If Only Women Played Like Guys

Undoubtedly many jaws dropped upon reading that somewhat offensive headline, but research does show that the rate of Anterior Collateral Ligament (ACL) tears would decrease if a women’s biomechanics in such actions as stopping, pivoting and landing more closely resembled the techniques used by male athletes. In fact, women are two to eight times more likely than men to suffer ACL injuries. Although some inherent hormonal and anatomical gender differences are also involved, women can certainly take control and protect their knees by relearning a few key tasks and by taking a more focused approach to some exercises in the gym. This article will discuss several indicators of susceptibility and what can be done to strengthen your knee joints.

Each section below describes a flawed technique which places the knee in an unstable position, allowing forward or backward sliding between the tibia in your leg and the femur in your thigh which could potentially tear the ACL. Keep in mind that not every incident with less than perfect form will result in injury, but improper technique simply increases your risk. It’s possible that a combination of other factors such as fatigue, poor field conditions or awkward landings while trying to grab your teammates swill might also be needed to actually tear the ACL. With an injury that can happen so quickly and is so devastating, why not correct a few bad habits, effect changes that will not only help reduce your risk but also make you a better and quicker player?

Muscle strength imbalances

The relative strength of muscles surrounding a joint impacts its stability. If, for example, the quadriceps muscles become much stronger than the hamstrings, a strain may be placed upon the ACL by pulling the tibia forward. A male’s hamstring muscles tend to fall within an ideal range of 60-70% of the strength of their quads while a female’s average only 45-55%. Weak hamstrings may go unnoticed day to day, but under the stresses of sport many women are stepping onto the field predisposed to overactive quadriceps that may actually contribute to tearing the ligament.

The easiest way to test your quadriceps to hamstrings strength ratio is to visit your local gym and complete a simple test for both leg curls and leg extensions. Gradually add weight until you reach your maximum load for completing a single repetition. With this information, you can figure out which muscle group needs the extra work to maintain the hamstrings at approximately 60-70% of quadriceps strength. Weak hamstrings are common in both men and women and should become a bigger focus of most people’s weight training routines. Deadlifts, lunges and leg curls are a few examples of exercises to work the hamstrings.

Women are also more likely to have one leg substantially stronger than the other, which can drastically increase the potential for injury. While working towards balanced quadriceps and hamstrings, make sure one leg isn’t noticeably dominant.

Trunk Flexion

If you take a look around the field, you’ll notice that some people play quite low by bending at the knee, maintaining balance by keeping their centre of gravity low to the ground. This is really important in quick stops and changes in direction. Women have been found to play more upright and when getting low, will often bend at the waist. This flexing at the trunk decreases the effectiveness of the quadriceps and can leave the knee in a very unstable state especially considering the force involved in turning.

Teammates’ observations can help to ensure proper technique in bending at the knees rather than the waist. Until the motion becomes natural, try over-emphasizing getting low in running-based drills that involve changes of direction. Be sure to mentally take note of how the two bending techniques feel different so you can distinguish between them and continue to train yourself to automate bending at the knees. Building up core muscles in the abdomen and lower back will help you keep your balance while getting low.

Angle of Knee Flexion

Even with balanced strength between the quadriceps and hamstrings, the two muscle groups under certain circumstances can still contribute to knee injury susceptibility. At knee angles close to full extension where the leg is straight, the hamstring muscles cannot exert   a sufficient posterior (backwards) force on the

tibia to counter the larger anterior (forward) force generated by the quadriceps. The straighter the leg, the greater the strain on the ACL.

Women tend to be more straight-legged than men in both running and landing activities. It seems that women are less likely to absorb shock in landing. Men will land with forces of two and a half times their body weight where a woman may sustain forces of as much as five times her body weight. Having a video tape of game play to analyze or, if that’s not possible, some teammates observing you, you can find out how straight your leg is upon landing. It might be necessary to relearn the skill with a focus on soft landings, using your knees as shocks.

Eccentric strength training will also help the body prepare for landings. Here’s an example to help you understand eccentric contractions. If you have something very heavy in your arms and start placing it down on the ground, you feel your biceps stretching as they work to stop you from dropping the object and instead let you lower it in a controlled manner. Your biceps are contracting eccentrically because they are lengthening as you move. If you were to pick up the object from the ground, you would find that it is much more difficult and would feel heavier because when your biceps contract concentrically, or shorten when flexing, they are not able to sustain the same force.

As in the previous example, while running or landing from a jump, eccentric contractions occur in your quadriceps when your foot hits the ground. These contractions can create a larger force than you might ever be able to lift in the gym. Plyometrics are a very effective way to build eccentric muscle strength. Since this is an article on knee health I won’t delve into proper plyometric practices. Make sure you have someone show you correct and safe techniques before beginning any program involving ‘plyos’.

Knee to Foot Positioning

Picture yourself planting to make a cut. As you plant with one foot, where is that foot positioned in relation to your knee? Often a woman’s foot will be lateral to the body, or in other words placed away from the middle of the body with the knee rotated inwards. Often women are ‘knock-kneed’ because of a wider pelvic angle and an increased lower back curve. These anatomical differences make this position more natural, although it puts the knee in a less stable and more vulnerable position.

It takes training and practice to ensure that while planting, the knee remains more centered and stable over the foot. Two anatomical terms, valgus and varus, respectively describe positioning either laterally or medially to the midline of the body. Women display a valgus moment of the knee when planting and landing, skills requiring a high force exertion. The combination of the pressure of landing and a less than ideal knee angle puts women at a high risk of ACL injury. Men doing the same tasks tend to have a varus moment, which minimizes the risk by keeping their knees more in line with their feet upon landing.

Again, ask your teammates to help identify those at risk. If you are rotating your knee inwards, learn how it feels to plant properly and continue monitoring yourself until you break your old habits.

Muscular Control

Women tend to have an electromechanical delay in muscle recruitment because of increased elasticity in the muscle and ligaments. This slows down the reaction time for muscles to fire because the slack must first be taken up before reaching a maximal contraction. Such a delay could be the difference between one person’s ability to correct for a bad landing versus someone else’s ACL tear in the same situation.

Plyometrics are again a great tool in developing quickness and increased reaction time. The principal behind these exercises is to load the muscle with the energy from an eccentric contraction and as quickly as possible use this store in an immediate concentric contraction, for example landing then quickly pushing off the ground. Plyometrics can help overcome muscle recruitment delays caused by ‘looser’ joints. General strengthening of the leg will also help. Women tend to be much more flexible than men, however, they seem to lack some functional joint stiffness created by muscular constraints. This stiffness is necessary for maximal control and stability in the joint, important injury prevention mechanisms.

At first glance it seems like women are doing a lot of things wrong on the field. In reality, lowering your risk only comes down to improving a few techniques in landing and pivoting, as well as some leg strengthening exercises; certainly not an insurmountable barrier. The statistics are overwhelming: women playing sport at a college level have a 1 in 10 chance of ACL damage. My own experience shows even higher numbers; I can think of too many players on my own team that have had surgery. You may never know if your preventative efforts pay off, but they will certainly make you a stronger player, and will give you back the power to decide when your season is going to end.

— Anne-Marie Carey, B.H.K.