PHD Training Program Aims to Reduce Female Knee Injuries

Presbyterian Hospital of Dallas (PHD) has instituted

an exercise program that experts say could dramatically reduce knee injuries among female athletes, who suffer approximately three times more anterior cruciate ligament (ACL) tears than males in comparable sports. The program was started when Dr. Scott Paschal, an orthopedic surgeon on the medical staff at Presbyterian Hospital of Dallas, began seeing a rash of serious knee injuries among female athletes in North Texas

“I was treating an unusually high number of girls with ACL tears and decided we needed to do something about it. I felt there was a huge need to implement an ACL injury prevention program in Dallas,” Paschal said.

The good news is that neuromuscular training programs have been shown to reduce the incidence of ACL tears in female athletes. I feel the exercise program we have developed, emphasizing core training, can reduce injury rates even further.”

The CORE Sports Enhancement and Injury Reduction Program focuses on strengthening the body’s core muscles (abdominal, lumbar, pelvic and hip muscles), which are crucial to lower body stability and strength. “Females tend to have more knee injuries, in part, because they have weaker core muscles and poorer pelvic stability compared to males,” Paschal said.

“Understand, about 70 percent of ACL tears among female athletes are non contact injuries that occur, for example, when the player lands from a jump.” Paschal said. “One of the main risk factors for the different ACL-injury rates between genders is the position of the knee joint at landing. Females tend to land from a jump in more upright, knock-kneed posture. This position makes the knee more vulnerable to an ACL tear. The core or pelvis — the top link in a kinetic chain — provides a stable platform for the movement of the lower extremity. If the core is unstable, the knee is more prone to injury. We feel that core stability is the key to optimizing proper landing position and enhancing neuromuscular control.”

Basketball and soccer players account for two-thirds of the ACL injuries suffered by females in the United States, according to one study. There are thousands of female high-school soccer and basketball players in the Dallas-Fort Worth area alone.

These female athletes are up to eight times more likely to injure their ACLs than male soccer players, Paschal said. Overall, an estimated 38,000 ACL injuries occur in female athletes per year in the United States — at an annual cost of $646 million.

“Those are staggering numbers. We can’t prevent all ACL tears, but we can dramatically reduce the incidence of them,” he said.

In addition to medical cost savings, reduction of ACL tears decreases the need for surgery, the risk of secondary knee joint problems, a full season lost from competition, a potential loss of scholarship funding, and the potential deleterious effects on an athlete’s performance.

“Most training programs focus on plyometric (explosive movement to develop muscular power), jump and agility training with relatively little emphasis on core training,” Paschal said. “We believe it is paramount to identify core deficits through proper pre-screening, build a solid core foundation first, and then implement jump and agility training to enhance athletic performance and reduce injury rates.”

“Athletes that participate in other programs do not attain the core foundation that is vital for competition and have a higher risk of becoming injured,” said Corey Eaton, a certified athletic trainer and CORE program director, who helped create the program at PHD. “The CORE program provides a foundation for high performance and helps prevent injury.”

Eaton has already implemented the program at several Dallas-area schools with positive results.

“Research shows female athletes have poorer neuromuscular control versus males,” said Ken Locker, a certified athletic trainer and director of Presbyterian Sports Network. “For example, girls tend to have less muscle strength, less efficient muscle contraction, and are less likely to have protective co-contraction of the hamstring muscles at landing. The CORE program will enhance neuromuscular control in part due to improvement of landing position.”

Paschal contacted Eaton about implementing the CORE program in Dallas after he surgically reconstructed the knees of three female teammates who sustained ACL tears within a two-week span. Paschal and partner Dr. Jim Montgomery, an orthopedic surgeon on the medical staff at Presbyterian Hospital of Dallas, were convinced that core muscles were the key to reducing not only ACL injuries but other lower-extremity injuries, including over-use syndromes.

The CORE Program at Presbyterian Hospital of Dallas — which is ranked by U.S. News & World Report as one of the nation’s top 50 hospitals for orthopedics — focuses on establishing a strong core stability foundation in each athlete through a series of progressively challenging exercises on the stability ball. Only after this foundation is attained do qualified trainers begin to incorporate jump, agility and sport-specific training.

The CORE Sports Enhancement and Injury Reduction Program is offered at the Finley Ewing Cardiovascular & Fitness Center at Presbyterian Hospital of Dallas.

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