But even football players with dramatically different bodies from female soccer players, including larger notches, still tear their ACLs, as do people with no family history of such injuries. And no athlete can fundamentally alter their anatomy, or their genes, anyway. So rather than dwelling on these differences and instilling fear—which, paradoxically, actually further increases the risk of injury—it makes a lot more sense to focus on prevention methods that are known to work, Dr. Silvers-Granelli says.
So what can women do to protect themselves?
If there’s one message women’s sports medicine experts have for athletes, it’s that their bodies aren’t fragile and injuries aren’t inevitable. Everything from proper nutrition and recovery to specific prevention programs can go a long way toward mitigating the risk of ACL tears and other injuries. Here are some other prevention strategies to keep in mind:
1. Follow the program.
Pinpointing the neuromuscular and biomechanical risk factors that increase the risk of ACL tears has allowed researchers like Dr. Silvers-Granelli to develop exercise programs specifically to address them. Most are 10- to 15-minute sessions involving elements like running drills, plyometrics, strength moves, and stretching, which can double as a dynamic warm-up. Not only do they strengthen muscles and improve mobility, they also increase body awareness and proprioception, or the sense of where your body is in space, which is important for pivoting and landing, Dr. Ode says.
They’re shockingly effective: In a 2005 study, one of those programs—Prevent Injury and Enhance Performance Program, or PEP—decreased ACL injuries among 14- to 18-year-old female soccer players by 88% over two years. Female players in college who did a similar program, the FIFA 11+, cut their risk of any type of leg injury by 83% by the third season. “A four in five chance that I can mitigate my risk is one I would take,” Dr. Silvers-Granelli says, noting they’re freely available and anyone can do them.
2. Hit the weight room.
In addition, strengthening your hamstrings, quads, and glutes can fortify your knees and improve your biomechanics, Dr. Ode says. Exercises with a mini band that work the sides of the hips can stabilize the pelvis and prevent the knee from collapsing inward, Dr. Silvers-Granelli says. And Dr. Trentacosta often recommends Pilates to her athletes, for its focus on the core and glutes.
3. Vary your training.
For athletes of any age, cross-training can prevent you from overstressing the same set of muscles and tendons, as well as get you moving in different planes so you’re a more well-rounded athlete. “Especially for younger athletes, don’t play the same thing all day, every day, four seasons in a row,” Dr. West says. “You need to diversify how you’re moving.”
4. Heed your hormones.
There’s not really solid evidence to support cycle-syncing your workouts—for one thing, not everyone experiences the same effects throughout the month—but it makes sense to note how you typically feel at various points in your cycle and factor that into your workout plans. “Certainly for women who say they’re on their period or at certain phases in their cycle, they may notice that they have more general fatigue or muscle aches,” Dr. Ode says. At those times, consider prioritizing recovery, prevention exercises, and other steps that can reduce your risk of injury.
5. Eat well and recover.
Sleeping well, incorporating plenty of rest into your training, and eating a nutritious diet give your body the time and building blocks it needs to recover from the hard work you do in the gym and outside of it, Dr. West says. And fueling your body appropriately can reduce your risk of injury overall.
Even with all this knowledge, there’s still a lot to be done to make women’s sports safer.
One big barrier has been convincing coaches to implement ACL prevention programs. Dr. Silvers-Granelli and others continue to promote them, hoping to persuade everyone from NWSL and WNBA coaches to youth leagues to incorporate them.
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