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 Inside Scoop On Ski Safety: 6 Tips

January 10, 2023

Injuries happen to skiers of all levels, even under pristine conditions and when using the best available equipment. “Beginners are more likely to get injured. But when experienced skiers go down, they tend to have more severe injuries,” says Michelle Gambino-Gorney, a certified athletic trainer at the Henry Ford Kutcher Clinic for Concussion and Sports Neurology.

Henry Ford Health logoBut you don’t have to let the risk of injury hold you back from having fun on the slopes. A few basic safety tips? Stay within your ability level and ensure your skis are in good condition. That said, going beyond ski safety basics and learning how to avoid injuries can help you stay safe on the slopes. Here are six expert tips: 

Use caution when getting on and off the ski lift. Ski lifts make a lot of people anxious. Being high off the ground on your journey up the mountain can invoke a fear of falling. “But it’s getting on and off the ski lift where the vast majority of lift-related injuries occur,” Gambino-Gorney says. To lower your risk of injury, remove pole straps and backpacks before loading, look over your shoulder to make sure you sit squarely on the seat at the correct time, and don't try to retrieve items you lose hold of (including poles, gloves and phones). It’s best to let them go and ski back for them.

Keep it simple at terrain parks. Terrain parks include human-made features like ramps and rails that enable skiers to do jumps, flips and other maneuvers. Any time your skis leave the ground, injuries are possible. You can safely enjoy terrain parks by starting with smaller obstacles and maneuvers and mastering them before moving on to other challenges. Do not rely on online tutorials to learn new skills. Ski instructors can help you learn the correct technique and provide personalized tips for achieving your goals.

Beware of trees. Trees present multiple dangers. Colliding with a tree, especially at high speed, leads to some of the most severe ski injuries. A small number of skiers die each year from tree collisions. To avoid collisions, ski with control.  Other concerns include tree wells and snow immersion suffocation. This type of injury occurs when a person falls head first into a pocket of loose snow near a tree trunk and gets trapped. Skiing with a partner on ungroomed paths, which typically run past tree wells, is essential. If you become immersed in a tree well, a partner can step in to help you break free. 

Pay extra attention during your final run of the day. Injuries are more common during skiers’ last runs. “Skiing later in the day can be dangerous because small changes can affect your ability to maneuver and react to conditions,” Gambino-Gorney says. Fresh powder may get matted down. Groomed areas become bumpy. And fatigue can make you less aware of hazards and other skiers. While it may be tempting to give it your all on your last run, it’s better to ease up and take your time.

Follow the Skier Code of Responsibility. People of all ages, abilities and ski levels can safely share the slopes when everyone follows the National Ski Area Association™ Responsibility Code. Key points include: Giving right of way to people ahead of (downhill from) you, staying off closed trails, and looking uphill for other skiers when merging.

Expedite access to help in an emergency. Being prepared can help you quickly reach ski patrol in an emergency. Most ski areas list their ski patrol phone number near the lifts. While you are waiting in the ski lift line, program it into your phone. If you or someone nearby experiences an injury, being able to call for help will save precious time. Instead of waiting for someone to ski down the mountain and ask for help, you can stay with the injured person and call for help. Calling also makes it easier to share important details so that ski patrol arrives with the appropriate people and equipment.

“Skiing is like any sport in that there’s a risk of injury. But many people hit the slopes without incident. Some skiers go decades without a single fall,” Gambino-Gorney says. Follow these insider tips and don't forget to wear a helmet so you can relish your next powder day and get the most out of the season.

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

Michelle Gambino-Gorney is a certified athletic trainer at the Henry Ford Kutcher Clinic for Concussion and Sports Neurology.