Some sobering and startling facts:

• Each year 100,000 ACL surgeries are performed in the US, largely on 15- to 25-year-olds, and the majority on females
• 70% of the ACL tears in females are non-contact injuries, meaning that an athlete's own movements or reaction to landing are the cause
• In the last 15 years, ankle injuries have decreased by 86% while knee ligament injuries have increased by 172%
• Over 1.4 million women been affected by an ACL tear in the past 10 years
• 1 in 100 female athletes will sustain an ACL tear (one source says 10% of collegiate soccer and basketball athletes will do so)
• Each year many women and girls stop participating in sports and exercises due to pain and musculoskeletal problems for which they have been unable to find effective help

PROGRAMS AT PHYSICAL SOLUTIONS

At Physical Solutions, we have many years of experience working with athletic and active females. We have helped many who have not been successful with other approaches. We keep up with the latest research, but don't abandon sound principles for the latest fad.

We offer a spectrum of treatments and services to assist individuals in being and becoming as active and successful as they can be.

Peak Performance Training — Improving overall fitness, functional strength, and power; reducing injury risk factors; and improving speed, quickness, and agility

• Peak Performance I — Increasing functional strength and power while reducing the risk of injury
• Peak Performance II — Increasing speed, agility, and quickness

Personal Strength Training — Improving personal strength, power, and flexibility

Physical Therapy — Providing evidence based, individualized treatment with an emphasis on biomechanical evaluation

Advanced Rehab — Restoring physical abilities in specific activities after injury or surgery

FEMALE ATHLETES INJURED UP TO 8 TIMES MORE THAN MALE ATHLETES

Today more girls and women engage in a wide variety of sports, exercise, and physical activity than ever. While the benefits of exercise, sports, and just being more active far outweigh the risks, studies show that females may be injured at a higher rate than males. Females tear their knee ligaments (ACLs) much more often than males, as much as three to eight times more often! Women and girls also seem to suffer from more overuse and chronic injuries.

But as this newsletter will show, new training techniques developed for women and girls can dramatically reduce their rate of injury — and provide as a bonus improved performance.

A FOCUS ON WOMEN MEANS BETTER TRAINING AND CARE

As a physical therapist involved in treating injuries and making training recommendations, I've learned that treating injuries in females requires more than just applying the same programs that work for males. A therapist or coach needs an understanding of the causes unique to females and the inherent differences in anatomy, physiology, and biomechanics. From this basis, one can design and implement effective programs to solve and prevent problems with active and athletic females.

In the past, most medical studies have been done with male subjects. Treatment for women was often then extrapolated from the results. This has at times resulted in less than ideal treatment of various problems experienced by females. Treatment of sports injuries and training techniques have followed similar patterns until fairly recently. This is now changing somewhat, even if a bit slowly.

Over the past several decades, women have been increasingly participating in collegiate athletics, especially in soccer and basketball. The alarming number of knee injuries, especially ACL tears, finally brought some attention to the specific needs of women. While much more needs to be done to fully understand all aspects of the issue, the information from recent studies combined with experience with active and athletic females in the clinic can lead to effective treatment, training, and injury prevention.

WHAT ARE THE CAUSES? WHAT CAN BE DONE?

The process of discovering the causes of non-contact ACL tears is still ongoing, but many likely factors are known through a number of good studies. While some factors can not be changed, many important ones can be effectively addressed. In the summer of 2000, the Journal of the American Academy of Orthopedic Surgeons published the findings of a study group convened to look at non-contact ACL injuries. They cited four categories of risk factors for these injuries: environmental, anatomic, hormonal, and biomechanical. The problems which can be addressed at this point are some of the biomechanical factors.

Recent studies have shown that female athletes frequently have a poor quadriceps-to-hamstring ratio. These are the muscles in the front and back of the thigh. Additionally, the hamstrings are weaker than they need to be to protect the knee. Another study showed that in most females there were no further strength gains in the hamstrings beyond age 11 — startling information considering that most girls are continuing to grow beyond this age!. With many female athletes, jumping, landing, and push-off mechanics are often less than ideal. These athletes tend to land on straighter rather than bent knees and to move their knees inward toward the opposite foot.

Young athletes are also playing at very intense and high levels at an early age without proper preparation. Very early specialization can also overuse of certain areas while ignoring the development of others.

BIOLOGY OR SOCIETY?

In addition to these biomechanical factors, the higher incidence of overuse injuries seen in female athletes may be partly a product of sociological factors that make girls' strength and conditioning levels lower than boys'. Additional gender-related risk factors include factors such as lack of knowledge on the part of coaches on appropriate training for girls and women. And while males are typically inherently stronger than females due to body structure and hormone differences, they are also more inclined to engage in activities such as weightlifting that make them even stronger.

GOOD NEWS: PROGRAMS REDUCE ACL TEARS UP TO 80%

Studies are showing that the certain programs can effectively reduce the incidence of ACL tears by as much as 80%. Two of these are Sportsmetrics from Cincinnati Sportsmedicine Foundation and the Prevent Injury, Enhance Performance (PEP) Program from The Santa Monica ACL Prevention Project. These programs are aimed at making changes in hamstring strength and in jumping and landing mechanics. They also focus on helping the neuromuscular system function more efficiently, so the proper muscles fire quickly enough. These programs include warm-ups, jump/plyometric training, strength training, specific stretching, and techniques of jumping, landing, and cutting.

Physical Solutions is pleased to announce that it is teaming with Phase II Personal Training to provide several programs to area athletes and teams to prevent injury. These programs include group training for injury prevention and performance enhancement and individual strength training for youth as young as 10 (following guidelines set by American College of Sports Medicine and the American Academy of Pediatrics).

TREATING OVERUSE AND CHRONIC INJURIES

Overuse and chronic injuries can also be reduced and effectively treated by similar means. A physical therapist can direct a program to treat, correct, or prevent problems after a thorough biomechanical evaluation of the individual and an analysis of the demands of the sport or activity.

Effective treatment of overuse and chronic injuries must include:

1. Evaluating and training of core strength (which includes the core of the trunk AND the hip and shoulder).
2. Correcting of joint mobility and range of motion limitations early in the process.
3. Observing of movement patterns and teaching the athlete to align and properly use joints from the trunk to the shoulder and hip and beyond.
4. Developing a program that acknowledges the balance needed between agonists and antagonists and between the smaller controlling muscles and the larger, global muscles, when strength is an issue. Most strength programs are developed without this balance in mind.
5. Supporting and controlling for biomechanical problems when necessary through bracing, taping, orthotics, or other means.

NEW ROLES FOR COACHES AND OTHER PROFESSIONALS

The significant increase in the number of females participating in sports and exercise has created new challenges for coaches, trainers, and medical and rehabilitation professionals. By using specific testing and training, they can help significantly reduce the incidence of injuries in active women and girls. As a bonus, this training for prevention often leads to performance enhancement including higher vertical jump, increased speed, quickness, and endurance.