Prevention of the ACL epidemic in female sports

Another ACL injury! Fremantle AFLW player Alex Williams clutches her knee this week, courtesy of The Advocate.

ACL (anterior cruciate ligament) knee injuries in female sports has increased dramatically in Australia in recent years, correlating positively with the huge uptake of AFL by girls and women. In fact, there have been up to 43% (74% under 25 years) more ACL injuries over the past five years!

The peak rate of these injuries occur during the age of 15-19 years old & are likely due to increased participation levels and changes during puberty, plus a range of other physiological factors.

The ACL attaches to the area in front of the intercondylar eminence of the tibia (lower leg), it extends backwards and laterally, to attach to the posterior part of the inside of the lateral condyle of the femur (thigh bone).

Its primary role is to resist excessive anterior translation and medial rotation of the tibia, in relation to the femur.

The ligament is stretched or torn in 70% of all serious knee injuries (Tortora & Grabowski (2000).

It is more commonly torn in women than men for a number of reasons:

– ligament is smaller and less strong in female
– less thigh muscle strength means there isn’t as much muscular protection to the ligament
– the increased elasticity in females means that there is more of a delay in hamstring firing, which will protect the ACL less (particularly with hormonal changes during the menstrual cycle)

– Greater Q angle due to wider pelvic compared with males (see diagram below) which places increased stress on the ACL

– Narrower intercondylar notch (which has an increased shearing effect when knee is under stress)

The good news however is that there are effective measures to help reduce the incidence of injury. Injury prevention programs have been shown to decrease severe injuries (including ACL) by up to 74% and all other lower limb injuries by 55% (including ankle, other knee injuries and muscular strains).

These programs focus on improving strength and control of movement (including balance and agility) that can easily be incorporated into routine warm-ups for training and games. Not only do these programs reduce the risk of injury, but they also performance of players completing the program (increased strength, improved movement patterns and balance/agility).

These programs have been implemented in both female and male community and elite sport throughout the world for different sporting codes. In Australia such programs include; the FIFA 11+ for soccer, FootyFirst for AFL and the netball KNEE program for netball.

The physiotherapy team at Dandenong Ranges Physio have developed our own abridged version of these

preventative training regimes assist local coaches, parents and trainers in the implementation of these programs. One downside of the above programs is that they often take 20-25 minutes to complete, and when coaches only have their players for 1-2 hours of training they are reticent to spend this time on preventative training. Perversely it is the younger and mid-teen girls teams which have shorter trainings yet are the demographic that would benefit most from preventative training.

So far we’ve presented this to local youth and adult football, soccer and netball clubs coaches, trainers and player with great uptake.

If you or your local club is interested you can get in contact by emailing or calling us on 97510400.

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