Much of the problem simply comes down to anatomy. During puberty, boys experience a growth spurt that is accompanied by a spurt in neuromuscular development, apparently spawned by an increase in testosterone. Girls, however, don’t have the increase in testosterone, and the increase in estrogen seems to do nothing to aid in that neuromuscular development.
Thus, girls who have yet to reach puberty are often stronger than those who have yet to reach that stage of development, she said.
The result for post-pubescent girls, Ramus said, is that instead of the knee being held in place by the neuromuscular system, the joint is being held together by the ligaments when the athlete lands, twists or suddenly changes direction.
“The ligaments should work 10 percent of the time, at the very end,” Ramus said. “The other 90 percent of the time, it should be the neuromuscular system — the muscles and mind.”
The ligament system works slower than the neuromuscular system, and when Ramus sees an athlete’s knees cave inward upon landing, she knows the ligaments are getting overworked.
“If you’re a ligament-dominant athlete, you’re going to hurt your knee, she said. “If you’re relying on that system, it’s too slow.”
To combat the problem, Ramus suggests a three-pronged approach including balance training, strength training and some old-fashioned lessons on how to jump correctly. That means plenty of squats, single-leg squats and multiple directional squats.
Many athletes, she said, have never been taught the proper technique for jumping, and with the proper training an athlete can not only guard against injury but also boost performance.
After years of treating athletes, first as a physical therapist and later as a certified athletic trainer, Ramus developed a passion for educating others about the dangers.
“As soon as Title IX passed, we started seeing these injuries,” Ramus said. “I had a real good idea that this was a real problem, and nobody was doing anything about it.”
Fueling her passion was her personal experiences of treating inner-city youths whose only opportunity to get to college and thus out of their poor environments was through their chosen sports. But Ramus has seen that without proper training an ACL tear can put an end to their promising futures.
“I’ve seen so many girls and so much devastation,” Ramus said.
Even those who make it into college can be in danger, Ramus said. Not all athletic trainers have shifted to the trend of neuromuscular training.
“When I get athletes who were at high-level Division programs it’s amazing to me that there are some still trained in the same traditional big-power strength programs,” Ramus said. “Some of them have some pretty bad knees.”