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VSO recently interviewed Dr. Cunningham on the topic of ACL tears. We continue the discussion here:

VSO: Are there other injuries you see that differ from male to female? 

Dr. Cunningham: Because women's tissues tend to be more lax (with men having stiffer ligaments), I see women have more shoulder instability as well (ie. shoulder subluxations). I probably see more males who dislocate their shoulders but this is traumatic (ie. major wreck in the terrain park) whereas a young female athlete (ie. volleyball player) may present with a shoulder that can slide partially out of the socket (=subluxation) but they have not had any major injury that caused it.

VSO: Why are women more at risk for an ACL tear?

Dr. Cunningham: There are several factors at play, but mostly neuromuscular. Women tend to land in a knockneed alignment. They also land with their center of gravity being posterior or behind their knee (ie. "landing in the back seat") and these positions place increased forces on the ACL and can cause it to tear. Women's ACLs are also generally smaller in diameter than males and their tissues are generally more lax and these factors predispose to tearing the ACL. Women's intercondylar notch at the end of the femur (kind of like the valley through which the ACL passes) is narrower and can more easily pinch the ACL in sports and predispose it to tear. Some question whether there are hormonal factors at play but this is unproven.

VSO: What can women do to help prevent an ACL tear?

Dr. Cunningham: Keeping strong but more importantly preventing imbalances in your musculature. In a lot my athletic patients, they do activities that are quadriceps dominant, but they neglect their gluteal and hamstring strengthening. Gluteal (=buttock) strengthening is critical as these muscle prevent your knee from falling into that knockneed (=valgus) alignment which places increases stresses across the ACL. Core strengthening is also critical so that athletes land directly over their feet and not land in the back seat which again stresses the ACL.

Gluteal and core strengthening, avoiding landing in the back seat position, doing some plyometric drills and exercises pre-season and in season are all helpful to learn how to land more safely when coming off a jump or in the terrain park or on the basketball court or soccer field.

If you are falling into the back seat and struggling to get upright, it's safer to let yourself fall. Make sure your ski bindings are adjusted appropriately. Injuries tend to happen at the end of the day when your muscles are tired so maybe skip that last run of the day if you don't feel up to it.