Prehab? – Hype or Health
One of the core principals of Athletic Gaines by Travelle Gaines (trainer of the pros) is the concept of “prehab”. Prehab is a focused exercise program to improve flexibility, balance, strength, and stamina to proactively treat injuries before they occur. While important for all athletes, this preventative regimen is perhaps even more critical for girls.
As the father of 3 beautiful daughters, I have observed the positive benefits enjoyed by girls who participate in sports. According to the Women’s Sports Foundation, those benefits include better grades, a more positive body image, lower rates of unintended pregnancy, higher rates of graduation, and overall improved psychological well-being compared with their peers who do not play sports.
However, as an orthopedic surgeon, I am also aware that ACL injuries are increasingly prevalent and that female athletes are disproportionately affected.
The anterior cruciate ligament (ACL) is one of four major ligaments that stabilize the knee. It protects the knee from hyper extension, excessive rotation, and angulation.
Females age 15 to 19 have the highest rates of ACL injuries, 4 to 6 times higher than their male counterparts in similar sports. The consequences are severe. According to JBJS (The Journal of Bone and Joint Surgery) the average lifetime cost to society for an ACL injury is $38,121, even higher if not surgically repaired.
ACL injuries can negatively impact school performance. Girls are less likely to return to sports after an
ACL injury. Having an ACL injury makes you 10 times more likely to develop early onset degenerative arthritis. The highest rates of ACL injuries in females occur in soccer, basketball, and gymnastics.
But why are females at higher risk than boys (especially for non-contact ACL injuries)? Many theories exist from anatomical differences to hormonal influences during puberty. But the most current evidence suggests that girls have less neuromuscular control of knee motion during sports.
Kinematic analysis has revealed that:
1. Girls tend to be quadriceps dominant. Compared to boys, when girls land from jumping, or change directions quickly, they tend to bend their knees less, have increased quadriceps activity, and decreased hamstring activity.
2. Girls tend to have one leg stronger than the other, promoting imbalance and unequal weight distribution.
3. Girls tend to have less core strength and core stability, decreasing control of their bodies during explosive athletic movements (jumping, landing, sprinting).
4. Girls tend to rely less on muscles and more on their ligaments to stop joint motion.
This is why Travelle, (trainer of the pros) and I believe that “Prehab” is so important.
The good news is that neuromuscular training (NMT) can decrease the risk of ACL tears by up to 72% when done properly.
The key components to an effective NMT program are:
1. Progressive strengthening of core and lower extremity muscles
2. Plyometric training (dynamic jumping) with emphasis on proper landing & technique
3.) Feedback-driven modification of technique ( having a trained coach/therapist correct bad form)
The most effective programs train at least twice a week for six weeks and take place during the off-season as well as during the season. Females 15 to 18 years old have the most to gain in response to an NMT program.
Daily Gaines and training like the pros is even more important for girls.
Dr. Keith Johnson is a board certified Orthopedic Surgeon and the
Director of Sports Medicine for Athletic Gaines and Contributor to Daily Gaines.