Monday, July 24, 2000

Knowing knee injuries in women

Tristate researchers seek answers to athletes' high risk

By Peggy O'Farrell
The Cincinnati Enquirer

        With more than 3 million girls and women playing sports in high school and college, doctors are becoming more concerned about how they are injured and how to prevent damage, especially to the knees.

A look inside the knee
        Statistically, women are four to six times more likely than men to suffer serious knee injuries, usually to the anterior cruciate ligament (ACL).

        Researchers at the Cincinnati Sportsmedicine Research and Education Foundation are focusing on what factors make women more injury-prone than men and how effective training is in correcting those factors. The study is one of a few nationwide that focus on women's knees.

        Since Title IX went into effect in the 1970s, requiring schools receiving federal funding to offer equal athletic programming for males and females, the number of females in school sports has increased some 800 percent, said Dr. Tim Hewett, director of applied research at Cincinnati Sportsmedicine.

        Add that to the fact that women are already more at risk for knee injuries and you'll find “this huge gender gap” in knee injuries, Dr. Hewett said.

        At the collegiate level, one in 10 women athletes will suffer a serious knee injury. With approximately 100,000 women playing sports, that's a pool of 10,000 blown knees every year. By contrast, one in 50 to one in 100 men will suffer a knee injury, Dr. Hewett said.

        At the high school level, where play is less intense, the ratio drops. But with about 3 million girls playing high school sports, the total number of knee injuries increases to about 50,000 annually, Dr. Hewett said. @SubHed:Surgery is expensive @ColText:

        Jaime Walz, 22, blew out her knee playing basketball for Western Kentucky University in January 1999. After surgery to repair her ACL, she was back on the court in October.

        “You're hearing so much more about injuries in the women's professional sports because we're so much more active than we ever have been,” said Ms. Walz, who was National Prep Player of the Year her senior season at Highlands High School.

        Beyond the numbers of knee injuries, there's the cost factor, Dr. Hewett said. “If you blow your ACL, you've basically bought yourself a car,” he said.

        Reconstructing and rehabilitating the ligament costs about $25,000. Nationally, the price tag for women's knee injuries is more than $100 million a year.

        The ACL controls the pivoting motion of the knee. With the hamstring and quadriceps muscles — located in the back and front of the thigh, respectively — it stabilizes the joint.

        Simple anatomy is probably a strong factor in women's knee problems, Dr. Hewett said. If the quadriceps and hamstring aren't nearly equal in strength, there's too much strain on the ACL, which can cause it to rupture.

        Women's hamstrings are significantly weaker than their quads, and women tend to rely more on their quads when they jump and pivot, Dr. Hewett said. Men rely more on their hamstrings.

        The unequal strength between women's hamstrings and quads means the ACL has to work harder to stabilize the knee when women jump. Sometimes the jump puts too much stress on the ligament, causing it to rupture or stretch too much.

        And the way women jump also plays a part. When women jump, they tend to land with their knees inward, putting more strain on the ACL.

        “When a woman jumps, she uses different muscle patterns,” said Dr. Frank Noyes, director of the Cincinnati Sportsmedicine and Orthopaedic Center. ""We don't know why this occurs. Why does a woman tend to use more of a quadriceps-dominant pattern than a hamstring-dominant pattern? We think that's probably not genetic. That might just be training, and we just haven't used the right training mechanism.”

        Differences in neuromuscular programming probably also make women more prone to injuries, Dr. Hewett said, “and we don't know where that programming comes from, whether it's from differences in play between young boys and girls or from training or whether it's hormonal.”

        Also, hormonal changes may affect muscle or ligament laxity throughout a woman's menstrual cycle. @SubHed:About the study @ColText:

        Cincinnati Sportsmedicine has developed Sportsmetrics, an athletic training program aimed at reducing knee injuries from jumping, cutting and pivoting moves with a combination of flexibility, strength and weight trainig, said Dr. Noyes.

        “What we're actually teaching them to do is to position their bodies first so they're always in the right position” to jump without risking injuries, he said.

        The program includes testing, also developed by Dr. Noyes and his team, to identify whether an individual is at risk for a knee injury.

        The training program is available to area high schools and is underwritten with a grant from the NFL.

        Increased training for women athletes could help reduce the number of injuries they suffer, Drs. Hewett and Noyes said.

        More than 400 athletes, male and female, have gone through the training and testing. Researchers want to follow the results of some 2,000 athletes in the program to determine what specific factors increase women's risk of injury, the best methods to screen for those factors and the most effective training to correct those factors, Dr. Hewett said.

        The current study follows several studies Cincinnati Sportsmedicine has done on women's knee injuries.


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