NATURE, NUTURE & KNEES

Steve Myrland

Much has been said and written about the epidemic of anterior cruciate ligament (ACL) tears in female athletes. The New York Times has offered several articles relating to this topic in the past year. Link to  NYTimes The Uneven Playing Field and NYTimes New Leaps in Research on Injuries. Initially, explanations for the disparity in the number of these injuries in males and females often centered on a few aspects of female-specific physiology. These include the “Q-angle” or “Quadriceps-angle” (the degree of internal slanting from the hips to the knees which tends to be more pronounced in post-pubescent females as a result of the natural widening of the hip structures for child-bearing), and the varying degrees of joint tightness and joint laxity that naturally occur over the course of a menstrual cycle.  Such explanations seemed to suggest that knee injuries could be simply blamed on the (unfortunate?) fact of being female.  In other words:  the injuries come down to nature.

This approach is simplistic, of course, and several studies and programs have been designed to show that athletic preparation, or lack thereof (nurture) plays a big part in such things.  Programs designed to prevent knee injuries have shown statistically significant positive results.  Even so, increased participation of females in athletics has seen an explosion in the rate at which young female knees are disintegrating.  Is this simply the unwillingness of some coaches to learn about and implement an injury-reduction program?  Or are there more (nature? / nurture? / other?) elements involved?

Why, for instance, do knee injury rates for dancers and gymnasts seem to defy the trend seen in many game-sports (soccer, basketball, volleyball, etc.)?  What is different about the dancers or gymnasts, or about what dancers or gymnasts do that might account for their reduced rate of knee injuries?  It seems certain that any understanding of why so many female athletes suffer torn ACL’s and / or miniscal tears must be firmly grounded on a more complete picture of the nature and nurture factors involved, and how they interact.  

In assembling this picture, we quickly see that the latter side is a longer list—by far—than the former.  Under the nature heading we have three commonly cited items:

NATURE:
1) Q-angle. The angle measured at the center of the patella (kneecap) formed by one line drawn from the anterior superior iliac spine (the top front of your hip-bone) to the center of the patella, and another drawn from the center of the patella to the tibial tubercle (the little “bump” located about five centimeters below and to the outside of the kneecap).  The Q-angle is expressed as the measured angle minus 180º.  Post-pubescent men’s Q-angles tend to be on the order of fourteen degrees, while the same angle in post-pubescent women tends to be on the order of seventeen degrees.  (In other words:  the Q-angle for females is more acute than for males.

2) Menstrual cycle effects on relative joint laxity.  Female joints may become tighter or looser as a result of changes dictated by the hormonal variable associated with the menstrual cycle.

3) Far lower levels of muscle-building hormones in girls than in boys.  Boys have a decided advantage when it comes to creating larger muscle mass and they do so more efficiently than girls as a result of their having far more human growth hormone and testosterone.

4) Smaller femoral intercondylar notch (essentially the space in which the anterior cruciate ligament moves within the joint):  This of often found to be dangerously small in females, and is often linked to ACL tears.

5) Deficiencies in hip abductor strength.  A recent study* shoed that hip abductor steadily increased in adolescent boys, but shoed no similar increase in girls.  This strength deficiency could easily contribute to an inability to withstand normally occurring joint stresses in competitive situations.**

*  Relationship Between Hip and Knee Kinematics in Athletic Women During Cutting Maneuvers: A Possible Link to Noncontact Anterior Cruciate Ligament Injury and Prevention, Imwalle, Lauren E; Myer, Gregory D; Ford, Kevin R; Hewett, Timothy E

Journal of Strength and Conditioning Research: November 2009 - Volume 23 - Issue 8 - pp 2223-2230

**  Is this truly “nature” or might it be (at least in part) “nurture”?  Normally observed gender-dependant strength deficiencies might be either, or both, but since this is a measurable physical trait, let us classify it as “nature”, for the time being.

NURTURE:

The “nurture” side of things is more involved—even if we restrict ourselves to commonly cited factors.  Here is my expanded version of the “nurture” list:

1)  Earlier onset of adolescent growth-spurt in girls. Put simply:  girls develop sooner (in real age measure) than boys.

2)  Awkward “strength-to-length” ratio.  This occurs in both boys and girls; however, this awkward phase (where bone [lever] growth outpaces muscular development) persists longer for girls and is more difficult to manage than in boys because of the relative absence of HGH and testosterone mentioned, above.

3)  Youth sport models are poorly designed and poorly matched with the realities of physical development in children (girls and boys).  But the youth sport model for girls is simply a copy of the boys’ model.  It often means that the pernicious influence of parents and clubs causes both boys and girls to face the tryout and travel-league reality (with those all-too familiar five-games / weekend tournaments [can you imagine what the NHL Player’s Association would say if the league tried to schedule fully grown professional athletes to compete five times in two or three days . . . ?) So, just as the girls are entering their most vulnerable developmental stage . . . their competitive sports become more intense and far more frequent.  This means that the sheer number of games makes the idea of training to play impossible, and playing to train the reality.

4) And:  since the girls’ “window of vulnerability (WOV)” (based on simple strength-to-length ratios) opens sooner than the boys’ window of vulnerability, and since that window is more difficult to manage (close) for girls than boys (as a consequence of the disparity in hormonal muscle-building adjuncts), the girls’ WOV remains open wider and far longer (on average) than the boys’ WOV.  

5) Most strength-training programs do not differentiate between girls and boys, so they are formulated and paced assuming both sexes respond to training in the same way.  (They do not.  See “NATURE” factors 1-3 and “NURTURE” factors 1-4.)

