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More Rationale for ACL Injury Prevention Programs for Youth Female Athletes

Posted Dec 23 2008 9:43pm
There is fairly definitive evidence that females have lower hamstring strength and subsequently lower hamstring-to-quadriceps (H:Q) strength ratios in comparison to men. This has a significant impact on the ACL injury rates in female athletes, as the hamstring assists in protecting anterior tibial translation and strain on the ACL. Thus, ACL injury prevention programs have traditionally incorporated exercises to enhance this ratio.

Yet another study has been released in the latest issue of the American Journal of Sports Medicine by researchers out of Norway looking at the H:Q ratio, but this time in a group of prepubescent children from 7 - 12 years old. The study looked at isokinetic strength of 368 children. The results show that hamstring strength and H:Q ratio was significantly lower girls between the ages of 8-12. No significant differences were observed in 7 year old subjects, though the amount of females was lowest in this group. I am not sure if the results would have been the same if the group size was larger. In total, boys had a 10% increase in H:Q ratio.

Clinical Implications

It is well known that injury prevent programs have been shown to be effective in preventing ACL injuries, especially in female athletes. Based on the results of this study, it is apparent that some of the musculoskeletal gender differences that have been associated with a higher incidence of ACL injuries in females are present in children under the age of 12. Thus, it may be advantageous for young female athlete to begin injury prevention programs designed to enhance hamstring to quadriceps ratios.

One particular program that I have read about lately is the PEP program developed by Holly Silvers and the Santa Monica ACL Prevention Project. PEP stands for Prevent injury, Enhance Performance." I have not used this program myself but I like the concept and it was backed up by a research report in the August 2008 issue of AJSM that demonstrated that subjects that did not perform the program had a 3.3x higher injury rate. The program consist of a 15-minute training session designed to be performed as a warm-up prior to athletics. The program includes running, agility, stretching, strengthening, and plyometric exercises in the format of a dynamic warm-up that can be performed in a group setting.

Another program that is popular is the Sportsmetrics program developed by Dr. Frank Noyes and the group at Cincinnati Sports Medicine. This program has been around for several years and has some research implemeneted within the program components. If you are interested, they also have a full certification program. Here is a video about the program:

Follow the above links for more details on the programs. Has anyone tried the PEP, Sportsmetric, or similar ACL injury prevention program? If so, tell us about your experience and share any recommendations.


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