Author Michael Sokolove pointed out that young athletes — especially those who have some talent — are encouraged to specialize in a single sport at an early age. Indeed, he asserted, they are not so much encouraged as "stampeded as if they were being rushed by a fraternity or sorority."
Meghan McDevitt, 18, was an elite lacrosse player at Manheim Township High School when she tore her ACL while playing in a lacrosse tournament. She stepped in a hole and turned. Her right knee gave way, and she heard the telltale pop of an ACL tear.
She had friends who had torn their ACLs; an ACL injury was her biggest fear. “You go from playing every day to all of a sudden, just done,” McDevitt said.
The tournament trainer said her knee was fine, but she couldn’t fully extend it. “It hurt a lot; to be told that nothing was wrong, I was, like, that can’t be right,” McDevitt said.
It wasn’t right. McDevitt had an ACL tear that required surgical reconstruction, and nearly half a year of rehabilitation.
She said she was miserable during her months on the sidelines. She loves lacrosse, a sport she began playing while in the eighth grade. “The competition, I just love it,” McDevitt said. “Setting goals yourself and working toward them, and finally achieving them, it’s like the best feeling ever.”
Not being able to run or play lacrosse for months was “terrible,” she said, adding of her injury, and the hard work of rehabilitation, “I wouldn’t wish it on my worst enemy.”
McDevitt, who now plays lacrosse for St. Joseph’s University in Philadelphia, said “something’s got to be done” about ACL injuries in girls.
Researchers and physicians have a variety of theories about why female athletes are more prone to ACL injuries.
Dr. Joy Long, an orthopedic surgeon with the Lancaster Orthopedic Group, said it may be partly a matter of anatomy — girls tend to run in a more upright position and land from jumps in a knock-kneed position, putting more stress on their ACLs.
It also may have something to do with hormones. Studies have shown that changing hormone levels during a girl’s menstrual cycle may make her ligaments more lax, and therefore more likely to tear, Long said.
According to the 2008 book, “Warrior Girls: Protecting Our Daughters Against the Injury Epidemic in Women’s Sports,” the youth sports culture also may be partly to blame.
Author Michael Sokolove pointed out that young athletes — especially those who have some talent — are encouraged to specialize in a single sport at an early age. Indeed, he asserted, they are not so much encouraged as “stampeded as if they were being rushed by a fraternity or sorority.”
Young athletes often play for clubs that have year-round practices and tournaments. Playing one sport, year-round, wearing down the same set of muscles, they risk overuse and overexposure, Sokolove maintained. Playing through pain becomes the norm for the athletes Sokolove dubs “warrior girls.”
Dr. Long of the Lancaster Orthopedic Group said there is a misconception that the more young athletes play, the better. “I disagree,” she said. “Everybody needs an off-season.”
Hempfield School District Athletic Director Steve Mummaw said he doesn’t see many three-sport athletes these days. Many students play a sport on a school team, which has a defined season, but then continue to play that sport year-round for a club team. “It’s just constant play,” he said.
Tim Drevna pointed out that even tennis champion Roger Federer takes lengthy breaks from competition. Unfortunately, he said, too many young athletes aren’t getting the rest they need. “Soccer players and swimmers are notorious for not taking breaks,” Drevna said.
Mummaw said he thinks that playing a variety of sports “refreshes the mind,” as well as the body. He thinks some kids specialize in a single sport because they and their parents think they are “going to get these great scholarships. But [scholarships] are really not out there like they think they are.”
Manheim Township School District Athletic Director Kevin Raquet said he thinks the increase in ACL injuries among girls owes to the “amazing” progression of girls’ sports in recent years. Since Title IX became law in 1972, opening up opportunities for girls to play school athletics, girls have taken their athleticism to new heights.
“Girls are so much quicker … They’re making cuts and getting to balls quicker, and the speed of the game is so much faster now in women’s sports,” Raquet said.
Proper conditioning
Dr. Long said that while girls may have become faster, they may not be getting the right conditioning and training. The anatomical factors that contribute to ACL injuries in girls cannot be changed, Long said, but girls’ functional mechanics — specifically, their running and jumping techniques — can be retrained.
She said girls need exercise programs that improve their core strength. These programs should include abdominal strengthening and balance training.
“It’s impossible to strengthen ligaments like the ACL, but it is possible to strengthen the muscles that protect the ligaments,” Long said.
Matt Soto, the field hockey head coach at Penn Manor High School, said his players participate in a conditioning program that includes core-strength workouts. The program has yielded results, he said, noting that he hasn’t seen an ACL tear among his athletes in four years.
The Santa Monica ACL Prevention Project in California has developed an ACL injury prevention program called PEP, Prevent Injury, Enhance Performance.
PEP is a 15-minute training program that seeks to increase flexibility and strength and to help girls to avoid positions that make them vulnerable to injury. The exercises are supposed to be done at least two to three times a week during a team’s season.
Tim Drevna has taught the PEP program to several area girls’ teams, including the basketball and soccer teams at Hempfield High School.