6) Girls are often mistrustful of the stated goals and the means utilized in strength-training programs—especially when they do not reflect their concerns about body image.  Female soccer players enter their school weight-rooms and find themselves doing much the same training as their male football-playing counterparts.  The boys make no bones about their goals: They want to be bigger and stronger.  The girls generally have something else in mind.

7) Society rewards boys for creating muscle, but is far less positive in its response to similar body changes in girls.  

8) Consequently, there are far more positive physically strong role-models in the culture and marketing messages for boys than for girls.  Generally, role models and marketing messages neither encourage nor value physical strength in females but rather conform to cosmetic images of a prototypical female body that will not be helpful in attenuating sport-related injuries.
(See www.projectgirl.org)

9)  Ostensibly gender-neutral factors . . . rarely are.  If the girls play soccer on the same field as the boys, we ought to be able to assume that the field is a neutral factor, right?  Well, only if we assume that girls and boys are the same to begin with.  (Anyone want to go there?)  Fields, floors, shoes and gender-neutral training programs may appear to effect all participants equally; but if we agree that A) Synthetic turf fields represent an enhanced risk potential for all knees, and B) Girls’ knees are vulnerable sooner and remain vulnerable longer than boys’ knees . . . then we must conclude that a synthetic turf field represents a greater risk—in duration, at least—to the girls than to the boys . . . don’t we?  (Isn’t assuming a given competitive venue poses identical risks for both boys and girls much like assuming a team of seventeen-year-old girls has an even chance against a team of seventeen-year-old boys in a game of tackle football played on that field?)

10)  Given that males and females respond differently in quantitative and qualitative terms to the interactions of child development (emotional, intellectual and physical) and do so at different ages and at different paces, strength-training is arguably more important for female athletes than it is for males.  Girls must begin strength-training sooner; do it better; and sustain it longer that boys, just to attenuate their window of vulnerability to injury.

11)  Quality may matter more than quantity.  The statistical anomaly represented by dancers and gymnasts—where ACL tears are concerned, at least—suggests that something in the “nurture” as represented by those activities plays a beneficial role in moderating injury potential.  I suspect it is the fact that in both cases, the movements being made are being made mindfully rather than mindlessly because, in both cases, success is a qualitative measure (gymnasts and dancers are judged by how well they move) rather than the simple quantitative scales (How many? How far? How fast? How high?) used to determine winners from losers in most other sports and activities.  Dancers and gymnasts often train and perform barefoot which eliminates the layer of confusion that shoes necessarily represent, and they take off and land in all three planes (sagittal, frontal and transverse).  

The above list of nature-nurture considerations is certainly not complete, yet; but if they cited factors are valid, the unavoidable conclusion is that we must review and rewrite the youth sport models for girls--at least; and it would be nice to think that, in the process, some of the excessive and unnecessary practices we employ with young boys might be reconsidered, as well.  Sadly, it is unlikely that this will happen because sport organizations—at all levels—tend to be highly sclerotic and rigidly opposed to change; however, it is (at least) plausible and therefore possible that if coaches, teachers, athletic trainers, physical therapists, et. al. are honest about all these considerations with parents, many more parents would be in a position to make better choices for their daughters and sons regarding the quality and quantity of their competitive involvement during their developmental years.  

 

 
Why Athletes Should Avoid The Bars (An intemperate look at barbell-centric training)

Perhaps the most persistent blunder athletes and coaches make in training to compete is regularly mistaking “strength” for “athleticism,” so let’s clear this up right away:  Athleticism—the ability to express one’s physical self with optimal speed, agility, strength, balance, suppleness, stamina and grace while avoiding injury—is the goal.  Strength, as you will note by re-reading the sentence, above, is a single element of the collective term:  athleticism.  You cannot be athletic without being strong; but you can be strong without being athletic.

Download PDF

Read more...
 
NATURE, NUTURE & KNEES

Steve Myrland

Much has been said and written about the epidemic of anterior cruciate ligament (ACL) tears in female athletes. The New York Times has offered several articles relating to this topic in the past year. Link to  NYTimes The Uneven Playing Field and NYTimes New Leaps in Research on Injuries. Initially, explanations for the disparity in the number of these injuries in males and females often centered on a few aspects of female-specific physiology.

Download PDF

Read more...
 
ATHLETIC BALANCE (AND PERSPECTIVE)

Steve Myrland

If you have ever spent an extended period of time aboard a sailboat, you will have firsthand knowledge of an interesting and telling phenomenon: When, after many hours on the water, you disembark and set your feet on terra-firma once more, you find your inner gyroscope is now a bit . . . off . . . when it comes to standing on something that does not move. Your central nervous system has, in fact, adjusted (beautifully!) to a world in constant (and often unpredictable) motion. You will experience much the same thing if you spend time running on a treadmill. Once you switch the machine off, you face some moments of awkward re-adjustment to a (relatively) stable world.

Download PDF

Read more...
 
OBSTACLES TO EXCELLENCE

Steve Myrland / Vern Gambetta

We do not coach in a vacuum. At the same time we are striving for athletic excellence, we are (always) contending with obstacles resulting from our contemporary (and changing) social order. And while advances in technology may cause the stock market to move, they, generally, have the opposite effect on people.

Download PDF

Read more...
 
Guru-ism And The Decline Of Coaching

Steve Myrland

Marshall McLuhan got it right, commenting on our collective gullibility. Truth is a relative ommodity. For example: the woman next door suggests to you over the fence one day hat we all ought to learn to live in peace. You nod, edge away and head back inside ondering how you managed to get saddled with such an oddball for a neighbor. But of ourse: If she has a Nobel Prize . . . you will be quoting her at every opportunity. “And did I mention we’re neighbors?” you will add with pride.

Download PDF

Read more...
 

A confident, young,Train To Play athlete.

 

ABC Agility Ladder footwork drills