Your Kid’s Not Going Pro

A Youth Sports Blog

Knee injuries and girls: lessons from my 10-year-old daughter

with 10 comments

I’m no physician, but I feel like I’ve become a little bit of an expert on noncontact athletic knee injuries suffered by girls. That’s because today, for the second time since February, I took my 10-year-old daughter to the doctor because she had sprained her left knee playing basketball. In that sense, I am becoming an expert in girls’ knees the same way I became an expert in the cars I drove in high school: because the same parts kept breaking down.

Tomorrow I take my daughter to her first appointment with an orthopedist, who will find out (hopefully) exactly why this same knee keeps getting hurt. In the short term, I know she’s worried about getting well before her softball league games start April 27 (and given the frantic messages I’ve gotten from her coach, he’s worried about it, too — hey, it’s my kid and my blog, so I can brag!), and so she can get back to her musical theater rehearsals. (Once she got her crutches today, she spent most of the afternoon walking around with them outside, fighting my entreaties to get back in and rest her knee.)

However, my wife and I are more worried that someday she’s going to need more than crutches and Ace bandages to take care of that left knee. Hence, why I’m planning on asking the orthopedist about any physical therapy or structural problems that might be causing my daughter to hurt that same knee.

As anyone who has watched women’s college basketball and its high knee-brace content knows, female athlete knees are more susceptible to injury than those of their male counterparts. Without using phrases like “narrow femoral arch,” researchers believe there are physical reasons why this happens. In particular, girls and women are more at risk of tearing their anterior cruciate ligament (ACL), especially after puberty. The ACL connects the femur and the tibia behind the kneecap, which is why when that sucker gets torn, you see athletes writing in so much pain. ACL injuries are commonly caused without contact, through twisting or jumping. Each time my daughter got hurt, she reported feeling pain after jumping.

I’ve become enough of an Internet expert on girls’ knee injuries to know that a common reason jumping is a problem is because of how many girls land. Mainly, the problem is that girls are more likely to jump with their knees pointed together, creating more stress on them upon landing. Do that enough times, and the ACL starts to tear, and when it tears enough, it pops. And when it pops — the pain!

We’ll find out at the orthopedist whether this is the root of my daughter’s problem, particularly because she noticed the pain after a jump, with no contact from anyone else. If the orthopedist doesn’t check that, I might have to break out my Internet Expert’s License and tell him. Although, technically, I don’t know for sure that it’s the ACL. It seems like it, given her complaints of pain under the kneecap, although I don’t know if that’s why her left kneecap seemed to move a lot more, and disturbingly, freely than the right when her pediatrician manipulated it today.

I might be a budding Internet expert, but that only will take me so far in trying to ensure my 10-year-old daughter isn’t having major knee surgery by age 13. Eventually, I was able to afford to buy cars that allowed me not to learn so much about how they fail. Hopefully, my daughter is on the road to allowing me to spend less time becoming an expert in how girls’ knees fail.

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10 Responses

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  1. The verdict from the orthopedist: dislocated kneecap. She’s got a knee brace, and likely will be on two good knees sometime next week.

    Bob Cook

    April 15, 2010 at 3:28 am

  2. Clearly, you are the poster parent for millions of us who share the same angst about our daughters’ physical well being as they pursue what is becoming year-round participation in organized sports. Sadly, as you point out, there is an increasing gender gap in the incidence of serious knee injuries suffered by young athletes. And once torn, the risk of recurrence is unfortunately quite high, as documented in Michael Sokolove’s well-researched book on this topic, “Warrior Girls” (Simon & Schuster, 2008).

    It is interesting to note, however, that certain sports generate more of these injuries than others, which may help us understand what it is about those sports that puts girls at increased risk. While soccer, basketball and volleyball see the preponderance of ACL tears in female participants, field hockey players appear to be far safer (see Sokolove’s book, pg. 177). One hypothesis for this is the fact that the sport forces players to activate their hamstrings more than is the case with the other sports. Because the girls are bent over to control the ball when they are most at risk – stopping or changing direction – there appears to be better balance between quadriceps and hamstrings, which is thought to be one of the key risk factors in the incidence of non-contact ACL injuries.

    A training program popularized by physical therapists in Santa Monica, CA is catching on at high schools and colleges across the country. This so-called PEP Program emphasizes hamstring conditioning as a key preventive measure against ACL injuries. What is missing, however, is a way to measure the degree to which an imbalance may be present or whether it is being eliminated.

