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Thursday, June 5, 2008
Bowie Gazette
Knee injuries a rising concern
Girls are playing more sports and suffering more knee problems than ever before
by Kevin Hilgers | Staff Writer
When a college basketball coach visited Elizabeth Seton High School last October, junior Cabria Johnson remembered playing harder than usual for a preseason open gym.
When she landed after a drive to the basket, she felt her knee twist, then severe pain, and her knee swelled up. It was first diagnosed as a sprain, but when swelling didn’t subside after two weeks, an orthopedist told her she tore an anterior cruciate ligament and would be sidelined until spring.
‘‘My face kind of dropped,” said Johnson, an Upper Marlboro resident. ‘‘The season hadn’t even started yet.”
Severe knee injuries such as Johnson’s are rare, but orthopedists say they are four to six times more likely to occur in girls than boys. Among the possible reasons are estrogen levels, the strength balance between the hamstrings and quadriceps and the tendency for females to be knock-kneed.
‘‘We don’t know exactly why,” said Dr. James Dreese, the team physician for the University of Maryland.
The twisting, planting and cutting required of athletes, especially for girls in basketball and soccer, puts stress on these ligaments that can lead to injury.
Research by the National Athletic Trainers Association shows high school injuries rarely require surgery — no more 3 percent, depending on the sport — but other studies have shown knee injuries account for nearly half those operations.
The ACL, a 4-inch-long strip of tissue, is one of four ligaments that stabilize the knee and help the shin bone from buckling under the thigh bone. If these ligaments don’t work properly, a person risks more serious injury. The ACL is one of the most commonly injured of these ligaments and cannot heal on its own or be repaired, but instead must be rebuilt.
‘‘It’s like almost sewing spaghetti together. It doesn’t really work too well,” said Dr. Michael Magee of county-based Capital Orthopaedic Specialists.
Reconstruction involves taking tissue from elsewhere — usually the knee cap — and grafting it so the new ligament can reincorporate with the bone.
The operation has made dramatic advances in just the last decade. Previously the ligament would be repaired using tissues around the site of the injury, but newer techniques have made the operation more effective, Dreese said.
‘‘It did used to be a career-killer for young and old athletes alike,” Dreese said.
Reconstructive surgery carries a risk of arthritis in the knees years after, but patients can function well in the short and long term after the surgery, he said. It’s better than the alternative, which is serious injury to bones and cartilage, Dreese said.
With such injuries coming not from contact but stress on the ligament, some coaches are wary of the year-round competition of many athletes, who move from high school seasons to club or AAU play and back again with little rest.
A recent study through Nationwide Children’s Hospital in Columbus, Ohio, reported knee injuries were three times more likely to happen in competition than in practice. As muscles fatigue, more stress is put on the ligament, Dreese said.
‘‘You do need a rest,” said Chris Williams, the girls’ basketball coach at Crossland High, who also coaches several AAU girls’ basketball teams. ‘‘Nobody can do it every day and not feel the pain from it.”
AAU basketball schedules can pack triple-headers into a single day. With AAU seasons often completely bridging the gap between the end of one high school season and the start of the next, the time for conditioning, practice and rest is lost, said Seton coach Jazz Perazic.
‘‘Basically, they play too many games and don’t practice enough,” she said. ‘‘They play more games than they practice. They’re not prepared.”
But some athletes simply are inherently prone to knee injuries because of their anatomy, Dreese said. For example, people who tear their ACL in one knee are more likely to tear it in the other knee, he said. While there are no failsafe preventative measures one can take, proper rehab after an injury and conditioning before one can lessen the risk, orthopedists say.
‘‘I think [conditioning is] the most important thing that you can do because your joint is more than just ligaments and tendons,” Magee said. ‘‘It’s the muscles around them and all of them have to work synergistically or else something’s going to fail.”
Mike Vawter, the girls’ soccer coach at St. Vincent Pallotti High, emphasizes balanced strength training with his players. Soccer players tend to build muscle more in their hamstrings, so to prevent overtraining, they have to do exercises to strengthen the quadriceps, he said.
‘‘If you don’t do these exercises, it can put your opposition muscles out of balance,” Vawter said.
Vawter also incorporates into Pallotti’s preseason training plyometrics, exercises that help athletes make strong, quick movements. That translates into better skills and safer play, he said.
Although Dreese said it usually is difficult to tell if an athlete is susceptible to injury by watching him or her play, Perazic said Johnson’s movements before her injury indicated to her she might be at risk. In fact, Perazic planned on working with her on better controlling her movements in the upcoming season before she got hurt.
But when Johnson returned to the court two months ago, she said she felt quicker and more powerful than before. Her rehab included practicing jumping, lateral movement and backpedaling — actions she didn’t think about much before.
Even if severe injuries can’t be avoided, awareness of how one moves and trains as they reach higher levels of competition could be keys to staying healthy, Perazic said.
‘‘Once you’re in high school and you want to be a college athlete, you have to take care of your body,” she said. ‘‘You have to know what it means to be in shape.”
E-mail Kevin Hilgers at khilgers@gazette.net.
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