Girls and Torn ACL’s…

A post by Benny One Six, to be found here;

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It’s long and filled with all kinds of stupid personality/biography stuff like they do for the olympics to get the women to watch… but the core is this:

http://www.nytimes.com/2008/05/11/magazine/11Girls-t.html

[...]If girls and young women ruptured their A.C.L.’s at just twice the rate of boys and young men, it would be notable. Three times the rate would be astounding. But some researchers believe that in sports that both sexes play, and with similar rules — soccer, basketball, volleyball — female athletes rupture their A.C.L.’s at rates as high as five times that of males.

Anthony Beutler, a major in the U.S. Air Force and a professor at the School of Medicine of the Uniformed Services University in Bethesda, Md., is among the cadre of doctors, scientists and researchers trying to crack the code of A.C.L. injuries. In 2001-2, he was a sports-medicine fellow at the Naval Academy, where he served as the physician for the women’s soccer team. Seven women were lost that season to A.C.L. ruptures. Beutler, already immersed in A.C.L. research, was still stunned. “I thought to myself, What in the heck is going on here?” he said. Last season, the women’s team at Navy suffered three torn A.C.L.’s. “They thought that was great, a fortunate year,” he told me. “Think about that. Just three. It’s bizarre.”

Men also tear their A.C.L.’s, most frequently in football and from direct blows to the leg. But even football players, according to N.C.A.A. statistics, do not rupture their A.C.L.’s during their fall seasons at the rates of women in soccer, basketball and gymnastics. The N.C.A.A.’s Injury Surveillance System tracks injuries suffered by athletes at its member schools, calculating the frequency of certain injuries by the number of occurrences per 1,000 “athletic exposures” — practices and games. The rate for women’s soccer is 0.25 per 1,000, or 1 in 4,000, compared with 0.10 for male soccer players. The rate for women’s basketball is 0.24, more than three times the rate of 0.07 for the men. The A.C.L. injury rate for girls may be higher — perhaps much higher — than it is for college-age women because of a spike that seems to occur as girls hit puberty.

If you are the parent of an athletic girl and live in a community that bustles with girls playing sports — especially the so-called jumping and cutting sports like soccer, basketball, volleyball and lacrosse — it may seem that every couple of weeks you see or hear about some unfortunate young woman hobbling off the field and into the operating room. The first time, you think: What a stroke of bad luck. But you figure it won’t happen to your daughter because, after all, what are the odds?

After a couple of more A.C.L. tears in the neighborhood, you get worried and think, Gosh, we must be in a really bad cluster for these injuries. Why here? But in all likelihood, what you are witnessing is not a freakish run of misfortune but the law of averages playing out.

The Injury Surveillance reports include commentary as well as data, and in 2007 the authors stated that an A.C.L. rupture is “a rare event” and advised against making too much of the tears sustained by male and female collegiate athletes across a range of sports. But a young woman playing college soccer can easily generate 200 exposures a year between her regular season in the fall, off-season training in the spring and club play in the summer. Plenty of younger players, girls in their early through late teens, will accrue well in excess of that number between their high-school seasons, their club seasons — which often run year-round — and multigame tournaments on weekends and soccer camps in the summer. (The same is true in other sports in which girls play school and club seasons, including basketball, lacrosse, volleyball and field hockey.)

So imagine a hypothetical high-school soccer team of 20 girls, a fairly typical roster size, and multiply it by the conservative estimate of 200 exposures a season. The result is 4,000 exposures. In a cohort of 20 soccer-playing girls, the statistics predict that 1 each year will experience an A.C.L. injury and go through reconstructive surgery, rehabilitation and the loss of a season — an eternity for a high schooler. Over the course of four years, 4 out of the 20 girls on that team will rupture an A.C.L.

Each of them will likely experience “a grief reaction,” says Dr. Jo Hannafin, orthopedic director of the Women’s Sports Medicine Center at the Hospital for Special Surgery in New York. “They’ve lost their sport and they’ve lost the kinship of their friends, which is almost as bad as not being able to play.”

Marshall says he feels a sense of urgency, because without a better understanding of the injury, the situation will get worse in coming years with the great numbers of girls playing sports — and the frequency and intensity of their play. In 1972, at the dawn of Title IX, about 300,000 girls participated in high-school sports. The number is now three million. Thirty thousand women played college sports pre-Title IX; about 205,000 now play.

“We’re studying an elite population at the service academies, but the big concern for me is the girl down the street who wants to play soccer on the rec team or the travel team,” Marshall told me. “They’re ripping their knees up, and they shouldn’t be. There’s got to be a way to prevent it. And we’re really on the up curve of this, because it’s still relatively recent that girls played sports in these large numbers. . . . So if you think we have a problem now, 10 years from now we’ll have a much bigger problem.”

ONE WEEKEND IN THE FALL OF 2007, I watched a soccer match involving two teams of 13-year-old girls in Southern California with Holly Silvers, a physical therapist and the director of research at the Santa Monica Orthopaedic and Sports Medicine Research Foundation. These were elite players, but from one end of the field to the other, Silvers pointed out girls she judged to have insufficient core muscle strength, balance or overall coordination to play safely. Their movement patterns put their knees — and probably their ankles, hips and backs — at risk.

