Ruptured Lives
Monday January 18, 2010
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More than 1.4 million women have sustained anterior cruciate ligament injuries in the past 10 years — that’s twice the rate of the previous decade, according to data cited by University Sports Medicine in Rochester, N.Y. It is estimated that more than 30,000 high school and college-aged females will rupture their ACLs each year.
But with the help of preventive exercise programs, the risk of injury can be significantly reduced. A Swedish study reported in the Jan. 11 issue of the Archives of Internal Medicine showed that a soccer-specific exercise program that includes individual instruction reduced these knee injuries by 77% in young females.
ACL injury rarely occurs during normal daily activities, but more often results from sports that involve pivoting and cutting maneuvers. One of the reasons that female ACL injuries are on the rise is that participation in women’s competitive sports has significantly increased since the implementation of Title IX of the Education Amendments of 1972.
“The girls participate in more than one sport, spending much more time practicing and playing,” says Andrew Duncan, PT, MS, SCS, ATC, CSCS, director of sports rehabilitation at USM, who sees approximately 50 patients with ACL tears each year. “ACL injuries are much more biased to females than to males. Some authors reported it is six to nine times higher than in male counterparts,” he says.
Researchers have not been able to pinpoint a specific cause for this gender bias. “Areas that have been researched are the differences in bone structure, such as pelvic width and knee angle; the activation patterns of hamstrings; and the change in hormones during the menstrual cycle,” Duncan says.
Neuromuscular Nuances
Although the root cause of gender bias with ACL injuries remains unclear, studies indicate that the risk of injury can be significantly lowered by adding neuromuscular and proprioceptive exercises to training regimens. With this in mind, the Santa Monica Orthopedic and Research Foundation developed the PEP Program (Prevent injury, Enhance Performance), which is a 20-minute warm-up replacement program typically carried out two or three times a week. It includes elements of flexibility, strength, proprioceptive and balance activities, plyometrics, and agility exercises to address potential deficits in the strength and coordination of the dynamic knee joint stabilizers.
The foundation’s study, “Effectiveness of a Neuromuscular and Proprioceptive Training Program in Preventing the Incidence of Anterior Cruciate Ligament Injuries in Female Athletes,” showed an 88% decrease in ACL injuries in the 2000 soccer season and a 74% reduction a year later.
The University of Wisconsin Health Sports Medicine Center, Madison, runs a different program, called ACL Injury Reduction Program. It was developed by Dan Enz, PT, LAT, of UW Health, and uses one-on-one risk assessment. Athletes are videotaped throughout a complex series of athletic movements to pinpoint peculiarities, such as the knee losing its alignment with the hip and ankle during walking. Enz then creates personalized training programs for correcting the flaws in movements such as slowing down and landing from jumps, cutting, and pivoting.
Without adequate prevention and training, ACL injuries can have devastating effects on an athlete’s mobility. Although many patients may be able to function in their daily lives without an intact ACL, athletes in high-demand sports, such as football, soccer, basketball, lacrosse, and softball, often decide to undergo surgery so they can continue to play.
“A decade ago, we mostly saw high school athletes getting reconstructive surgery done, but today we see 13-year-olds and even people in their late 50s undergoing surgery,” says Marc Sherry, PT, LAT, CSCS, PES, manager of sports rehabilitation at UW Health Sports Medicine Center.
Rehab Regimen
In most cases, rehabilitation begins the day after ACL reconstruction surgery, with an emphasis on regaining full knee extension. After about four weeks, the athletes are able to ambulate without braces or crutches, with progression to full recovery of strength, balance, and proprioceptive control evolving over four to eight months.
For patients who choose not to have surgery, the course and length of physical therapy treatment depends on the presence of other injuries, the patients’ age, goals, and the amount of time they are able to commit to rehab.
“These patients can very well function without an ACL, and they can even do low-impact sports like swimming or biking,” Sherry says.
Duncan and Sherry agree that one difficult aspect of treatment is the extended time athletes must spend away from their team. “I remember the frustration I had to go through until I was able to play again,” says Duncan, who himself experienced a torn ACL 25 years ago. “For adolescent females, the emotional and social changes that occur as the result of not being able to be on the team can be devastating.”
To counterbalance this isolation, UW Health Sports Medicine Center runs the Performance Spectrum group rehabilitation program, in which patients who share injuries such as ACL tears go through rehabilitation as a group.
“Another problem is when [patients] have a misconception about the length of recovery,” Sherry says. “They see professional athletes return to play after five months, but they don’t take it into consideration that those athletes’ job is to do the recovery full time. If you have a 9-to-5 job and want to spend time with your family, rehabilitation will take much longer.”
