Since the passing of Title IX in 1972, opportunities for female athletes have consistently grown. In the past decade, however, that growth has been nothing short of remarkable. Women’s college basketball now rivals its male counterpart in many parts of the country; professional women’s basketball leagues have been greeted with success; and who can ignore the fervor that was created by the U.S. Women’s Soccer Team in the summer of 1999 as they played before sellout crowds in some of the largest athletic venues in the United States, on their way to winning the Women’s World Cup Soccer title.
As women continue to raise the bar in the world of sports, we learn more and more about their potential. At the same time, however, we also learn more about their tendencies toward injury. As athletic achievement for women has grown, an unsettling injury pattern also has arisen. Although medical experts are unsure of the reasons, female athletes appear to be more susceptible to knee injuries, particularly injuries to their anterior cruciate ligaments(ACLs). Recent studies indicate that women are anywhere from five to eight times more likely than men to suffer painful, disabling ACL injuries at some point in their lives.
The ACL is a strand of soft tissue that, along with other ligaments, muscles, and tendons, helps stabilize the knee joint. It’s role in pivoting, jumping, and sudden changes of direction is critical. Once it is damaged, mobility is often reduced. This ligament is most severely compromised when women partake in contact sports, such as soccer, basketball, and volleyball, although injuries have occurred in noncontact activities as well.
Once injured, the ACL must be repaired surgically and requires months of painful rehabilitation for any chance of a return to normal athletic levels. Even with therapy, ACL injuries can predispose people to later bouts of immobility, injuries due to lingering instability, and various forms of arthritis.
Why are we seeing this trend? Does the explanation lie in the fact that female participation itself has increased, or are female athletes truly more susceptible to these injuries? A number of hypotheses, ranging from physiological and anatomical differences to hormonal variances, have been suggested and are being explored further.
Many researchers in sports medicine suspect that musculoskeletal differences serve as the basic reason for the greater risk of ACL injury. According to the American Academy of Orthopedic Surgeons, the answers lie in physiological differences between males and females. Female athletes are thought to be at a disadvantage because of an imbalance in strength between the hamstring muscles, behind the thigh, and the quadriceps muscles in front of the thigh. When these two muscle groups work together, they act antagonistically to protect each other and supporting ligature, including that around the knee, from damage. Some researchers suggest that women tend to have underdeveloped or weak hamstrings, which results in increased stress placed on the ACL, particularly during unusual movements. In addition, during actions such as jumping and landing, it is felt that women tend to land more straight-legged and more flat-footed, a tendency related to weaker thigh muscles. In contrast, men often have much stronger quadriceps and hamstrings and tend to bend the knees and cushion the shock when jumping, thereby causing less stress on supporting structures. Thus, in women who are underexercised or have a severe imbalance between their quadriceps and hamstrings, the risk of ACL injury increases. In addition to lower muscle strength, sports medicine officials speculate that structural characteristics, such as wider hips, put greater pressure on the inside of the knee and less on the leg muscle.
Another hypothesis is that women are more prone to ACL injuries during ovulation, when increased estrogen works to reduce the production of collagen, the body’s connective tissue. Orthopedic surgeon Dr. Edward M. Wojtys put this theory to the test by evaluating the injuries of 40 young women with acute ACL injuries. He discovered that a majority of these women did in fact sustain their injuries during ovulation, encouraging the need for further investigation.
So, what can women do to protect themselves from ACL injuries? At this point, Dr. Wojtys says that there is no evidence that hormone supplements will protect women against ACL injuries. For the time being, however, doctors advise women to get involved in sports at an early age and partake in weight training and other types of conditioning that will build the hamstring muscles. When knee injuries do occur, they must be taken seriously and treated with rest, ice, compression, and elevation (RICE). If pain doesn’t subside, a visit to an orthopedic surgeon may be necessary.