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It’s b-ball season, girls: Don’t be an ACL stat. Listen to the PT.

December 16, 2010 – 6:00 AM

By Wendy Farnen Price

Girls are playing basketball with a level of passion and skill – and in numbers — we couldn’t have imagined a few decades ago (and just think how many more will be inspired to play by UConn’s run on UCLA’s 1970s-era win streak!).

But a troubling fact remains: female athletes have an incidence of noncontact anterior cruciate ligaments (ACL) injuries two to eight times higher than their male counterparts, according to American Orthopaedic Society for Sports Medicine (AOSSM).

Girls and women who play in “pivoting” or “cutting” sports like basketball or soccer are particularly at risk. The problem is not just lost playing time, but long-term complications such as osteoarthritis at a younger than average age (think 30-40 with pain, difficulty walking stairs, etc.)

What can girls do?

Before the season starts, have a routine screening by a physical therapist (evaluations are covered by most insurance plans). Because girls are specializing in specific sports at younger ages they may not develop their muscles in a balanced way. A girl can appear athletic and strong but have neuromuscular imbalances. Screenings can pick up problems such as knee valgus (knock knee), core weakness, quadriceps or leg dominance – all of which may increase the risk of an ACL injury.

What can a screening show?

The screening should include the young athlete’s sports participation history, a comprehensive physical assessment of jumping and landing; strength, core/abdominal stability and strength, flexibility, speed, agility and endurance.

I do several general tests that involve jumping and hopping  — and I videotape them so I can break down movements. Jumping and landing tests are a quick, practical way to assess an athlete’s neuromuscular control, strength and alignment. Are they knock-kneed? Do they bend their knees? Are their knees over their toes? Does their trunk sway? Do they lose their balance? Do feet overpronate (roll in)?

In one test, for example, a girl jumps off a box to the ground and then jumps up again. I am looking for a “soft landing” and proper alignment. For a “soft landing,” girls should have a big hip and knee bend to absorb the forces and toe to heel rocking. For proper alignment, girls should be in an “athletic position” with feet under shoulders, and knees over toes, and weight evenly distributed.

This position is important because being in a vulnerable, non-athletic, position during play can cause a non-contact ACL injury. A girl vulnerable to ACL tears will land with the knee pointing inwards and almost straight and the foot pointing outwards with torso leaning forward.

What if there are problem areas?

The good news is that training programs (check out the PEP program) aimed at correcting neuromuscular imbalances can help prevent ACL injuries. Good training also increases body awareness, improves coordination and develops proprioception (that is, a better feel for how our body moves in space). The keys to prevention: focusing on good technique, proper alignment, and pre-positioning to help girls recognize and avoid vulnerable positions (see above).

There are specific exercises to strengthen hamstrings (single leg bridges, Russian hamstring), strengthen the core (planks, abdominal crunches, criss-cross sit-ups), and calf muscles (single leg toe raises). And in general, Pilates is a great rehab tool often used in treating athletes because it is a whole body, balanced, non-impact exercise program.

When should girls start?

It may be surprising, but studies show that starting training programs at an early age (10-11) before the onset of puberty leads to maximal benefit. However, I believe it is never too late to start. Not only can these programs possibly prevent an ACL injury, but they may lead to improved performance!

Wendy Farnen Price PT MS CPI STAR Certified Clinician has been a practicing physical therapist since 1994. Price, who specializes in orthopedics, oncology, women’s health and sports performance, is a training specialist and consultant for Oncology Rehab Partners and also has her own practice/pilates studio, Healthcore, in Woodbridge, CT. Wendy has presented at national conferences and been featured in magazines, newspapers and TV news programs. As a USTA tennis player and co-manager of her daughter’s travel soccer team, Wendy has a personal interest in preventing injuries in female athletes.

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