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The  sudden deceleration, shifting in the knee, popping sound and screaming  from the intense pain that immediately follows is becoming increasingly  common among our young athletes.  Those who have witnessed or suffered a  torn anterior cruciate ligament (ACL) are familiar with the pain,  surgery and intense 6 to 8 month rehabilitation that accompanies the  injury, not to mention the disappointment of ending a season.   Nationwide, this will occur more than 500,000 times this year, and  female athletes with ACL injuries outnumber males 5 to 7 to 1.


Why  is this injury more common in female athletes, especially basketball  and soccer players?  What is it about young female athletes that puts  them at such a high risk for this devastating injury?


Several  factors contribute to this trend.  ACL injuries in females and the  biodynamics involved are among the most widely studied topics in sports  medicine.  Through this research, we have learned that boys and girls  differ in many ways beyond those typically considered.


Anatomic Differences
Females  have wider hips than males, which increase the angle on the knee joint.   The knee was designed as a hinge joint that is supposed to rock  forward and back in the frontal plane.  Females’ wider hips create an  inward-directed inward angle on the knee, which causes it to roll side  to side like a ball and socket joint. This increases stress on the ACL,  especially during landing and cutting movements.


Females also  have a narrower notch in the inside of the knee.  The ACL travels  through the middle of the knee joint through a notch called the  intercondylar notch.  Since it is narrower in females, the ACL may get  pinched or frayed during cutting, increasing the risk of tear.


Muscle Imbalances
Hamstrings  (muscles in the back of the thigh) are protective of the ACL and the  quadriceps (muscles in the front of the thigh or quads) are antagonists  of the ACL.  In other words, during landing or cutting, if the  hamstrings contract first, the tibia (shinbone) is stabilized and the  ACL is “protected.”  On the other hand, if the quadriceps contract  first, before the hamstrings can stabilize the ACL, then the stress on  the ACL is increased, leaving it at risk for a tear.  In general, the  quadriceps of females are stronger than their hamstrings, putting the  ACL at an even higher risk. In males, the hamstrings are stronger, thus  protecting the ACL.


Additionally, biomechanical research shows  that the gluteus muscles, or external rotators of the hip, fire  differently in males and females.  In males, the hip muscles fire a  split second before landing, thus stabilizing the hips, or core.  With  females, the glutes don’t fire before or after landing, so the hips  rotate in, the knees buckle inward, and the ACL is stressed.


Landing Patterns
Sports  typically involve some degree of running, jumping, landing, cutting,  acceleration and/or deceleration.  Females tend to perform these tasks  with more of a straight leg than males.  This straight leg landing  pattern does not let the muscles of the thighs and calves absorb the  shock, so the stress of landing is transferred to the ligaments of the  joint, like the ACL.


The solution
Now that these biomechanical  differences have been identified, can we correct them?  Some we can,  but some we cannot.  For example, we can’t change the shape of an  athlete.  If a child has wide hips and a stocky build, this may increase  the inward angle on the knee, stressing the ACL.


On the other  hand, through strength and proprioceptive (balance) training, we have  been able to train female athletes to fire their hip muscles and glutes  in ways similar to males, thus stabilizing their ACLs.  We can also  change the hamstring to quadricep strength ratio to make it more  favorable for protection of the ACL.  With proper training and  conditioning, female athletes can avoid ACL injuries and stay in the  game.


David Marshal, M.D.

Medical Director, Sports Medicine Program

Children's Heathcare of Atlanta

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539 Views 0 Comments Permalink Tags: soccer, volleyball, softball, lacrosse, injuries, acl



Member since: May 30, 2007

Covering youth sports ages 5-15 including baseball, football, lacrosse, softball, volleyball, basketball, golf and soccer.

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