Weak at the Knees

Noyes admits that his program isn't perfect. Although it reduces the risk of injury, athletes can still get hurt. It's also time consuming. Because players are retraining themselves to move in ways that don't come naturally, it takes three 90-minute training sessions a week for six weeks before the program is effective. "Less doesn't work," Noyes says, "and they have to be serious about it." But to encourage trainers and coaches to do it right, Noyes regularly offers free instruction on the program at his clinic in Cincinnati. (For more information, visit www.sportsmetrics.net.) Another program that's been shown to work in studies published in 2005 in the Current Sports Medical Report is the PEP Program, developed by the Santa Monica Orthopedic Sports Medicine and Research Foundation (available free at www.aclprevent.com). It's a 20-to-25-minute daily workout that can be done before practice drills. The program includes detailed instructions on appropriate warm-ups, stretching, strengthening and plyometrics (muscle training designed to produce very strong and very fast movement) as well as sport-specific knee exercises. "That's a good program for large groups of people," Noyes says. "After doing it for four weeks, you see benefits."

Since there's no simple way to identify which girls are the most vulnerable to this injury, many sports medicine and orthopedic specialists are lobbying schools across the country to adopt injury prevention programs, but it can be an uphill battle. Coaches and trainers who work with the most elite athletes have been the easiest sell, Noyes says, because they often know firsthand how devastating one ACL injury can be to their program. But it's been harder to get the attention of those coaching younger girls. "Some coaches are enlightened, but others have been doing their own routine for a long time and don't want to change it," Noyes says. "Sometimes it takes a push from the school board or the athletic director." Parents and players can demand change as well.

In the meantime, Griffin and Noyes suggest that female athletes read up on ACL injuries and familiarize themselves with protective workout techniques. Those who have already suffered one ACL injury should probably be extradiligent about doing the exercises and stretching recommended by their physical therapists, even after full function returns. Griffin says there's no clear data indicating whether scrupulous conditioning can help stave off arthritis in women who have had ACL surgery, but her professional opinion is that it's probably worth the trouble.

"Until we do a better job of getting the word out to younger players, we're not going to see a decrease in the number of these injuries," Griffin says. "We need to recognize that training girls is different than training boys and that they need different conditioning at all levels of play."

For more information about ACL injuries, visit the Web site of the American Academy of Orthopaedic Surgeons at www.AAOS.com.

© 2008