Paul Wynn is a contributing writer for Today in PT.
But with the help of preventive exercise programs, the risk of injury can be significantly reduced. A Swedish study reported in the Jan. 11 issue of the Archives of Internal Medicine showed that a soccer-specific exercise program that includes individual instruction reduced these knee injuries by 77% in young females.
ACL injury rarely occurs during normal daily activities, but more often results from sports that involve pivoting and cutting maneuvers. One of the reasons that female ACL injuries are on the rise is that participation in women’s competitive sports has significantly increased since the implementation of Title IX of the Education Amendments of 1972.
“The girls participate in more than one sport, spending much more time practicing and playing,” says Andrew Duncan, PT, MS, SCS, ATC, CSCS, director of sports rehabilitation at USM, who sees approximately 50 patients with ACL tears each year. “ACL injuries are much more biased to females than to males. Some authors reported it is six to nine times higher than in male counterparts,” he says.
Researchers have not been able to pinpoint a specific cause for this gender bias. “Areas that have been researched are the differences in bone structure, such as pelvic width and knee angle; the activation patterns of hamstrings; and the change in hormones during the menstrual cycle,” Duncan says.
Neuromuscular Nuances
Although the root cause of gender bias with ACL injuries remains unclear, studies indicate that the risk of injury can be significantly lowered by adding neuromuscular and proprioceptive exercises to training regimens. With this in mind, the Santa Monica Orthopedic and Research Foundation developed the PEP Program (Prevent injury, Enhance Performance), which is a 20-minute warm-up replacement program typically carried out two or three times a week. It includes elements of flexibility, strength, proprioceptive and balance activities, plyometrics, and agility exercises to address potential deficits in the strength and coordination of the dynamic knee joint stabilizers.
The foundation’s study, “Effectiveness of a Neuromuscular and Proprioceptive Training Program in Preventing the Incidence of Anterior Cruciate Ligament Injuries in Female Athletes,” showed an 88% decrease in ACL injuries in the 2000 soccer season and a 74% reduction a year later.
The University of Wisconsin Health Sports Medicine Center, Madison, runs a different program, called ACL Injury Reduction Program. It was developed by Dan Enz, PT, LAT, of UW Health, and uses one-on-one risk assessment. Athletes are videotaped throughout a complex series of athletic movements to pinpoint peculiarities, such as the knee losing its alignment with the hip and ankle during walking. Enz then creates personalized training programs for correcting the flaws in movements such as slowing down and landing from jumps, cutting, and pivoting.
Without adequate prevention and training, ACL injuries can have devastating effects on an athlete’s mobility. Although many patients may be able to function in their daily lives without an intact ACL, athletes in high-demand sports, such as football, soccer, basketball, lacrosse, and softball, often decide to undergo surgery so they can continue to play.
“A decade ago, we mostly saw high school athletes getting reconstructive surgery done, but today we see 13-year-olds and even people in their late 50s undergoing surgery,” says Marc Sherry, PT, LAT, CSCS, PES, manager of sports rehabilitation at UW Health Sports Medicine Center.
Rehab Regimen
In most cases, rehabilitation begins the day after ACL reconstruction surgery, with an emphasis on regaining full knee extension. After about four weeks, the athletes are able to ambulate without braces or crutches, with progression to full recovery of strength, balance, and proprioceptive control evolving over four to eight months.
For patients who choose not to have surgery, the course and length of physical therapy treatment depends on the presence of other injuries, the patients’ age, goals, and the amount of time they are able to commit to rehab.
“These patients can very well function without an ACL, and they can even do low-impact sports like swimming or biking,” Sherry says.
Duncan and Sherry agree that one difficult aspect of treatment is the extended time athletes must spend away from their team. “I remember the frustration I had to go through until I was able to play again,” says Duncan, who himself experienced a torn ACL 25 years ago. “For adolescent females, the emotional and social changes that occur as the result of not being able to be on the team can be devastating.”
To counterbalance this isolation, UW Health Sports Medicine Center runs the Performance Spectrum group rehabilitation program, in which patients who share injuries such as ACL tears go through rehabilitation as a group.
“Another problem is when [patients] have a misconception about the length of recovery,” Sherry says. “They see professional athletes return to play after five months, but they don’t take it into consideration that those athletes’ job is to do the recovery full time. If you have a 9-to-5 job and want to spend time with your family, rehabilitation will take much longer.”
Paul Wynn is a contributing writer for Today in PT.
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Monday January 18, 2010