Jenn Wettig, the head athletic trainer at Hempfield High School, said that she’s seen a decline in ACL injuries among the girls’ basketball and soccer players since their teams incorporated the PEP program into their workouts.
Drevna said he would urge the coaches of school teams and club teams to visit the PEP program Web site, http://aclprevent.com, where the exercises are detailed.
And parents, Drevna said, should ask their daughters’ coaches what they are doing to prevent ACL injuries. “It’s an important question to ask, and it’s important to ask it early.”
Concern, not fear
Louis Rivera, physical therapist and owner of Rivera Physical Therapy in Manheim Township and Hempfield Township, said he doesn’t want girls to be discouraged from playing sports because of the fear of injury.
Rivera said he just wants parents and coaches to be more proactive about injury prevention.
His practice saw both Ruthie Rosenberger and Meghan McDevitt through rehabilitation after their ACL tears.
Rivera said that when an athlete is sidelined, the emotional toll can be intense. “Sports, to some girls, is their identity,” Rivera said.
Their friendships center around sports. They are accustomed to working out their emotions and their anxieties on the playing field. Having worked hard to get to their level of competition, they are suddenly bereft of the focus of all their striving. It can be “horrible” for the athlete, and life-changing for her entire family, Rivera said.
And the injury can have lasting implications for the athlete, Rivera said.
Onset of arthritis
Dr. Long, of the Lancaster Orthopedic Group, said that X-ray evidence of degenerative arthritis sometimes can be seen years after ACL injuries — even in patients who have not yet developed arthritis symptoms.
ACL reconstruction cannot prevent this arthritis, but may make a knee more stable, which may prevent any further tearing of cartilage. The more damage to the cartilage, “the more likely it is that the patient will develop arthritis,” Long said.
Long explained that when the ACL tears, “it stretches and then ruptures,” often ending up looking like “strands of spaghetti.”
“Trying to sew the pieces back together … does not work,” Long said. So in ACL reconstruction, a new ligament must be fashioned from other tissue, either from the patient or from a cadaver, Long said.
Long said she does not allow her patients to return to full athletics until at least six months after surgery.
For an athlete, six months can seem like an eternity.
Ruthie Rosenberger said her months away from soccer were difficult ones.
“I’ve played sports my whole life,” said Rosenberger, who’s now 18. “Pretty much, my life revolves around my athletics.”
She started playing club soccer in elementary school. She ran cross-country in high school, and also swam competitively. But, she said, “Soccer was my main sport. I played soccer year-round.”
Rosenberger has had a lot of time to wonder why she had ACL tears in each of her knees. Her father, Leo Rosenberger, said he thinks his daughter might have “some genetic weakness there in the knees.” Both he and Ruthie think she wasn’t helped by wearing cleats on artificial turf.
She said her second ACL injury was more emotionally painful than the first, not least because it came just a few days after her appointment to the U.S. Military Academy at West Point. She was recruited to play soccer at West Point.
It was decided that Rosenberger would spend this school year at the U.S. Military Academy Prep School, in Fort Monmouth, N.J., and enter West Point in 2010. She continues to rehab at West Point Prep. She cannot play in a contact situation until November.
She said if she tore her ACL again, she might be forced to give up soccer. “I’m hoping that’s not going to happen … I don’t think I’d ever quit soccer. I love it too much,” she said.
Her father said he’s told Ruthie that he doesn’t care if she ever plays another soccer game. He said that he and Ruthie’s mother were “not the pushy type parents.” His daughter’s drive was internal, he said.
Leo Rosenberger said he would encourage other parents of female athletes to educate themselves about injury prevention. “No matter what you do … accidents can happen,” he said, “so you have to have your child prepared not only physically but emotionally.”
His daughter said: “I made it eleven grades. I didn’t think anything was going to happen to me. In a minute, that can change.”
PEP PROGRAM REDUCES ACL INJURIES
A 2008 study by the Centers for Disease Control and Prevention showed that a specific warmup program was effective in reducing ACL injuries among female college soccer players.
That program is called PEP, Prevent Injury, Enhance Performance. It was developed by the Santa Monica Orthopaedic and Sports Medicine Research Foundation in California.
The PEP program is a set of exercises focusing on stretching, strengthening, and improving balance and movements — particularly the way female athletes jump, land, stop and turn. The 15-minute program is meant to be done at least two to three times a week during a team’s season.
In a press release, Dr. Julie Gilchrist, a CDC epidemiologist, said the CDC encourages “coaches, athletic trainers, and athletes to consider adapting this program into their routine.”
For information, readers may visit the PEP program’s Web site at http://aclprevent.com.
The Lancaster Orthopedic Group offers occasional ACL prevention clinics, at which athletes can undergo screening to assess their injury risk. The next clinic is 10 a.m. Saturday, Oct. 31, at 1009 E. Main St., Mount Joy. To register, call the Lancaster Orthopedic Group at 560-4200 in advance.
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