Treating, preventing knee injuries in girls' sports not an exact science

Thursday, July 28, 2011 | 7:16 p.m. CDT; updated 5:06 p.m. CDT, Friday, July 29, 2011
Morgan Breneman, left, lines up her shot while McKenzie Lute watches during competition Sunday at the Show-Me State Games at Cosmopolitan Park. Injuries in popular girls' sports like soccer have proven to be increasingly common.

COLUMBIA — Exhausted after her soccer game, 14-year-old Katy Bland trudged up the hill to meet her mother.

“You’re limping, is your knee bothering you?” Leanne Bland immediately asked.

“No mom, I’m just walking up a hill,” Katy Bland replied, mildly irritated by her mother’s concern.

Leanne Bland has reason to be concerned about her daughter. Last month, doctors discovered that Katy Bland, like many female athletes, has bad knees, what is commonly called runner’s knee. Her kneecap slides up at an angle instead of straight, causing friction.

She wears a brace during soccer games to hold her kneecap in place, and is also supposed to complete daily physical therapy exercises. There’s a difference, however, between what Katy Bland is supposed to do and what she actually does.

“If she does the exercises, the stretches and strengthening that she’s supposed to do, and wears the brace she should be well on her way,” Leanne Bland said. “But I think it’s going to be longer because she doesn’t do the exercises.”

When asked to describe the exercises, Katy Bland admitted, "I don't really know; I don't do them.

Dr. Richard White, from Missouri Orthopedic Institute, said this mindset is common in young patients. Anxious to compete again, they often don't complete the rest period or rehab that's needed.

“Some people believe that if they’ve had a treatment, like surgery, then that should’ve fixed it," White said. "But rehab is as important if not more important.”

For female athletes, physical therapy is crucial because women are more predisposed for knee injury compared to men. Doctors however, don't know which gender differences are to blame.

"I think there's enough data out there to say, yes, some injuries occur more often in females than males," White said. "It's difficult to figure out why more females than males get these injuries. I think a lot of factors may play a role."

One possible cause is skeletal structure. Women have wider hips and a more tilted pelvis compared to men.

This alignment difference causes women to be knock-kneed more often than men. Knock-kneed refers to the knee joint collapsing inward when weight is put on it, especially during running.

Stefanie West, a certified athletic trainer at Peak Performance, said knocked knees are common in injured athletes.

“When they’re pivoting and landing, that’s when you have a problem,” she said.

Knee injuries are most common in soccer and basketball players because of sudden stopping and change of direction while playing. The angle of the knee collapsing can cause tears in knee ligaments. Dr. Matt Thornburg, from Columbia Orthopedic Group said most ACL injuries are actually non-contact.

Hormones could also play a role. Studies have shown a link between knee injuries, specifically ACL injuries, and estrogen.

“Some say there are higher incidents of ligament tears in female athletes when they’re on their menstrual cycle,” West said. “It changes the makeup of the ligaments.”

To avoid injury, Thornburg said to focus on strengthening, neuromuscular control, and flexibility.

"The more fit you are, the less likely you’ll have injuries,” he said.

West said she focuses a lot on fixing athletes’ mechanics, like correcting knocked knees, through plyometric exercises. While these corrections prevent injury, they are difficult to achieve.

“Athletes start at a young age; I think that gets them into their muscle memory and gait patterns early on. If we have to make corrections, it’s really hard,” she said.

Leanne Bland realizes that young female athletes are at a high risk for knee injuries, and that steps can be taken to decrease the chance of injury. She was concerned however, that not enough is being done to educate other parents and female athletes about this problem.

“I don’t think that’s talked enough about. What can really cause an injury? What can prevent an injury?” she said. “I think it’s something we need to focus more on in sports.”

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Warren Potash July 29, 2011 | 3:54 p.m.

I have successfully trained more than 600 teen female athletes since 1995.

BNP Training - balance, neuromuscular control, and proprioceptive exercises help each female athlete form a stable foundation from the ankle-knee-hip; i.e., the kinetic chain.

Over time, advanced exercises can be added to a stable foundation as each female athlete gains the muscle memory required to stabilize their lower body.

My website: teaches student-athletes and their parent(s)/guardian(s) with quality information so each person can make an informed decision about training to play sports which is the next hurdle for all female athletes.

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