I’ve been sitting here in my study for the better part of three hours, just surfing the net, while looking for articles and news bulletins that will inspire me to write about some topic that will teach you something about orthopaedics. And what should I see but a study that shows a trend that orthopaedists have been aware of for some time: that ACL Injuries are far more common in women athletes than men.
According to our parent organization, the American Academy of Orthopaedic Surgeons, the incidence of ACL ruptures is about 4-6 times greater in females than in males. In some studies, the incidence is as much as 8 times greater in women.
Why? Well, there are anatomical differences between men and women (THERE’S a newsflash for you!). As you are probably aware, the female pelvis is wider, so the angle of the knee is more valgus (slightly knock-kneed) than that of a man. As I’ve pointed out in the past, this has implications for the kneecaps. But it also increases shearing forces across the joint. In addition, there are demonstrated neuromuscular imbalances in women, that cause them to land with their knees slightly inward, which exaggerates their anatomical tendencies and rely more on their quadriceps.
Men, by contrast, tend to land with their knees straight in line, or slightly outward, with more balance between their quadriceps and their hamstring muscles. And finally, there are some studies that implicate estrogen spikes in the bloodstream, a consequence of the menstrual cycle. The theory is that the increased estrogen may weaken the ligaments, making them more prone to injury.
Regardless of the actual cause, it’s apparent that some factor or combination of factors results in a significantly higher incidence of Anterior Cruciate Ligament ruptures among young women. This is especially true in those playing basketball and soccer, where sudden deceleration, combined with sudden change of direction, applies increased force to the ACL.
The need to slow forward progress and tolerate directional change simultaneously requires strengthening of the posterior muscles: the hamstrings, the gluteals and the gastrocnemius. These can be affected by backwards walking, back pedalling on the stationary bike, walking lunges and kicks, and bounding from leg to leg.
In the past, all the focus was on the quadriceps, in an effort to stabilize the knee and increase power and performance. But the modern recognition of the danger of ACL rupture has led to a rethinking of this method of training, in favor of a more balanced development of both front and back thigh muscles. Exercises, such as those I teach in my PAIN-FREE PROGRAM http://drbillsclinic.com/exercise_eliminate.html can be selected in such a way as to result in balanced development, with strengthening of quads in front and glutes and hams in back. And I’ve always been a strong proponent of calf development, since the gastrocs cross and therefore help to stabilize the knee joint.
The same program, used to rehabilitate the postoperative knee after ACL reconstruction, can also be used to PREVENT the ACL injury from occurring. By using these exercises, together with other measures before the fact, we can often AVOID KNEE SURGERY. See how at http://drbillsclinic.com/avoid_knee_surgery.html
In this as in many other cases, merely taking a different perspective on “old” training methods can result in great new benefits. Today, the emphasis is on prevention, rather than cure.
BTW, today’s the LAST DAY you can get my classic LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN at http://drbillsclinic.com/eliminate_knee_pain.html
At midnight, the “introductory price” is gone for good. So, if you want it, make your move NOW. Click on: http://drbillsclinic.com/eliminate_knee_pain.html
That’s it for today, my friend. Be well. Talk to you soon.
Yours for a pain-free tomorrow,
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to http://drbillsclinic.com/advanced_masters.html
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Copyright, 2008 by William Thomas Stillwell, MD
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