Detecting knee issues early imperative

Editor's note: Nancy Justis, a former competitive swimmer, is a partner with Justis Creative Communications.

By Nancy Justis, correspondent

The adage 'an apple a day keeps the doctor away' does little for athletic injuries, in particular for anterior cruciate ligament (ACL) injuries.

That doesn't mean you shouldn't eat an apple every day.

ACL injuries, by most accounts, are increasing. At Midwest Orthopaedics at Rush in Chicago, the number of ACL patients 'doubled in five years, while the ACL patients under age 25 tripled in the same time period.'

Dr. Dawn Comstock, in her blog (www.training-conditioning.com), noted 'on average, athletes are eight times more likely to suffer anterior cruciate ligament injuries in competition than practice and girls are eight times more likely to suffer ACL injuries than boys when playing similar sports.'

She also noted knee injuries 'account for 60 percent of all sports-related surgeries' and 'ACL injuries can account for more than 50 percent of knee injuries.'

It is estimated that 'up to 50 percent of pediatric injuries involve overuse injuries, and thus are preventable. One-third of all overuse injuries involve the knee,' according to Nicholas J. Honkamp, M.D., of Des Moines Orthopedic Surgeons.

The Illinois Athletic Trainers Association (IATA) and Rush joined forces recently to launch 'Knees for Life,' a public awareness program that recommends high school and college athletes be properly screened for ACL injuries. If at risk, those athletes should participate in a prevention program that focuses on exercises to improve strength, agility, balance, coordination and flexibility, all of which should decrease the risk of an ACL injury.

These exercises can be found at www.KneesforLife.org.

Knee injuries cannot only lead to shortened seasons, but can affect sufferers later in life.

The National High School Sports-Related Injury Surveillance Study has found about one ACL tear occurred in every 15,000 times an athlete practiced or competed. It also found when comparing sports played by both boys and girls, girls were eight times more likely to suffer an ACL injury.

Why are females more likely to suffer ACL injuries?

Dr. Lynn M. Lindaman of Lindaman Orthopeaedics said studies have focused on hormonal differences between the two genders. They have 'focused on the actual size of the anterior cruciate ligament in males versus females. They have looked at the strength of the hamstrings and quadriceps in males versus females with respect to the body weight. They have looked at the difference in the shape of the knee and the alignment of the bones ... nothing has proved to be definite and more importantly nothing that we as physicians or coaches could do anything about.'

A study published in American Journal of Sports Medicine found screening the knee muscles of a non-injured female athlete with electromyography (EMG) technology 'can determine if she is at high risk for an anterior cruciate ligament rupture.

'EMG analysis can be used to evaluate neuromuscular activity in specific muscles during sports specific movements. The study utilized the technology to screen 55 non-injured female athletes while they performed a standardized side-cutting maneuver ... Of the 55 athletes studied, five had lower EMG signals in the medial hamstring muscle on the back of their thigh and higher activity in their quadriceps muscle. Those same five athletes experienced an AL rupture later on in the competitive season.'

The study was determined to provide a foundation for future screening tools in an effort to prevent female athletic injuries.

The Surveillance Study found the three most common sports for ACL injury during practice or competition are girls' soccer (one in 6,500 times an athlete practiced or competed), football (one in 9,800 times) and girls' basketball (one in 11,000 times).

The percentage of ACL injuries per sport observed were football (41 percent), girls' soccer (19 percent), girls' basketball (13 percent) and boys' soccer (nine percent). The percentage of ACL injuries requiring surgery by sport are volleyball (100 percent), boys' basketball (85 percent), softball (80 percent), girls' basketball (70), wrestling (62), boys' soccer (58) and baseball (50 percent).

In a nutshell, proper mechanics and preventive exercises should be at the top of the list when coaching youth athletes. The science of screening and prevention will only become more accessible in the future. No matter what age your young athlete, it would be a good practice to discuss exercises with a doctor or certified trainer and to make certain your youth coaches are knowledgeable of form and function.

l Let us know what you think by contacting Justis at njustis@cfu.net