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Exercises can help combat and prevent girls' ACL injuries

Members of the MSC Mustangs soccer team take a class at Balance gym for teenage girl athletes, designed to help them protect their ACLs and MCLs through strength and agility exercises.  Corinne Lake, who has already had knee surgery, does squats with a light weight.
Members of the MSC Mustangs soccer team take a class at Balance gym for teenage girl athletes, designed to help them protect their ACLs and MCLs through strength and agility exercises. Corinne Lake, who has already had knee surgery, does squats with a light weight. (Dayna Smith for The Washington Post)
By Lenny Bernstein
Thursday, January 28, 2010

It's no secret that young women athletes are suffering an epidemic of crippling injuries to their anterior cruciate ligaments (ACLs), one of the four strong bands of tissue that connect the leg bones at the knee joint. A decade of research and books such as Michael Sokolove's "Warrior Girls" have shown that our daughters are three to eight times as likely as our sons to tear an ACL.

Less recognized is that preventive measures can be quite effective if the right program is implemented in the right way, according to some of the same research.

One determined Bethesda mom recently resolved to do just that. Patricia Lake's daughter, Corinne, ruptured her ACL the day before her 15th birthday, the day after she made the Whitman High School varsity soccer team as a freshman. Because she had not finished growing, doctors were reluctant to drill into her femur, a routine part of repairing the ligament. They held off her surgery for six months.

The operation was followed by grueling physical therapy and personal training. As Corinne grew stronger, Lake began to wonder how she could keep her daughter's strength and flexibility regimen on track and help spare other girls the same fate. She spoke with Corinne's physical trainer, Graham King, owner of Balance Sport and Fitness, who was eager to start a program for teen girls.

Now, once or twice a week, a dozen girls on Corinne's travel soccer team work on protecting their knees in Balance's Dupont Circle facility, a converted high school gymnasium, while their parents get in workouts of their own.

"As I watched Corinne go through physical therapy and then personal training and then surgery and then PT again and training again, I realized how much she was learning about how to train to be an overall athlete," Lake said. "So my thought was, 'Why not have the whole team share in the fun and become better athletes and hopefully stop the overuse injuries?' "

We are long past the silly argument over whether girls are physically equipped for soccer, basketball, rugby and other rough sports. Thanks to Title IX, girls have pulled more or less even with boys in the opportunity to play them at the collegiate, high school and youth levels. As Sokolove points out, adolescent girls with talent may play and practice soccer more than 200 times a year in school, on travel teams and at summer camps. (Disclosure: Sokolove is married to a Post writer.)

But it is not sexism to recognize that girls' bodies are different from boys'. Their ACLs are thinner. Their pelvises are wider, creating a greater "Q angle" with the knee that puts more stress on the ligament. Their femoral notch, the passage in the femur where the ACL attaches, is narrower and can wear against the ligament. There is evidence that during menstrual cycles, hormones make girls' ACLs more lax. More girls tend to be knock-kneed.

"The bodies are different, but we've given them the same programs," King says.

While boys may learn to cut, jump, land and stop at a very early age, girls tend to come to sports later. Certain movements, such as absorbing the force of a landing, may not come as naturally, and the muscles involved may not be as strong.

"Something is going to take up the slack," says Lauren Polivka, a physical therapist at Balance. For most teens, it's a knee ligament.

But young women are not destined to a life of injury. "You can't make an ACL bigger," says Trent Nessler, executive director of Baptist Sports Medicine in Nashville. "So what we tend to look at is what factors can you affect through training."

And so, for the past few weeks, the girls at Balance have been practicing landing softly by jumping off huge truck tires onto the gym floor. They do sit-ups and push-ups to strengthen core muscles that keep their bodies stable under the stress of athletic competition. They strain to run against resistance belts to strengthen their legs, especially their quadriceps.

The program is by no means the only one in the area. Some schools have adopted their own programs, and others are involved through research studies.

Nessler says girls who take part in such programs can reduce their chances of injury by as much as 88 percent compared with those who don't. And the same exercises can boost athletic performance. As girls' sports become more competitive, he believes the way to get schools, parents and the girls to buy into prevention programs is by marketing them as ways to gain an advantage over opponents.

"Coaches and parents need to understand what the correlation is with performance," he says. "Coaches want to prevent ACL injuries, but if you can prevent ACL injuries and drive their athletic performance -- wow."


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