One of the most debilitating injuries an athlete can suffer is an anterior cruciate ligament (ACL) injury. This injury not only requires surgery but also typically involves several months of rehabilitation. As a result, both athletic performance and quality of life will be negatively affected. the athletes, in particular, are four to six times more likely of suffering an anterior cruciate ligament injury compared to menThere are various theories, ranging from physical factors (such as pelvic width) to psychological factors (such as a tendency toward overtraining and poor diet).
How do hormones influence the menstrual cycle?
The menstrual cycle has also been considered one of the most influential factors in susceptibility to ACL injuries. The obvious difference between men and women lies in the hormones involved in the cycle (estrogen, progesterone, and relaxin), which affect muscle tone and joint laxity. But how do these hormones influence and how can you prevent injuries? It is difficult to give an exact answer, but A study analyzed thirteen different studies on the effect of the menstrual cycle in joint laxity and anterior cruciate ligament injuries. Eight of these studies found a correlation between the menstrual cycle and susceptibility to this injury, while the other five presented inconclusive evidence, suggesting that the topic remains under investigation.
Do contraceptives affect?
In another investigation It was highlighted that a disproportionate activation of the quadriceps in relation to the hamstrings could reduce the stability of the knee joint, generating instability. The use of hormonal contraceptives that tend to reduce cyclical fluctuations in hormonal levels could decrease this instability. Although the reasons are not yet completely clear, the correlation between the proportion of quadriceps and hamstrings and knee stability suggests that it is essential to design training routines that seek balance between both muscles to reduce the risk of knee injuries and optimize sports performance.
The menstrual cycle and anterior cruciate ligament laxity
The female menstrual cycle is divided into three phases: follicular, ovulatory, and luteal. During the ovulatory phase, increased ligament laxity has been observed, which may increase the risk of injury. Several studies have shown that women with high relaxin levels, typically during ovulation, have a significantly higher risk of ACL injuries.
Furthermore, The menstrual cycle causes changes in the proliferation and synthesis of fibroblasts and type I procollagen in the ACL, which can predispose women to injury. Stress and other factors such as diet and physical performance can also influence this process.
Structural and biomechanical risk factors
- Anatomy of the knee: Women tend to have wider hips than men, which can lead to a greater angle at which the knee sits, known as genu valgum. This condition can increase pressure on the ACL and increase the risk of injury.
- Musculature: Many female athletes have lower muscle tone than men, which is often associated with less development of the hamstrings and gluteus medius muscles, crucial for stabilizing the knee. Lack of strength in these muscles can increase the risk of injury during sports.
- Physical activity: A lack of time and resources for physical preparation can also play a role. Women's teams often have insufficient training loads, which limits injury prevention and the development of appropriate skills.
Recommendations for preventing ACL injuries in women
To mitigate the risk of ACL injuries, it is essential to implement prevention strategies that include:
- Proper warm-up before any physical activity.
- Specific strengthening exercises for the hamstrings and quadriceps, since a good
muscle strength can be key to maintaining joint stability. - Improve jumping and landing technique during training.
- Monitor training load and allow sufficient recovery time to avoid overtraining.
In addition, it is recommended to use suitable and personalized footwear that provides support during sports practice, which can contribute to prevent knee injuries.
The role of the physiotherapist in prevention and recovery
A physical therapist can play a crucial role in identifying and managing the risks associated with knee injuries. During your consultation, they will begin by taking a detailed medical history, assessing risk factors and the mechanism of injury. They will then perform a physical examination, which may include specific movement tests. If necessary, they may refer the patient to an orthopedic physician for further testing such as X-rays or an MRI.
