Knee Injuries Among Young Women: What is the reason and how can we better prevent?
The world of youth sports has drastically changed over the last 20 years in the fitness landscape. Every direction you turn there is AAU teams, club teams, everyday practices, and the pressure of always being the best in your sport at a young age. My opinion on youth sports in this challenging day and age is outlined quite simply the following list of issues:
1. There is far too much sport-specific training and playing of sports for youths under the age of 16 for a biological age.
2. Pressure on our youth is by far greater than ever before to be successful.
3. Kids focus too early on one sport and this has shown to be problematic for injury, loss of interest in that sport, and not enough focus on playing multiple sports to enhance that particular sport of their choosing.
4. GPP or General Physical Preparedness is no longer used at a young age, but coaches have the youth focus on sport specific at too early of an age.
As we review the four major issues with youth Training currently, we can now focus more solely on knee injuries amongst young females in various sports. Women are more likely to establish a knee injury 4-6 times greater than men in the same sports played (Hewett 2000). The reason for the higher knee injury rate is based off major factors surrounding anatomical, neuromuscular, and hormonal differences that effect the knee in various forms in women. The number one factor for more knee injuries among women is the Q Angle which is a line connecting the Anterior Superior Iliac Crest to the mid-point of the patella to the tibia tubercle. Since nature has gifted women with the ability to bare children, this makes them have a wider pelvic structure than men, which in turns puts greater pressure on the joints and tendons of women.
Neuromuscular differences can also play a factor in some injuries among women. The difference in muscle recruitment and longer reaction times or longer times to produce maximum force production with cutting or landing movement within the sport can also be a major factor that we must take into consideration. One area I have also seen to be an issue is women are more anterior dominant, meaning their quadriceps and the anterior of the body is more focused compared to the posterior part of the body (glutes, hamstrings etc…). Thus, we can say that the training focus is much more anterior based, and the posterior end is ignored. Basically, we need to have balance among the anterior and posterior chains, which in turn, will help prevent knee injuries among our youth.
The last major difference and one possibly that could lead to greater risk for women is hormonal variations which can and heighten the chances for young women for knee injury. Through the hormones of estrogen, progesterone, and relaxin it has been stated that this can create laxity among joint, tendon, and ligament strength. This then increases the chances of injury during the menstrual cycle.
The next step would be how do we prevent or at least try to lessen the case of injury for female youth athletes. My first recommendation would be to input the young athlete into a multiple sport facet to allow variation within their early stages of their athletic career, this will allow the athlete to adjust, and also grow physically and mentally within their sport journey. Here are some other major points to consider for prevention or lessen the risk of injury:
1. Physical Conditioning Programs that include plyometrics and weight training are always a step in the right direction for young athletes.
2. Focus on a training plan that involves anterior and posterior training to balance the body out during training sessions.
3. Always perform physical assessments to allow proper programming for your clients. You can use assessments thru Functional Movement Screening, PRI, DNS, and etc…
4. Single Leg Work is key to developing balance and symmetry amongst the lower body, and given the athlete’s capabilities this is a must in a young athlete’s program.
5. Focus on GPP work, and not Sport Specific at the ages of 12 thru 16 years of age. Even at the ages of 17 and 18 this could be too much for sport specific training, but depending on the ability and the level of athlete they are, this is client by client basis.
6. Train plyometrics and jump training at low volume and low intensity. Also focus on landing positions and athletic stance positions. Landing is vital for recruitment of muscle fibers, and helping to practice landing positions while in full mode during game of play. Good source of information for this material could be Lee Taft from Athlete Acceleration.
7. Most of all, do not force anything! Have the young athlete have fun during your training sessions as well, as we cannot control what goes on outside our gyms and training facilities. We can only hope to help prevent and better these young ladies!