Why it is Common for Female Athletes to Tear their Knee Ligaments – By William P Rix, M.D.

Why it is Common for Female Athletes to Tear their Knee Ligaments,or “Move your Feet, Not your Hands”

Female athletes tear their anterior cruciate ligaments as much as eight times more than male athletes.

This is due in part to anatomic and physiologic factors, but much is due to what we call “neuromuscular deficits or imbalances”. This can be defined as the inability of the athlete to move around the court or field with her trunk or core well-balanced over her legs. Preventive exercise programs addressing these weaknesses can significantly reduce the risk of these devastating injuries.

The anterior cruciate ligament is a key stabilizing structure of the knee. In women athletes, a rupture of this ligament occurs most often during rapid deceleration activities and, unlike in male athletes, predominantlyin non-contact situations. This injury occurs in 1 in 5 women who participate in sports at the college level.

In women athletes there is a strong predictive association between neuromuscular imbalances and torn anterior cruciate ligaments. A female athlete with these imbalances tends to play her sport in an off- balance position, a position that poorly absorbs the energy of deceleration.

For example, when an athlete rebounds she ideally lands with the trunk well positioned over the pelvis, which in turn is centered over the knees; the knees, ankles, and feetare all slightly flexed. By landing perfectly balanced on the balls of the feet, the energy of impact (many times body weight) is absorbed and “softened” by the muscles of the calf, thigh, pelvis and spine. This energy absorption protects the vulnerable knee ligaments from being injured.

Contrast this with the woman who lands “off balance”, with her arms reaching for the ball, waist bent, knees straight, and foot flat on the floor. In this position the energy of landing is transferred directly, unmodified, to the knee. When this force exceeds the breaking point of the anterior cruciate, the anterior cruciate tears and renders the knee unstable.

It is important to identify these “at risk” female athletes. This can be done by direct observation on the field or with a few simple testsadministered by a physical therapist or a qualified athletic trainer.Once recognized, these athletes are instructed in neuromuscular training programs which emphasize balance, core strengthening, proper body positioning, and sport specific exercises. These programs, administered by physical therapists and athletic trainers,are highly successful, reducingthe incidence of knee ligament injuries in female athletes by 50%.

So, in practice, when you are going for the ball and your coach yells, “Move your feet, not your hands!”,do it. It`s good