100,000 – 200,000 per year. This is the frequency of anterior cruciate ligament (ACL) ruptures each year in the United States (1). Female athletes tear their ACL at an alarmingly higher rate than males in certain sports including basketball and soccer:

• Basketball: For every 1 male ACL tear, 3.5 tears to female athletes
• Soccer: For every 1 male ACL tear, 2.8 tears to female athletes 

Chances are if you’re reading this, you’re a parent to a female athlete participating in soccer, basketball, or other field/court sport. You’ve caught the wave of concern from other parents or coaches over immediate devastation and long road back following an ACL tear. The ACL rupture is one of the most common serious non-contact injuries to the knee and many young female athlete’s biggest fear.

To throw some gasoline on the fire, did you know an astonishing 70% of ACL injuries occur in a non-contact moment?! One bad step and a life changing twist. No opponents crashing down on them or anyone to blame… yet. Athletes don’t know what they don’t know. Athlete stakeholders such as parents, sport coaches, and strength coaches SHOULD be assessing and training to PROTECT female athletes.

Not “Just Part of the Game”

Parents and coaches, be aware of the greater risk your girls face for non-contact ACL injuries, currently reported to be 4 times more likely than male athletes in comparable high-risk sports and rising (3). Many factors contribute to this underlying gender disparity, including related extrinsic (physical and visual perturbations, bracing, and shoe-surface interaction) and intrinsic (anatomic, hormonal, neuromuscular, and biomechanical differences between genders) variables (4).

This injury typically happens during deceleration, lateral pivoting, or landing tasks associated with high loads on the knee joint (2). These actions are unavoidable in your daughter’s sporting arena, often occurring instantly with her attention upfield or on the opponent, anything but what knee is doing. It only takes a single moment of high dynamic loading for something to go awry. Despite the extrinsic and intrinsic factors stacked against the young female athlete, this injury is not inevitable or “just part of the game.” 

What if we were to tell you there is a simple movement you do at home to help identify if your girl is at risk for an ACL rupture? No fancy equipment necessary, just a phone to record and the knowledge of what to look for. This article will introduce a highly researched, at-home ACL screening and signs an injury risk factor is present.

The Tuck Jump

Purpose: identify jumping and landing deficits from front and side views. 

Set Up: Stand tall, toes forward and heels aligned directly under hips, forming a straight line through the hips, knees, and feet.

Execution:

• Slightly crouch downward, bending at the waist and knees (don’t just hunch over), loading the legs and bringing the arms back.
• Explosively swing the arms forward and up towards the head, jumping straight up.
• At the peak of the jump, pull the thighs parallel to the ground.
• Immediately recover leg and arm position prior to landing, preparing for the next jump.
• Upon landing, initiate the next tuck jump, minimizing ground contact, and focusing on maintaining the same footprint with each jump.

Time: perform the tuck jump for 10 seconds vertically. Stop if technique declines sharply within the :10 window.

Common Risk Factors

Increased dynamic valgus position and abduction loads in the lower extremity successfully predict increased risk of ACL injury in female athletes. These loads are often driven by dysfunction of the core or trunk, as well as loss of symmetry between limbs (4). neuromuscular imbalances

Ligament Dominance

This is mostly present in taller, leaner athletes like volleyball and basketball players, and especially in teenage athletes whose muscles have not caught up to their growth spurt. Signs include knee(s) caving inward or foot placement consistently narrower than shoulder width when landing the tuck jumps.

Quad Dominance

Signs of quad dominance include landing from the tuck jump with little or no bend in the knee, very vertical torso throughout the jumps (we want athletes to bend at the ankles, knees, and push back into the hips simultaneously on ground contact), or catches in a flat foot position. You will also likely observe excessive landing contact noise as if the jumps are not in control.

Leg Dominance

This neuromuscular imbalance can be objectively identified via size difference between thighs or knowledge of their asymmetrical sport like volleyball (hitting with dominant arm) or soccer (kicking with dominant foot). This is demonstrated in a tuck jump when one thigh or hip is constantly higher during jumps. Pay attention to the athlete’s landing. If foot contact is rarely equal and foot position is constantly off set, then a leg-to-leg imbalance may be present 

Trunk Dominance

Female athletes with a poor sense of where their trunk is during movements like the tuck jump, is unable to bring their knees up above their hips at the peak of each jump, or are unable to consciously maintain the same landing point each jump, are at risk of future ACL injury. Be sure to mark an ‘X’ on the ground to observe how much displacement around the start position the girl has throughout the tuck jump test.

Empower Your Performance: Knowing is Half the Battle

The tuck jump is an assessment for risk for ACL injury, it is not the fix. You are looking for the four neuromuscular imbalances during this movement, to become aware of your girl’s risk when she steps into the sporting arena. The good news, these are modifiable risk factors. Through identification and a directed training strategy, you as the parent or coach can intervene and protect your athlete before it’s too late. 

Enroll now for our in-depth online ACL Injury Prevention course designed to enhance your ability to watch your girl’s movement and provide specific training strategies to correct neuromuscular imbalances specific to each of your athletes.

Parents, we also have the option to submit your athlete’s tuck jump film for review and consultation with one of our Power Athlete Block One Coach DPT’s. Email training@powerathletehq.com for review and coaching information.

We fall to the margins of our experience. You’re trusting a sport coach to take your daughter’s skills to the next level, but enhancing their athleticism and protecting from injury is well outside the coach’s skill set. Take guidance and direction specific to your daughter’s movement and needs to not only empower her performance, but protect her from injury for a lifetime.

Related Content

PODCAST: PA RADIO – EP 358: THE ACL EPISODE w/ DR TIM HEWETT
BLOG: WHAT THE SCIENCE SAYS: YOUTH WEIGHT TRAINING by Ben Skutnik
BLOG: REHABILITATION AFTER ACL SURGERY by John Welbourn
BLOG: A TALE OF RECOVERY FROM AN ACL TEAR by Carl Case

Sources

1. Gordon MD, Steiner ME. Anterior cruciate ligament injuries. In: Orthopaedic Knowledge Update Sports Medicine III, Garrick JG (Ed), American Academy of Orthopaedic Surgeons, Rosemont 2004. P.169.
2. Myer, G. D., Brent, J. L., Ford, K. R., & Hewett, T. E. (2011). Real-time assessment and neuromuscular training feedback techniques to prevent ACL injury in female athletes. Strength and Conditioning Journal, 33(3), 21–35.
3. Myer, G. D., Chu, D. A., Brent, J. E., & Hewett, T. E. (2008). Trunk and Hip Control Neuromuscular Training for the Prevention of Knee Joint Injury. Clinics in Sports Medicine, 27(3), 425–ix.
4. Hewett, T. E., Ford, K. R., Hoogenboom, B. J., & Myer, G. D. (2010). Understanding And Preventing ACL Injuries: Current Biomechanical And Epidemiological Considerations – Update 2010. North American Journal of Sports Physical Therapy : NAJSPT, 5(4), 234–251.