    This past January, using a promising new technology called vibromyography, we screened many high school female athletes at a local PT clinic for quad/ham muscle balance. By converting muscle vibration to effort while the girls performed simple side jumps, we identified imbalance in several individuals and provided objective information about where to target training. It is our hope that such a modality will help reduce the incidence of the kinds of injuries that destroys the dreams of young athletes and anguishes their parents.

    chuckschwerin

    April 15, 2010 at 11:10 am

  3. My daughter injured her knee playing volleyball, and another coach I know whose daughter made it through the club system to play soccer at the collegiate level told me about the horrendous knee injuries that he saw during her career. I didn’t know that girls are more vulnerable to knee injuries – that’s good to know.

    A girl that I coached in volleyball wore a band below her knee that her father said was a device to help reduce knee injuries in rapidly growing girls. Seemed to work for that girl, who has become an elite softball player who played on last year’s number 1 ranked softball team. Just curious, have you heard of such devices and whether they really work?

    jeff

    April 16, 2010 at 12:46 am

  4. Jeff: I haven’t heard of such a device, but it sounds like something I would consider using for my daughter. The orthopedist said she’s at a particular risk for knee injuries now because of her long legs, her left kneecap already facing slightly askew to the right (she gets that from her old man, who has two knees working like that), and her rapid rate of growth. I wonder if sometimes the severe knee injuries you see in high school athletes are the result of ignoring pain when they were younger. Having had a slightly torn Achilles myself (a more painful way to say “sprain”), I was told that as I long as I took care of it now, I wouldn’t have it snap in two later.

    I’m considering having my daughter play softball with the knee brace on, as long as she can move comfortably with it. I think she’s more comfortable with the idea that she won’t injure it again than I am. It is burning her up not to be able to participate in sports and, well, a two-legged life.

    Bob Cook

    April 16, 2010 at 11:33 am

  5. I finally found an example of one of these things. You can see one at:

    http://www.kneeshop.com/proddetail.asp?prod=79-80322&cat=14

    This is the kind of thing the girl was wearing.

    Not sure about the cause of the severe knee injuries seen by the other coach. That coach attributes it to overuse, brought on by club soccer coaches telling girls and their parents early on in their sports careers that they have to choose one sport and that they have to do it year round.

    jeff

    April 16, 2010 at 9:24 pm

  6. That coach is like many orthopedists, up to and including the great James Andrews, who say they are seeing overuse injuries in teen athletes for just that reason — early specialization. The New York Times had a story a few years back about dads begging for their kids to get Tommy John surgery because they thought it would give them superpower arms.

    For the record, that device looks like it’s supposed to keep the ACL in control. It would do no good on my daughter, because her injury was the kneecap itself. But I could see how it would be good for athletes at risk of knee ligament problems.

    Bob Cook

    April 16, 2010 at 11:25 pm

  7. For what it’s worth, my daughter uses the brace described for a condition called Osgood Schlater’s syndrome, a condition common amongst preteens and teens due to rapid growth. It is used to help alleviate/prevent knee pain. Just google it and you’ll find a lot of information.

    My daughter, who is almost eleven, also suffered her second knee injury today. The first was a knee sprain much like your daughter’s. Today, she injured herself playing soccer with friends on the playground at school. I’m praying that it is a minor injury, but I too worry about her future. Hopefully, the orthopedic will say nothing is torn and she can rest, recover and enjoy being a kid again.

    Khai Regan Guidinger

    April 30, 2010 at 12:15 am

  8. I checked on Osgood Schlater for the very reasons you outlined. My daughter has grown at least six inches or so in the last year (she’s now 5-foot-2 at age 10), so it was one more reason I worried the problem might be endemic.

    So far, she’s run a mile in gym class and played softball with no pain. She still has a follow-up with the orthopedist, but in looking back, she first complained of knee pain after collided with another player in basketball. The kneecap didn’t dislocate because of a cut or a bad landing.

    As for your daughter, I’m no doctor, but as hard as it can be, I would recommend, after my own daughter’s experience, as much treatment and rest as possible. It drove my daughter crazy, but in the end I think it’ll her help her long-term. Not just in sports, but also in, say, walking to the bus stop.

    Bob Cook

    April 30, 2010 at 10:39 am

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