“Look at the girl on the left back with the ponytail,” she said as we stood on the sideline of a game at the Home Depot Center, a vast complex of fields in Carson, Calif., where the men’s and women’s national soccer teams train. “She really concerns me.” At first I couldn’t pick out whom she meant; there were lots of ponytails out there. “No. 8,” she clarified, and I fixed my attention on a tall, stiff-legged girl whose upper and lower bodies seemed not to be in communication with each other. She ran bolt upright, with very little bend in her trunk. Her knees seemed not to flex. When she came to a stop or slowed to change directions, she landed flat-footed. “She’s got really poor form,” Silvers said. “She won’t hold up running like that.”

She pointed out another girl with possibly even worse form. She was one of the better players on the field, but Silvers said her advanced skills masked serious physical flaws. I asked her if she could fix the girl, given the opportunity. “Yes, I could,” she said. “In four to six weeks I could improve her a lot. In three months, I could get the job done. I would educate the muscles, educate the nerves. She could build strength and change her patterns.”

Silvers directed my attention to one more player, a girl who seemed light on her feet, quick and springy. When she changed directions, she stayed in what generations of gym teachers have called “the athletic position” — knees bent, butt low to the ground. Even when walking casually during stoppages in play, she seemed more lithe than the other girls. “She moves more like a boy,” Silvers said. “Believe me, that’s a good thing.”

Silvers, along with a Santa Monica orthopedic surgeon, Bert Mandelbaum, designed an A.C.L.-injury-prevention program that has been instituted and studied in the vast Coast Soccer League, a youth program in Southern California. Teams in a control group did their usual warm-ups before practices and games, usually light running and some stretching, if that. The others were enrolled in the foundation’s “PEP program,” a customized warm-up of stretching, strengthening and balancing exercises. An entire team can complete its 19 exercises — including side-to-side shuttle runs, backward runs and walking lunges — in 20 minutes. One goal is to strengthen abdominal muscles, which help set the whole body in protective athletic positions, and to improve balance through a series of plyometric exercises — forward, backward and lateral hops over a cone. Girls are instructed to “land softly,” or “like a spring.”

There is nothing complicated about the program. And nothing really exciting about it either — which, as with many preventive routines, is one of its challenges. As essential as it may be, it’s not as interesting as kicking a soccer ball around.

The Santa Monica Orthopaedic and Sports Medicine Research Foundation published results of its trial in the American Journal of Sports Medicine. The research was nonrandomized and therefore not the highest order of scientific research. (The caoches of teams doing the exercises made a choice to participate; the control group consisted of those who declined.) Nevertheless, the results were attention-grabbing.

The subjects were all between 14 and 18. In the 2000 soccer season, researchers calculated 37,476 athletic exposures for the PEP-trained players and 68,580 for the control group. Two girls in the trained group suffered A.C.L. ruptures that season, a rate of 0.05 per 1,000 exposures. Thirty-two girls in the control group suffered the injury — a rate of 0.47. (That was almost twice the rate for women playing N.C.A.A. soccer.) The foundation compiled numbers in the same league the following season and came up with similar results — a 74 percent reduction in A.C.L. tears among girls doing the PEP exercises.

The program has direct parallels with the research taking place at the military academies. Both are focused on biomechanics — the way athletes move — in no small part because gait patterns can be modified, unlike anatomical characteristics like wider hips. Marshall has been encouraged by information taken from the sensors attached to his subjects as they jump. “Women tend to be more erect and upright when they land, and they land harder,” he said. “They bend less through the knees and hips and the rest of their bodies, and they don’t absorb the impact of the landing in the same way that males do. I don’t want to sound horrible about it, but we can make a woman athlete run and jump more like a man.”

Silvers stressed the importance of training girls as young as possible, by their early teens or even younger. “Once something is learned neurally, it is never unlearned,” she said. “It never leaves you. That’s mostly good. It’s why motor skills are retained even after serious injuries. But ways of moving are also ingrained, which makes retraining more difficult with the older athletes. The younger girls are more like blank slates. They’re easier to work with.”

The PEP program, and others like it around the country, are not without their skeptics, who ask how you can try to solve a problem before you are even confident of its cause. Donald Shelbourne, an Indianapolis orthopedic surgeon and researcher, is perhaps the most vehement of the critics. “It’s like me taking antioxidants,” he says. “I don’t have cancer yet, so it’s working, right? These retraining programs play on emotions without data. They’re unproven. Jumping and landing is something that everyone knows how to do, and now we’ve got people saying, ‘We can teach you to do it better.’ I don’t buy it.”

caoches rarely like to give up precious practice time for injury prevention, and often have to be pushed by parents. As Diane Watanabe, an athletic trainer who is part of the Santa Monica research team, puts it: “caoches have to see a performance boost. Otherwise, they won’t do it. That’s the only way we can sell them on this program.”[...]

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