher risk for ACL injures.

Steps To Prevent ACL Injuries – Conditioning Early, Often

“The best way to prevent ACL injuries is to begin and maintain regular conditioning exercises at an early age,” Dr. Natwa says. “The more frequently you engage in proper exercises, the lower your risk for injury.”

Consult with a sports medicine specialist, physical therapist or athletic trainer to develop a training routine to prevent ACL and other injuries. Your training program should include exercises that:

Strengthen the muscles that support your knee: Add strength training to build up your calves, hamstrings and quadriceps muscles. These muscles help stabilize your knee as you move. By strengthening these muscle groups evenly, you can lower your risk for injury.

• Improve overall neuromuscular control: Focus on adding neuromuscular exercises that train your nerves and muscles to react and communicate. For example, you may work on your balance by standing on one leg or sit upright on an exercise ball for short periods of time. And core exercises can strengthen the muscles that support your abdomen and back and help improve your posture as you move. These moves can strengthen your joints and help you learn appropriate balance and technique.

“Exercise really is the best medicine. It can improve your balance and agility as you participate in a sport or prevent injury as you move through your daily activities,” says Dr. Natwa. “Consider adding these exercises to your wellness program.”

Dr. Nithin Natwa is a sports medicine doctor who sees patients at Henry Ford Macomb Health Center in Chesterfield and Henry Ford Macomb Orthopedics and Wound Care in Clinton Township.

Want to learn more? Henry Ford Health System sports medicine experts are treating the whole athlete, in a whole new way. From nutrition to neurology, and from injury prevention to treatment of sports-related conditions, they can give your athlete a unique game plan. To find a sports medicine physician at Henry Ford, visit henryford.com or call 1-800-436-7936. 

The Dangers of Returning to a Sport Too Soon After an Injury

September 12, 2023

Henry Ford HealthWhen you've been hit with an injury, it's natural to want to get back to your regular activities as soon as possible. In fact, it's not uncommon for athletes to sidestep doctors' orders and return to the field or the court before an injury has healed.

"It doesn’t matter how much you train, or how much you prepare, injuries are going to happen, especially if you're an athlete," says Jamie Schwab, an athletic trainer at Henry Ford Health System. "But the real trouble arises when athletes try to play through their pain without allowing sufficient time for recovery."

Risks Of Returning Too Soon After Injury

If you sprain your ankle during a cross country run, it can be tempting to finish the race. Unfortunately, hiding your pain and powering through the activity can actually make matters worse.

"If you continue to work out after suffering from an injury, you run the risk of furthering that injury," Schwab says. So what began as a minor ankle sprain can evolve into a major sprain that sidelines you for weeks.

Returning to play after surgery demands extra precautions. "Athletes are a lot more susceptible to re-injury after returning from surgery, especially if they don't complete the entire 9-month or year-long rehabilitation protocol," Schwab says. In some cases, you can exacerbate an injury to such a degree that you'll never be able to participate in the same capacity.

A Safe Return To Play

The road back to play after an injury is a long and winding one. Before you can even consider returning to exercise, you need to reduce swelling, get pain under control and get your range of motion back to almost normal.

"The recovery process takes time," Schwab says. "But if you stick with it, and you take it seriously, it's going to be a whole lot easier for you to return to the playing field in a timely manner."

Once you get pain and swelling under control, you can focus on agility and weight exercises that will help you regain strength and slowly return to baseline. The key tenets for a safer return to play:

Be honest about your abilities: "So many athletes are afraid to tell the truth," Schwab says. "But if you're hurting and you're not competing at your full potential, you're letting your team down and yourself down, too." Even worse, you could increase your risk of further injury.

Focus on building strength: Strength training is critical. It can help you become faster, stronger and more agile on the field. It can also help you recover more quickly after an injury.

Listen to your body: If something doesn't feel right, pay attention to it. Talk to your athletic trainer or a physical therapist to get to the bottom of what's bugging you and put a plan in place to address it.

Boosting Performance Over The Long Haul

Unfortunately, not every coach and athletic trainer stresses the importance of a maintenance program. In fact, focused training and maintenance exercises are key to preventing injuries in the first place.

"The rehabilitation exercises you begin doing on day one after injury need to be maintained at least three to four times each week, indefinitely," Schwab says. "If you follow that regimen, all of your muscular nagging strains will no longer be a problem because your body is constantly adapting to the stresses. It's conditioned, it's strong, it can withstand the constant changes in direction."

Most importantly, don't be afraid to try complementary strategies. Practice using a foam roller, try cupping to release tension in the muscles and enhance blood flow and consider getting a monthly massage.

Jamie Schwab, AT, ATC, SCAT, CSCS, is an athletic trainer with Henry Ford Sports Medicine and works with student athletes at Edsel Ford High School. She is a National Strength and Conditioning Association-certified strength and conditioning specialist.

To find a sports medicine doctor or athletic trainer at Henry Ford, visit henryford.com/sports.