he American Physical Therapy Association (APTA) is urging female athletes — particularly soccer players — to consider a new warm-up program to help lower their growing risk of anterior cruciate ligament (ACL) injuries.
Concurring with a new study published in the American Journal of Sports Medicine (August 2008), APTA says specialized stretching, strengthening, agility and jumping exercises could lower the overall ACL injury rate among female athletes.
The study evaluated outcomes of NCAA Division 1 female soccer players who performed the Prevent Injury, Enhance Performance (PEP) program, designed by physical therapists at Santa Monica (CA) Orthopedic and Sports Medicine Group. Those who performed the PEP program had an overall ACL injury rate 41 percent lower than a group of female athletes who did their regular warm-up. This was one of the largest studies conducted in the NCAA with 1,435 athletes participating.
The PEP program, one example of the many physical therapy-based programs that have demonstrated an equal ability to reduce ACL injuries among female athletes, consists of sport-specific agility exercises and addresses potential deficits in the strength and neuromuscular coordination of the stabilizing muscles around the knee joint. Physical therapist and APTA spokesperson Holly Silvers, MPT, who helped develop PEP, says, "The program was created to address the deficits that are seen in female athletes, particularly weakness in the lateral hip muscles, gluteal, and core muscles." These deficits can contribute to ACL injuries, notes Silvers.
According to physical therapist and APTA spokesperson Mark Paterno, PT, MS, MBA, SCS, ATC, coordinator of orthopedic and sports physical therapy at Cincinnati Children's Hospital Medical Center, recent research published in the British Journal of Sports Medicine found that ACL tears occur four times more frequently in females than in males involved in the same amount of sports participation. He says the difference in neuromuscular control, or the way our muscles contract and react, is one of four primary factors contributing to why women are more susceptible to knee injuries than men. Other discrepancies are anatomical (men and women are structurally differently), hormonal (women's hormonal makeup affects the integrity of the ligament, making it more lax), and bio-mechanical (the positions our knees get in during athletic activities).
Sample exercises athletes can perform to avoid ACL injuries can be found on the APTA Web site.
"Women perform athletic tasks in a more upright position, putting added stress on parts of the knee such as the ACL, resulting in less controlled rotation of the joint," said Paterno. "While men use their hamstring muscles more often, women rely more on their quadriceps, which puts the knee at constant risk. To combat these natural tendencies, physical therapists may develop a treatment program to improve strength, flexibility, and coordination, as well as to counteract incorrect existing patterns of movement that may be damaging to joints," he added.
Silvers notes that physical therapist-designed programs can teach athletes how to avoid abnormal movement patterns and lessen stress on the knee, which may include exercises to strengthen hamstring and core muscles.
"Whether patients are athletes or not, physical therapist expertise includes not only rehabilitation and restoration of normal levels of function, but also education regarding how to prevent further injury," says Silvers.
The APTA is celebrating National Physical Therapy Month this October, an annual observance designed to educate the public about the important role physical therapists and physical therapist assistants play in the health care system.
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