by Kelsey Cognetta, PT, DPT, ATC
When it comes to competitive sports, injuries are a familiar topic of discussion among the athletes who participate and the parents who spectate.
In recent years, anterior cruciate ligament (ACL) injuries have become a household name, occurring at a rate of 200,000-250,000 annually. About 25% of these injuries occur in children under the age of 18, making ACL injuries a significant concern for high school athletes. Female athletes sustain these injuries at a rate that’s approximately eight times greater than their male counterparts, according to current research. In turn, female athletes at the high school level are a particularly vulnerable population for a season-ending injury.
The anterior cruciate ligament is one of several ligaments that provide stability and control of the knee during pivoting, cutting, and jumping forces. These movements are crucial to any sport, but they are most commonly seen in basketball, lacrosse, football, and soccer, making the ACL susceptible to injury.
As a physical therapist and an athletic trainer who has suffered ACL rupture twice during high school basketball and lacrosse, there are three key things I stress to parents and athletes when it comes to injury prevention: the importance of strength training, the risks that come with sport specialization, and the importance of prioritizing recovery. Here’s why:
1. The Importance of Strength Training
When you think of strength training in high school sports, what comes to mind? For many, the thought might conjure images of the high school football or wrestling team working out in the weight room.
However, strength training should be considered an integral part of training for all high school girls who participate in sports to help significantly reduce the risk of ACL injuries.
Female athletes under the age of 18 are thought to be at higher risk of ACL injuries due to several factors, including biomechanical, anatomical, neuromuscular, and hormonal influences. Strength training helps address risk factors by improving muscle strength, coordination, and joint stability to match the demands placed upon the knee during sports maneuvers.
One of the most effective strategies is to implement an individualized approach, where movement screening is used to identify the athlete's specific weaknesses and unique movement patterns. By tailoring a program to the individual, the athlete can address muscle imbalances and strength deficits and retrain proper body mechanics to better prepare their bodies proactively for competition.
Likewise, it’s essential that warm-ups before games or practices resemble the actions performed during the sport, such as incorporating dynamic movements and agility drills. This approach not only prepares the muscles and tissues for activity but also reinforces proper movement patterns, reducing the risk of injury.
2. Avoid Sport Specialization
A common concern among athletes and parents is focusing all their time and effort on playing one sport all year around. The fear is that without this level of commitment, the athlete won’t be able to develop their skills or strength compared to their competitors. But the opposite is actually true.
Year-round high sport specialization can be taxing for an athlete and can increase the likelihood of overuse injuries like an ACL tear, due to overexposure without adequate recovery periods.
One study from the Orthopedic Journal of Sports Medicine suggests that sports specialization can increase girls’ risk of injury by 30 percent, and that young athletes who engage in the most hours of intense activity per week are the most likely to be injured.
Encouraging participation in several sports throughout each season exposes the body to different movement patterns and changes the demand on different muscle groups in the body. It is especially important to athletes below the age of 18, this helps develop various muscle groups as they are still growing.
It also reduces the risk of overuse injuries by not subjecting the same muscles and joints to repetitive stress. For instance, basketball involves a lot of jumping and pivoting, while swimming emphasizes endurance and flexibility. These differences in movement can provide a more balanced physical development for athletes.
3. Take Time to Come Out Stronger
Consider this: An ACL tear usually requires surgery and extensive physical therapy, sidelining an athlete for 9 to 12 months (or even longer!). Unfortunately, the risk of re-injury is higher after recovery, and there are potential long-term consequences, such as a significantly increased likelihood of developing osteoarthritis in the knee within 10 years post-injury.
Given these risks, injury prevention strategies are essential. While many believe injury prevention means training harder, consider the importance of recovery. This means prioritizing proper nutrition to fuel your body and maintaining a consistent, high-quality sleep schedule. These pillars of recovery are essential for healing muscle tissue that can be broken down during repetitive exercise and have been shown to improve accuracy and reaction times during competition. If we can maximize our healing through diet and sleep we decrease the chances for a potential season-ending injury.
For teenage girls, early involvement in strength training, engaging in a variety of sports, and recognizing when and how to optimize recovery and rest are crucial for preventing ACL injuries and ensuring a healthy and safe sports experience.