Effects of ACL injuries on female performance

Effect of ACL injuries on female performance which help to reduce chances of injuries on female and increase performance in physical activities and athletic events.

1. Effect of ACL injuries on female performance BY AMTUL BASIT Roll No PEDU51F20S025 University of Sargodha Department of Sports Sciences

2. Ligaments in knee joint Ligaments are band of elastic tissue around your knee joint, provide protection and their names are; ACL PCL MCL LCL ACL is front of your knee & control forward movement of your shinbone. PCL is back of your knee & control backward movement of your shinbone.

3. Introduction Anterior cruciate ligament Commom knee injuries among athletes Mostly occur in football, basketball, gymnastics Mild or severe Contact and non- contact injuries Although, non-contact tears and raptures are most common. Approximately 70% of acute injuries (Martin, D.S. 2022) 2.4 and 9.7 times higher in female athletes then male. (Angel, 2005)

4. Epidemiology of ACL injuries 1 in 3000 individuals each year ( Samuelson K Anatomic, 2012) Estimated 2 million ACL injuries occur each year worldwide 3 to 5 times grater risk of injuries occur during games compared with practice.

5. Bones in knee joint Three bones articulate to form knee joint Your thighbone(femur). Shinbone (tibia) Fibula

6. Meniscus C-shaped pad of cartilage Sit between tibia & femur Medial meniscus & lateral meniscus Act as shock absorber 50% of patients with ACL tears due to meniscus tears. ( Beynnon BD, 2005) Meniscus occur when athletes turn their upper leg.

7. ACL injuries commonly classified in three grades Grade 1 Grade 2 Grade 3 Mild damage, Slightly stretched ACL stretched and becomes loose Severely damaged, unable to perform any function Knee joint stable Partial tear of ligaments Complete tear of ligaments ACL split into 2 pieces Physical therapy, Rest Icing Recovery within 3 months without surgical intervention. Surgical treatment is necessary.

8. Common Causes of ACL injuries Suddenly slowing down Changing direction Pivoting with your foot firmly planted Landing awkwardly from a jump Stopping suddenly

9. Risk factors on training In female, two-to eight fold greater then male. (Acad Ortho Surg, 2010) Impingement on intercondylar notch Quadriceps contraction Increased abduction movement Axial comprehensive force

10. Contributing factors

11. Intrinsic factors

12. Structural differences Lower extremity contribute to overall stability Difference in pelvic width Difference in tobiofemoral angle Width of femoral notch Joint laxity and flexibility Magnitude of quadriceps memories angle Jumping and landing characteristics

13. Quadriceps femoral angles Q angle in adult men & women no history of lower extremity abnormalities. Normal range from 80 to 170 Women greater Q angle then men due to; Wider pelvic base Shorter femoral length Q angle greater then 150 for men & 200 for women lead to abnormal. Anterior superior iliac spine Centre of patella Tibial tuberosity angle

14. Femoral Notch Size of ACL was smaller in women then man but no difference b/w the notch width index. Size determine width & shape Smaller notch increase rate of ACL injuries Women have narrow notch then men due to height and weight covariants. Women who were talls then male counterparts have narrower femurs for all height. Volume of femoral notch smaller in women compared to men due to height difference. Questions remains unknown bigger ligaments is stronger.

15. Recommendations Surgeons/orthopedists choose notchplasty to widen femoral notch when reconstructing the ACL injuries. But authors that this surgical procedures be avoided because scientific justification is lacking at the present time.

16. Joint flexibility Joint flexibility greater in women then men. Relationship b/w ligaments flexibility & injury is not clear. Several authors tried to relate ligament flexibility with increased chances of injuries. For example Football players having looses joint suffered more knee injuries. Other studies disputed this claim.

17. Recommendations Joint flexibility is inherent within an individual. So, it is possible to strengthen the knee muscles around flexible joint such as; Quadriceps muscles Hamstring muscles Gastronemius muscles

18. Extrinsic factors

19. Muscular strength Muscle strength Muscle coordination Muscles reaction time are maintain knee stablility. Women have less muscles strength in quadriceps & hamstring compared with men. Quadriceps and hamstring contraction pattern increase chances of ACL injuries in female.

20. Recommendations Weight training improve muscles function. Female athletes not only need to be strong, but reaction time need to be quick as possible. Plyometrics and agility types exercise such as Running through cones Single leg jump

21. Knee stiffness Muscle stiffness important component as knee stiffness. Muscle contraction that across the knee joint, decrease tibialfemoral displacement Lowering forces on ACL. Muscles contraction has 2 components Intrinsic component dependent on muscles. Extrinsic component dependent on nervous system.

22. Recommendations Muscle stiffness may increase with training program. Mens increase two to fourfold with isometric training. Women increase two folds with isometric training Knee stiffness less in women as compared to men. Some investigation tells that knee stiffness depends on; muscles strength BMI American journals of sports medicine (April15, 1999) show that knee stiffness depends on muscle mass.

23. Core stability The “core” defined as abdominal, back extensor & hip muscles structure/ function contribute to stablility. Person centre of gravity is located & all movements begins. If extremity muscles are strong Core is weak, not enough force produce efficient movements. Observations shows weakness is in “core strength” are seen.

24. For example 75 collegiate basketball players 50 female, 25 male Four test were used to perform core test; Back extensor muscles test Side-bridge test Straight- leg abdominal lowering Hand-held dynamometer strength Males performed better then in females on all test. ( Bouisset & Zattara )

25. Jumping & landing characteristics High percentage of ACL injuries occur lands from jump. Landing imposes forces on body Lower extremity absorbed these forces. If load too great for body During landing Greater range of motion. If impact absorption fails lead to injury.

26. Hewett tested effect of jump training on landing & strength lower extremity in female 11 females volleyball players 6 weeks jump training program 2 hours a day, 3 days a week Three phases were implemented throughout program Technique phase , first 2 week Fundamental phase , use of proper technique to build Strength
Power
Agility 3. Performance phase focus on achieving maximal vertical jump. The program increased hamstring power 33% & strength 20%. Abduction & adduction moment at knee decreased during landing. No difference were observed in hip flexion & extension anle during on landing.

27. Preventive measures In preventions focus on some instructions for further damage; Avoid heat, you should use ICE. Avoid too much running Use proper technique Take breaks/take time off Wear a knee braces Wear protective equipment such as knee braces, helmet, faceguards and eyewears etc. Do not play through pain.

28. Reduce risk of ACL injury A sports medicine physician, physical therapist, athletic trainer, or other specialists in sportswear Medicine can provide instructions and feedback that can help you to reduce risks. Proper training and exercise Take non-steriodal anti-inflammatory drugs(NSAIDs) Strength the muscles Increase flexibility

29. Treatments Surgical treatment Individual who have grade 2 or grade 3 ACL injury occur. Surgical treatment is ACL grafts fixed in same ligament position. Non-surgical treatment R.i.c.e method Use proper technique Take breaks Play safe Do not play through pain.

30. Conclusion An overview given of intrinsic and extrinsic factors thought to female athletes to greater risk of ACL injuries; Structural differences Joint laxity Muscular strength/imbalance Joint stiffness Jumping and landing characteristics However, each of these factors is not solely responsible for high rate of ACL injuries. Extrinsic factors including physical conditionin, body movements and muscular strength decrease ACL injuries in women. Today’s children are playing inside, using computer and watching T.V missing out opportunity to learn safe movement pattern during activities.

31. References https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805849/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9806737/