Therapists work to reduce risk of ACL injuries in young athletes

 It has been known for about a decade that female athletes suffer a disproportionate share of tears to the anterior cruciate ligament — “ACL,” for short — a flexible, rectangular-shaped band of tissue that stabilizes the knee joint.

Why this is the case remains a mystery, however. In the meantime, North Shore Physical Therapy has brought into local schools an education-and-exercise program aimed at sparing these young athletes from having to endure the recovery process from such a catastrophic injury.

A torn ACL means surgery, months of rehabilitation and, according to medical statistics, an increased likelihood of re-injury and future osteoarthritis, meaning cartilage deterioration and bone enlargement.

“It turns out that the incidence of ACL injuries in girls [ages 11-20] is between 200 to 800 percent higher than their male counterparts,” said Fawn Anderson of North Shore Physical Therapy, which has offices in Marblehead and Swampscott. “Researchers are still trying to figure out why, and they think that they have narrowed it down to several different factors, but the bottom line is they still don’t know exactly why.”

Some factors that have been identified include the anatomical and hormonal differences of boys and girls, as well as the current trends of playing through pain and sport specialization.

“If you look back at the previous generation, it was really not uncommon for kids to be playing lots and lots of sports, and most of them weren’t even organized,” said Anderson. “You’d go out and you’d play with your friends. You’d play some kickball, you’d play some soccer, you’d play a little baseball, and in the winter you’d ice skate. You were basically cross-training, but the kids didn’t really think about it this way; they were just having fun.

“Now most sports are very organized, and kids who are identified as having special skills are strongly encouraged to ‘specialize,’ meaning that is pretty much the only sport they play. That has been suggested as a reason why kids are at a higher risk for ACL injuries because the number of exposures [to possible ACL injuries] has been increased.”

Anderson also noted how the current trend of playing through pain, or “toughing it out,” can play a role in these injuries.

“The concern is that a lot of kids, especially on the more elite squads, are having injuries and having pain and not even telling their parents and coaches about it, and these could have been picked up as warning signs before they have what could be a season- or career-ending injury, like an ACL injury,” Anderson said. “It’s universally accepted that playing through pain is not a healthy thing for these kids as their bodies are growing and changing. They need to have these injuries taken care of, and the concern is that a lot of kids out there are playing through quite a bit of pain.”

To help combat this epidemic locally, Anderson and North Shore Physical Therapy are taking steps to protect kids at risk and educate their parents. One of these steps is the introduction of NSPT’s PEP — for “Prevent (injury), Enhance Performance” — Program.

The PEP Program is a highly specific 15-minute training session that replaces an athlete’s traditional warm-up. It was developed by the Santa Monica ACL Prevention Project, a team of physicians, physical therapists, athletic trainers and coaches with funding support from the Amateur Athletic Foundation of Los Angeles. The program’s main focus is educating players on strategies to avoid injury and includes specific exercises targeting problems as identified in previous research studies.  

“I contacted some of the local schools, and we were able to work with the sixth- and eighth-graders at the Marblehead [Veterans] Middle School,” said Anderson. “We were in their gym classes, and we had them doing some of the physical drills that are part of the PEP Program.”

The children were given information to take home about the PEP Program, as well as handouts highlighting what the ACL is and the role it plays, what age groups are at a higher risk, and the signs that you could be at risk.

“We are in negotiations with [the Marblehead Charter School]; we’re just trying to set up a date,” said Anderson of plans for the program. “We’re also contacting the Swampscott Public Schools to try to do the same thing there; and we’re hoping to reach out to Salem as well.

“What we’ve done is try to identify some easily performed tasks that our physical therapists can use to watch how a child is moving — to test their strength and flexibility and see if there is anything jumping out at us when we look at the research that says this child may be at a higher risk.

“Our program is in its growing stages, but we really feel that it is important. We really want to try and be of any help to these kids.”