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. 

Sports Injuries & Student Athletes: A Parent’s Guide

March 7, 2023

Playing sports is a great way for children of all ages to maintain a healthy lifestyle. It also builds confidence and teaches them valuable life lessons, like working as a team and the value of hard work. While it may be every sports fanatic’s dream to have their kid make it big time in the arena or on the diamond, sometimes pushing young athletes to be the best at a young age can lead to serious injuries that will take them out of the game altogether.

Henry Ford Health"Sports help with physical and psychological well-being," says Matthew Santa Barbara, M.D., a sports medicine physician at Henry Ford Health. "However, year-round participation in a single sport at a young age can lead to overuse injuries and mental burnout."

Nowadays, many kids will start playing one sport at a young age and continue to play that same sport year-round for years. This can be harmful to your child because his or her soft tissue and bone structures aren't fully developed. Furthermore, the pressures of year-round participation and focus on excelling, rather than enjoyment, can negatively affect a young athlete's mental health.

Basketball causes the most injuries among high schoolers, causing many visits to the emergency room each year for stressed and torn ankle ligaments. In baseball, the Tommy John surgery, a procedure to reconstruct torn ligaments in the elbow after overuse, has also been increasingly used to treat young athletes still in high school.

How To Prevent Sports Injuries

Preparing your children appropriately before a sports season begins and supporting them during the season is important. Dr. Santa Barbara offers four key pieces of advice to help your youth athletes avoid injury.

1. Don’t limit your child to one sport. Playing a variety of sports in different seasons is a great way to work different parts of the body. When your child gets older, they can make the transition to playing a single sport they are good at and enjoy.

2. Warm up. Make sure your child is properly warming up before they play any sport. Dynamic warmups--incorporating exercises that involve moving the body such as lunges, high knees and arm circles – are preferable to stretching alone.

3. Strengthen core muscles. Building up core strength takes pressure off joints in the arms and legs. It gives young athletes more momentum and can help improve their performance.

4. Abide by rest rules. Many schools and sports leagues have rules in place to limit how many teams kids are on or how often they play. Follow these to ensure your child is allowing time for their joints and muscles to recover from physical activity.

Children participating in a sport should never push through pain, and injuries should be promptly evaluated by a sports medicine physician. Physical injuries are often more obvious, while mental health issues due to sports participation can be more subtle. Symptoms such as fatigue and declining performance can be signs of burnout. In these situations, rest is also important.

"Sports should be fun for kids," says Dr. Santa Barbara. "Avoiding single-sports specialization at a young age keeps the focus on enjoyment while reducing the physical and psychological risks of year-round participation."

To find a sports medicine provider at Henry Ford Health, visit henryford.com/sportsmedicine or call 313-651-1969.

Matthew Santa Barbara, M.D., is a non-operative sports medicine physician at Henry Ford Health. He sees patients at the Henry Ford Center for Athletic Medicine in Detroit, Henry Ford West Bloomfield Hospital, Henry Ford Medical Center - Columbus, Henry Ford Medical Center - Bloomfield Township and Henry Ford Medical Center - Fairlane.