Female Athletes Most at Risk for Ligament Injuries

The risk of potentially devastating tears to an important knee ligament may be reduced in female college soccer players by an alternative warm-up program that focuses on stretching, strengthening, and improving balance and movements, according to a CDC study published online this week in The American Journal of Sports Medicine. The program can be done without additional equipment or extensive training that other prevention programs may require.

Female athletes are at greater risk for anterior cruciate ligament (ACL) injuries, compared to males participating in similar activities. The gender difference becomes even greater for noncontact ACL injuries, which occur usually in stopping, turning, or landing from a jump as opposed to colliding with another player or something on the field like the goal post.

“This study shows tremendous promise for female collegiate soccer players, especially those with a history of ACL injuries,” said CDC’s Injury Center epidemiologist Julie Gilchrist, M.D., lead author of the study. “Enjoying sports is a great way to stay fit. And to stay healthy, we encourage coaches, athletic trainers, and athletes to consider adapting this program into their routine.”

The study explored the effectiveness of the Prevent Injury and Enhance Performance (PEP) program developed by the Santa Monica Orthopedic and Sports Medicine Research Foundation, Santa Monica, Calif. The Foundation conducts research to prevent musculoskeletal and neurologic injuries. The PEP program is designed to help teams prevent noncontact ACL injuries without a significant investment in equipment or time. The session includes warm-up, stretching, strengthening, and sport-specific agility exercises.

The study followed 61 women’s soccer teams with 1,435 players in Division I of the National Collegiate Athletic Association for a single season. Twenty-six teams were randomly assigned to use the program and 35 other teams served as a comparison group. Teams participating in the study came from many different regions, conferences and experienced a variety of competitive success.

Researchers noted that while the number of injuries reported in this study was small, the use of the PEP program was effective in reducing the risk of ACL injuries, and the program can be done during regular practice time and without special equipment.

Significant findings include:

• Athletes on teams using the PEP Program suffered no ACL injuries during practice, compared to six injuries among other teams.
• Among athletes with a history of ACL injury who used the program, none experienced noncontact ACL injuries, compared to four injuries among other players with a similar history.
• In the second half of the season, athletes using the PEP program reported no ACL injuries, while other athletes experienced five injuries.

While many teams may conduct various warm up and stretching exercises, the PEP program focuses on improving biomechanical techniques in jumping, stopping and turning to reduce ACL injuries.

“PEP was developed specifically to prevent serious knee injuries and their consequences,” said Dr. Bert Mandelbaum, director of the research foundation. “We recommend that teams use it as an alternative warm-up before training sessions. Putting PEP widely into practice, we hope, will continue to show reduced risk of ACL injury among soccer players.” 

The study was made possible by additional support from the American Academy of Orthopedic Surgeons, American Orthopedic Society for Sports Medicine, International Federation of Football Associations, National Collegiate Athletic Association, and the Santa Monica Orthopedic and Sports Medicine Research Foundation.

For more information about CDC’s injury prevention efforts, please link to www.cdc.gov/injury. For a copy of this study, please visit http://ajs.sagepub.com/cgi/reprint/36/8/1476. To obtain a copy of the PEP program, go to www.aclprevent.org.