Importance of a structured Strength & Conditioning program for injury prevention in female athletes.

 

The most important priority of any strength & conditioning coach is to reduce the incidence of non-impact injuries in their athletes. This can be achieved through individual screening of each athlete as well as understanding the physical requirements of the sport. With this information the coach can then structure a program to improve mobility/stability in necessary joints as well as muscular strength and power.

Data has shown that there is a gender gap between female and male athletes when it comes to the incidence of non-impact joint injuries such as knee and ankle ligament injuries. (1,2,3,5) Non-impact injuries usually occur when landing, cutting, stopping or changing direction

A review of ACL injury prevention in female athletes (1) found females were 3.5 times more at risk of a non-contact ACL (anterior cruciate ligament in the knee joint) injury than male athletes. In a systematic review of ankle sprain injury (5) it was found that females were almost twice as likely as male athletes to suffer an ankle sprain.

There are a number of (non-conclusive theories) as to why females are at greater risk of such joint injuries and a number of these if not all may contribute to the higher risk:

• Higher estrogen levels and lower testosterone levels than males means females have less muscle mass to help absorb and dissipate forces during landing, decelerating, turning etc.
• Greater flexibility leads to looser ligaments and therefore less joint stability
• A wider pelvis alters the Q-angle (basically angle of outside of pelvis to centre of kneecap) which can affect rotation of the knee and the alignment of knee and ankle. Males tend to have a much smaller Q-angle meaning joints are in better alignment for landing etc.
• Landing mechanics – females tend to land more upright with more valgus stress on knee (inward rotation) than males meaning joints absorb a greater percentage of force than male counterparts.
• Nutrient deficiency – females generally have a lower calorie intake than males meaning they may not be ingesting as much calcium and vitamin D as male counter parts.

While none of these theories is the conclusive reason for a higher incidence of ACL and ankle sprain injuries is females they provide us with useful information we can use to structure a program for injury prevention.

Several studies have shown very successful reduction in incidence of non-impact injuries in female athletes following a structured strength & conditioning program (6,7,8). In one study (7) the control group who didn’t do the program had 3.6 times more non-impact injuries over the course of the season than the training group. In a review of 7 different studies that used neuromuscular training as an intervention it was concluded that a structured program reduced the risk of acute knee injuries and ankle sprains.(6)

Key components of these programs included:

• Flexibility
• Plyometrics
• Weight training
• Coaching correct landing mechanics
• Balance work

It is important that a needs analysis of the sport and an individual screen is carried out prior to beginning any strength & conditioning program. This will help ensure weak muscles are strengthened, appropiate joints are mobilised or stabilised and avoid overuse injuries.

 

References

1. ACL Injury prevention in female athletes: Review of the literature and practical considerations in implementing an ACL prevention program. (Voskanian et al, 2013)
2. The female ACL: why is it more prone to injury? (Ireland et al, 2002)
3. ACL Injury patterns among collegiate men and women. (Arendt et al, 1999)
4. Comparison of hamstring strain injury rates between male and female intercollegiate soccer athletes. (Cross et al, 2013)
5. The incidence and prevalence of ankle sprain injury: A systematic review and Meta-Analysis of prospective epidemiological studies. (Doherty et al, 2003)
6. Neuromuscular training for sports injury prevention: A systematic review. (Hubscher et al, 2010)
7. The effect of neuromuscular training on the incidence of knee injury in female athletes: A prospective study. (Hewett et al, 1999)
8. Prevention of ACL injuries in female handball: A prospective intervention study over 3 seasons. (Myklebust et al, 2003)