ACL Injury Part 3: A Risk for Adolescent Female Soccer Players

In ACL Injury Part 1 and ACL Injury Part 2, we discussed prevention and treatment options for tears and sprains to the anterior cruciate ligament.  In both articles, high risk activities were also briefly mentioned.  Basketball players, with their constant fast-paced twists and stops, are generally thought to be more susceptible than any other group of athletes.

And while that’s nearly true, there’s in fact a lesser-known group just as vulnerable to ACL injuries.  I previously mentioned soccer as another high-risk sport in ACL Injury Part 1, but I didn’t elaborate on a demographic particularly prone to these types of injuries: adolescent females.

Unless you are, have been, or are the parent of an adolescent female soccer player, this may come as a surprise.  So, let’s delve into why young female athletes, and their parents, should be aware of the possibility.

Why Are Adolescent Female Soccer Players at Risk?

As pre-teens go through puberty, their bodies are changing.  They’re becoming heavier and taller, which are two factors that increase the chance of an ACL injury, as well as risk further complications during and after treatment.  During the transition to adolescence, these changes can seemingly happen overnight.

A maturing body will have an impact on any young athlete, but the changes girls endure require considerably more adjustment.  While boys tend to develop more muscle strength in addition to their newly gained weight, that isn’t usually the case for females nearing teen hood.  This isn’t the only hindrance pre-teen female athletes encounter, however.  The female body undergoes more drastic changes, mainly the widening of the hips, redistribution of body fat, and breast development.  An eleven-year-old female soccer player may start her season with a completely different figure than the one she’ll have when she turns twelve.

So, imagine you’ve been a talented soccer player since you were a small child.  You’ve been practicing the same techniques for all these years, and in a consistently straight-down body shape the entire time.  Suddenly, your bone structure and fat tissue has shifted all over the place.  You might feel a little off balance when you run, especially if you’re constantly making quick twists and turns every second.  Your new weight and shape is unfamiliar, and you’ll need some time to get used to it; but you had no warning for these changes before your soccer team reached mid-season.

We already know that increased height and weight put extra pressure on the knees, increasing one’s risk for an ACL tear.  But one way to decrease the impact of the knee pressure is to strengthen the hips and thighs.  Remember though, girls aren’t as likely to gain significant muscle strength alongside puberty.  So, while pre-teen female soccer players switch rapidly between twists, turns, stops, kicks, jumps, and anything else soccer-related that involves the hip and thigh muscles, the very muscles put to work likely haven’t gained the strength to protect the ACL to their best abilities.  And also keep in mind that soccer, unless it’s indoor soccer, takes place on unpredictable terrain.  The bodily changes aren’t working in the pre-teen girl’s favor from the start, so now combine that with muddy or snowy ground.

What Should be Cause for Concern?

While not ideal, it’s normal to endure a minor sports injury here and there.  Knee pain after a soccer game doesn’t necessarily mean there’s an ACL tear.  That being said, there are signs you should never ignore:

• Popping sound or sensation in the knee joint
• Severe pain
• Knee swelling within 24 hours post-injury
• Limited range of motion
• Instability of the knee while bearing weight

What Are the Next Steps?

Studies have shown that, compared to pre-teen boys, maturing girls are more likely to undergo surgery following an ACL injury.  And unfortunately, young females are less likely to return to sports following surgery.  This can be devastating, and especially for athletes working towards a scholarship or a sports career.

First things first: all athletes, no matter what age or gender, should learn what to do to decrease the chances of an ACL injury.  But if you or your child should encounter an ACL tear, what should you do?

Get an X-Ray

• An MRI is the best way to determine if a full ACL tear has taken place.

Determine If Surgery is Necessary

• If x-rays reveal only a sprain, partial tear, or looseness in the ligament, surgery might not be required.
• If surgery isn’t needed, she will move on to the next step.

Physical Therapy

• Find a practitioner who specializes in pediatric physical therapy.
• Modifications will be made to her athletic and physical activities, and rehabilitative exercises will be assigned.

Adjust Rehabilitative Devices

• As young girls are continuing to grow, knee braces and crutches may need to be adjusted throughout the months of recovery.  For the knee to rebalance, the devices must fit properly.

At-Home Self-Care

• Never forget RICE: Rest, Elevation, Compression, Ice
  • If you’re the parent or caregiver for a girl with an ACL tear, make sure all of these steps are taken on a daily basis.  Supervise or provide assistance if needed.
  • Avoid bearing weight on the knee; apply ice to the knee for 15-20 minutes at a time, 3-4 times per day; use compression bandages to reduce swelling; place leg on a rest (arm of a sofa, an ottoman, etc.) in an elevated position.

After suffering an ACL injury, a young female soccer player can expect to be away from the field for six to twelve months.  And while that seems like a long time, she and her caregivers must be patient.  If she returns to the sport before the medical professionals recommend, she very well may tear her ACL again.  Additionally, leaving rehabilitation early can put her at risk for premature arthritis, and the onset of the condition can occur as soon as fifteen years after the tear.

Resources for Young Female Athletes, Their Parents, and Their Coaches

As soon as girls develop an interest in soccer, or any other sport with similar movements, they should be introduced to Knee Injury Prevention Programs.  Classes and training programs are often offered at physical therapy offices but are also available online.  During these educational sessions, girls will learn how to do preventative warmup routines, strengthening exercises, dynamic balance training, agility drills, as well as plyometrics (jump training).  Always remember the importance of injury prevention, especially in the case of one so debilitating as an ACL tear.  But also know that an ACL injury doesn’t have to mark the end of an athletic career.  There is hope.

Resources

kipp.instituteforsportsmedicine.org. (n.d.). KIPP for Coaches. [online] Available at: http://kipp.instituteforsportsmedicine.org/.

Shea, K.G., Pfeiffer, R.P., Apel, P.J., Wang, J.H. and Curtain, M. (2004). Anterior Cruciate Ligament Injury in Pediatric and Adolescent Soccer Players: An Analysis of Insurance Data. J Pediatr Orthop, 24(6).

Stracciolini, A., Stein, C.J., Zurakowski, D., Meehan, W.P., Myer, G.D. and Micheli, L.J. (2014). Anterior Cruciate Ligament Injuries in Pediatric Athletes Presenting to Sports Medicine Clinic. Sports Health: A Multidisciplinary Approach, 7(2), pp.130–136.

Wolf, MD, FAAP, S.F. (2019). ACL Injuries in Young Athletes. [online] HealthyChildren.org. Available at: https://www.healthychildren.org/English/health-issues/injuries-emergencies/sports-injuries/Pages/ACL-Injuries.aspx.

Photo Credit

Canva by Joseph Calomeni

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