By Georgia Zuill – Physiotherapist
Understanding ACL Injuries and Injury Risk in Female Athletes
ACL injuries are a common and often debilitating injury for female athletes, sidelining players for at least a year. In fact, a recent study by Ardern et al. (2014) reported that only 65% of individuals returned to their pre-injury level of sport after ACL surgery. The study noted that symmetrical performance in single leg hop testing was a strong positive indicator of return to sport. While many focus on knee musculature for prevention and treatment, emerging research underscores the critical role of hip muscle strength in maintaining knee stability, improving plyometric and hopping performance, and preventing ACL injuries. A recent systematic review and meta-analysis by Jack Dix and colleagues (2018) offers valuable insights into this connection, highlighting the importance of hip strength. This is especially important for female athletes to prevent the risk of ACL injuries, as females are typically more likely to have an ACL injury than males.
Connection Between Dynamic Knee Movements, Knee Valgus, and ACL Injury Risk
The anterior cruciate ligament (ACL) is crucial for stabilizing the knee during dynamic movements. ACL injuries typically occur during activities that involve sudden stops, pivots, or jumps—common in sports like soccer, football, netball, basketball, and volleyball. One key factor contributing to ACL injuries is dynamic knee valgus, a movement pattern where the knee collapses inward, typically during squatting, hopping, or jumping movements. This valgus movement is influenced by the strength and control of the hip muscles, which stabilize the pelvis and femur during motion. When the hip muscles, particularly the abductors and external rotators, are weak, the knee is more likely to move into a valgus position during high-impact activities, increasing the risk of ACL injury.
The study by Dix et al. (2018) systematically reviewed literature from multiple databases to investigate the relationship between hip muscle strength and dynamic knee valgus in asymptomatic females. The meta-analysis revealed that weaker hip strength is associated with greater dynamic knee valgus during single-leg ballistic tasks, such as landing from a jump. These findings suggest that the relationship between hip strength and dynamic knee valgus is conditional on the specific movement task and that certain activities might place higher demands on hip muscle strength to control knee motion effectively. It also suggests that to decrease knee valgus during plyometric single leg hopping and therefore decrease ACL injury risk – it is vital to measure and track hip strength during ACL rehab.
Female athletes are at a higher risk for ACL injuries compared to their male counterparts due to a combination of anatomical, hormonal, and biomechanical factors, including differences in muscle strength and activation patterns. For instance, women generally have a wider pelvis, which can increase the angle at which the femur meets the tibia, predisposing them to valgus alignment. Understanding the specific relationship between hip strength and knee valgus in female athletes can help in developing more effective preventive and rehabilitative strategies. This means it is extremely important for female athletes of all levels and in any sport to have their hip strength and stability assessed to ensure minimal risk of knee injury, and especially ACL injury.
Physiotherapy Assessment at Saunders Physiotherapy – What Will it Involve?
Physiotherapy plays a crucial role in preventing and rehabilitating ACL injuries by focusing on improving hip muscle strength. At Saunders Physiotherapy, we have access to Kangatech technology which allows for the systematic and thorough assessment of hip, knee, and ankle strength and stability. This helps to build a 3D profile of your hip muscle strength and any imbalances that might exist, which could put you at risk of future injury. Whether you have had an injury and are looking for specific strength assessment to assist with your rehab, or if you have not had a knee injury but want to minimize the risk of one occurring in the future, the Kangatech assessment is useful for either scenario to identify any muscular deficits and focus your goals during rehabilitation.
From this assessment, your physiotherapist will read your KangaTech chart assessment and develop a personalized strengthening program that will focus on the muscle groups around the hip, knee, and ankle. These exercises target the muscles essential for maintaining proper alignment and control during dynamic movements.
Following your strength assessment, the physiotherapists at Saunders Physiotherapy will also assess and develop your hip/knee stability during plyometric and ballistic movements. This can be done using our Hawkins Dynamics Force plates technology to assess force production into the plates during a variety of movements. Assessment may include a variety of movements like jumping, landing, single leg hops, or rebound hopping. This will help to identify any differences between left and right force production during a variety of plyometric movements and track the progress of these throughout your rehab.
So, if you are experiencing knee pain, have an ACL injury, or want to take proactive steps to prevent ACL injuries, booking an appointment with a Saunders physiotherapist can be a game-changer. At our clinic, we offer comprehensive assessments and personalized treatment plans designed to strengthen your hips and protect your knees. Our physiotherapist Georgia is trained in completing force plate and Kangatech strength assessments and has extensive experience rehabbing anterior cruciate ligament injuries. Don’t wait until an injury sidelines you—take action today to safeguard your knee health and enhance your overall performance.
Book your Physio appointment at Saunders Physiotherapy today and take the first step towards stronger hips and healthier knees.
References:
Dix, J., Marsh, S., Dingenen, B., & Malliaras, P. (2018). The relationship between hip muscle strength and dynamic knee valgus in asymptomatic females: A systematic review. Physical Therapy in Sport, 1-13, https://doi.org/10.1016/j.ptsp.2018.05.015.
Ardern, C. L., Taylor, N. F., Feller, J. A., & Webster, K. E. (2014). Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: An updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. British Journal of Sports Medicine, 48(21), 1543-1552. https://doi.org/10.1136/bjsports-2013-093398.
