I coach girls soccer. The girls I am currently coaching are between 13 and 15, so the following sentence from a study by the Journal of the American Medical Association (JAMA) certainly caught my eye.
The study found that “Among teenage athletes, the rate of ACL tears is rising, with the sharpest increase seen in females aged 13-17 who, over the last 13 years, have experienced a 59 percent increase in the number of required reconstruction procedures.”
There are many reasons girls are more likely than boys to suffer ACL injuries, including wider pelvis, slower reaction time, changes in estrogen levels and the fact that the groove in the femur through which the ACL travels tend to be smaller in women.
But let’s concentrate on a couple factors we can do something about – flat-footed landing and hamstring strength, both of which require special attention.
When they are at the age when they feel invincible and bullet-proof, getting players to understand the importance of jumping and landing techniques and hamstring strength is half the problem.
Stick the Landing
One of the major reasons female athletes suffers ACL damage is because they land in a flat-footed position, as opposed to landing on the balls of their feet.
"If the calf muscles are not absorbing the force, and if the knee is not in the proper position, the knee buckles and tears the ACL," explains Dr. Barry Boden of the Orthopedic Center in Rockville, Md.
When I first heard about this, I was skeptical. It seemed completely unnatural not to bend your knees when landing. But I watched my players as they performed the FIFA 11-plus warmup, part of which is jumping and landing. Guess what? Almost every player landed flat-footed.
Correcting how players land is not as easy as you’d think. As you can imagine, getting someone to actually think about how they land after a jump is asking them to do something unnatural. You have to add it to the long list of bad habits that need to be broken. That requires constant reminders, or more accurately, nagging.
Your Hamstring is Your Friend
I’m no scientist, but I did learn in third grade that the “shin bone’s connected to the knee bone, knee bone’s connected to the thigh bone, thigh bone’s connected to the hip bone, and the hip bone’s connected to the back bone.”
And that little ditty tells me that all the muscles are connected, which makes it easy to understand how the strength of the thigh muscles and hamstrings can impact the ACL.
Studies indicate there is an imbalance between the strength of thigh muscles and hamstring muscles in females. The thigh muscles, for whatever, reason, tend to be more developed.
According to an article on Mom’s Team, “It is well-established that female athletes typically have poor hamstring strength, which is considered one possible risk factor for ACL ruptures. If the hamstring cannot balance the power of the quadriceps (front thigh muscle), the imbalance can cause significant stress to the ACL, leading to injury.”
Obviously, it is well worth your time to have your athletes do hamstring-strengthening exercises. A video put together by US Soccer shows former women’s national team player Ali Krieger, who overcame a serious ACL injury, demonstrating some simple exercises.
In general, coaches and players concerned about ACL injuries can pay attention to some simple guidelines from a study published by Sports Health.
• Proper leg muscle strength training and core training;
• Proper neuromuscular (balance and speed) training;
• Proper coaching on jumping and landing and avoiding any straight knee landing;
• Proper footwear and orthotics if necessary (the amount of traction or "grippiness" of athletic shoes needs to fall within an optimal range that minimizes rotational friction to avoid injury yet optimizes transitional friction to allow peak performance in activities such as cutting and stopping).
Lastly, there is another thing that coaches can do to help prevent ACL injuries and it is completely in our control – pay attention!
Coaches without sports science or medical staffs obviously need help keeping up with their players’ fitness. DRVIN can do that. Players can complete a daily questionnaire and answer questions about their general fitness, giving coaches an opportunity to see something that could indicate a potential problem.
Additionally, DRIVN trackers measure and record things like fatigue and muscle soreness which can indicate an athlete needs a rest, and tracking activities that involve core or hamstring strength can identify athletes who might be prime candidates for ACL tears.