
Diagram courtesy of Wikipedia
Did you know...
that the ACL (anterior cruciate ligament) is a short vertical ligament that connects the femur and tibia bones of the leg, just behind the knee cap?
Did you know...
that different studies show women athletes are at least 4-6 times more likely to tear an ACL than men?
Did you know...
that once an ACL is torn it is more susceptible to re-injury?
Did you know...
that there are exercise programs that have been developed to aid in the prevention of ACL tears?
Did you know...
that methods have been developed that are used to predict which girls are physiologically more susceptible to ACL tears?
Did you know...
that two soccer playing mothers of children currently with Santa Rosa United have had 9 ACL surgeries between them?
I am not a doctor, however, recently the high incidence of torn ACL’s among young women, specifically soccer playing young women, has been brought to my attention. We are all parents of young and talented soccer players who have the opportunity to play this great game for a long time. Consequently, I feel that it is important to share some of the resources that I have come across that deal with this issue. Conversely, if you have information that you would like to share, please don’t hesitate.
There are different theories as to why ACL tears are more prevalent in females than males and millions of dollars are being spent annually in research programs to help more specifically identify the differences. Many of these theories are based on anatomical differences in the pelvic structure between men and women and how this results in different angles between the bones of the legs. Whatever the cause, the effects of ACL tears, surgery, and the rehabilitation process is traumatic. The implications effect not just soccer careers; they can carry broader, life altering consequences.
The most extensive source that I reviewed is a substantial, and thoroughly researched book, Warrior Girls (Simon and Schuster), that was written in 2008 by Michael Sokolove. This book deals with contemporary women in sports, with a majority of it looking specifically with the causes and implications of ACL tears in women soccer players.
Locally, Todd Weitzenberg, MD of Kaiser Permanente has developed an ACL injury prevention regime. This program is directly accessible from the Santa Rosa United website or you can just click here. This program stands out for its ease of implementation. No special equipment is required; it can easily be done at home. Also, there are self-directing videos on the website that are easily followed. Dr. Weitzenberg played high-level soccer for many years and is also the father of a current SRU player.
Another noteworthy ACL prevention program is one developed by the Santa Monica Sports Medicine Foundation. It is known as the “PEP” (Prevent Injury and Enhance Performance) program. Dr. Bert Mandelbaum is the developer of this program as well as being Team Physician for all U.S. Soccer Federation teams.
A third well known program is “Sportsmetrics”. This program was developed by an orthopedic surgeon, Dr. Frank Noyes, and a human movement specialist, Timothy Hewett. You can learn more about this program by clicking here.
In addition to the previously mentioned injury prevention programs, there have been methods developed to assess an athlete’s susceptibility to ACL injury. These are based on posture and movement. While these evaluation techniques vary from visual to using sophisticated force plates, they do not, and cannot eliminate ACL injuries. They can provide a “red flag” for those athletes who may be most prone to the injury. Dr. Christopher Powers, Professor of Biokinesiology and Physical Therapy at the University of Southern California and co-director of the Musculoskeletal Biomechanics Research Laboratory uses the sophisticated laboratories of the University to perform his analysis. A visual analysis by a trained professional (Dr. Weitzenberg performs such an analysis) can be similarly effective.
I recently had the opportunity to speak with Denise Rapinoe, mother of Rachel and Megan Rapinoe. As many of you probably know, Megan is a starting midfielder for the USA National Team and one of the stars of the 2011 USA Women’s World Cup team. Megan has had two ACL tears and her twin sister, Rachel’s career was shortened by a season ending second tear during her senior year at University of Portland. (Check out this video.) Denise is a strong proponent of exercise programs that will strengthen the supporting muscles of the knees.
This summer the Riptide had special sessions in plyometrics. When properly designed and executed, these exercises form a portion of most ACL injury prevention programs. The effort made by SRU to include this in the program is commendable. There is also more solid information available on the SRU website, if a little buried, by going to the "Home" page, clicking on the “Resources” tab at the top of the page, and then scrolling down to “Health and Education Info”.
Finally, if you also have boys playing soccer, these ACL prevention tips are also appropriate for them. If your kids play other sports, especially basketball, they also are susceptible to ACL injuries; again with the prevalence being higher in women.
Of course, many, many women have competed for years at all levels of soccer and never suffered a serious ACL injury. However, I feel that the incidence of injury is high enough, and the potential consequences severe enough, that this information should be made available to our soccer community. Thanks for reading and we’ll see you at the pitch.