Female Athletes and ACL Prevalence

As a former female division 1 gymnast, I personally experienced and witnessed many types of injuries. I had a few teammates who had recurring injuries that impacted their ability to continue the sport they loved. Seeing the sub-par rehabilitation process in a college setting without physical therapy interventions available, re-injury was extremely common. Many of these recurring injuries involved the knee and internal knee structures such as the ACL, PCL, MCL, and LCL. 

ACL injuries are becoming more and more common in the young athlete, but did you know that female athletes are up to 10 times more likely to experience an ACL injury compared to men? This may be due to the anatomy and biomechanics of the female knee joint. Often due to wider hips and a smaller groove at the bottom of the femur where the ACL inserts, the ACL in the female knee may experience greater stress and further restriction during twisting, jumping, changing direction, and landing movements compared to men. Other contributors to increased risk of injury include weakness of the posterior chain musculature (glutes and hamstrings) and ligament laxity during hormone cycles. Recent studies have found that woman may be more susceptible to ACL injury just prior to ovulation compared to the follicular phase due to increased ligament laxity.

The most common form of treatment following ACL injury is a reconstructive surgery using a graft from either the patient’s own patellar tendon, hamstring, or an ACL from a cadaver. Although an athlete may go through ACL reconstruction, it does not guarantee normal functions of the knee or prevention of subsequent knee injury. In recent studies, it has shown that about half of athletes who underwent ACL reconstruction return to high level sports, and only about 20% of these younger athletes will return to higher level sports in the first year following injury. Given these findings, it is extremely important that ACL rehabilitation encompasses deficits related to surgical interventions as well as initial cause of injury occurring prior to surgery.

Current generalized ACL rehabilitations programs may not have all-inclusive motor training, and neuromuscular re-education needed to safely allow return to sport within one year’s time. It has been statistically proven that proper recruitment and strength of the posterior chain as well as muscles that stabilize the knee will decrease risk of  re-injury in the young athlete with a prior ACL tear. Physical therapists have the training and knowledge to specifically pinpoint weakness and instability within the hip and knee complex, analyze gait and movements patterns, and build sport specific training programs to assist in injury prevention of the young athlete. 

In early rehabilitation, it is crucial to protect the graft site, and begin regenerating the quad musculature. Research shows that following knee injury or surgical interventions there is a reflex response to inhibit muscle activation called Arthrogenic Muscle inhibition (AMI). Physical therapy can assist in targeting the muscles that have been affected during this reflex inhibition process. Some examples include quad setting, resisted terminal knee extension, straight leg raises with a knee extension brace until the patient can complete a straight leg raise without knee flexion. Other exercises to assist overall hip and knee stability include closed chain activity such as partial squats, step ups, single leg balance activities, and bridges. It is critical for the physical therapist to ensure the patient is completing exercises without compensatory strategies and progressing toward proper movement patterns. 

Due to the high prevalence of re-injury, as well as muscular inhibition following knee injury, it is highly recommended that athletes, specifically women receive intensive rehabilitative care following ACL repair. Without specific neuromuscular re-education, proper movement pattern restoration, and addressing pre-injury mechanical deficits, young athletes are at risk for re-injury or significant time lapses as they attempt to return to sport. Physical therapy can provide young athletes with the education and tools they need for success as they return to the sports they love. 

Amanda Lievendag, DPT, CMTPT is a Physical Therapist in the outpatient setting at Frederick Health Physical Therapy & Sports Rehab. Amanda’s professional interests are Sports Orthopedics, Sports Rehab, Trigger Point Dry Needling, and Spine Rehabilitation. She is a high energy physical therapist who has specialized experience with post-op, sports injuries, return-to-sport training, overuse injuries, and general wellness with athletes and patients of all ages.


Ask an Expert: Should I Stretch Before a Workout?

Question: Should I stretch before a workout?  

Yes, but not in the way you probably think! Let’s look at the goals of stretching before a workout- to warm up the muscles and to prevent injury.

To warm up the muscles we need to increase blood flow, which comes from movement. While stretching is technically moving, there are far more effective options, such as walking. A five-minute walk or light cardiovascular exercise (jogging, biking, elliptical) will warm up your muscles much more than stretching will.

Does stretching prevent injury?  

Laursen, et al in 2014 found strength training and proprioception (balance) training both decreased risk of injury but stretching did not have any effect on injury risk. Swing and a miss there. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials – PubMed (nih.gov)

Is there any benefit to stretching? 

Yes, yes there is! We do not need to stretch all our muscles, but if we have limited range of motion, then we should be stretching those involved muscles. A few movements we should be able to do- look up, down, left, right. When we raise our hand, our arm should be in line with our ear. While sitting with our feet in front and legs straight, we should be able to touch our toes.

When we do not have proper mobility, our body will compensate; this can cause overuse or long-term injuries. So, while stretching does not reduce injury risk for your workout, it is still beneficial to our bodies.

Warm-up Routine:  

  • 5-10 minutes of light cardio
  • Targeted stretching for flexibility deficit
  • Exercise!

Alex Strahle, PT, DPT, CSCS is a Physical Therapist in the Employer Based Clinic setting in Indianapolis, IN.  Alex enjoys seeing patients return to an active lifestyle after treatment for their pain and dysfunction. He takes into consideration the psychosocial and physical requirements in treatment and believes in creating a positive and healing environment for his patients.

Safety Tips for Shoveling Snow

When the snow starts to accumulate and shoveling becomes a common household activity, injuries occur more frequently. Low back pain affects 70% of people at some time in their life, and can often be caused by unaccustomed strain or exertion like shoveling snow.

To avoid getting hurt while shoveling your sidewalk or driveway this winter, we have some simple tips for you to protect your body.

  1. Stretch before you shovel. Warming up your muscles by stretching before you go outside to shovel will help prevent injury and fatigue.
  2. Keep a wide base of support. The wider your base, the less strain you put on your back in trying to get low. Let your arms and legs do the work. Rely on your legs by keeping your back straight and engaging your shoulder muscles, pushing the snow instead of lifting by using your legs.
  3. Don’t try to be a hero! You don’t need to cover half the driveway in one shovel, take smaller shovel-fulls and work your way down. It will be easier on your body and it will take about the same amount of time. In addition, try to pace yourself and take breaks when you get tired. Don’t overwork yourself and be aware of your heart rate.
  4. Routinely switch sides back and forth. For every stroke you take on the right, swap it around and take a stroke on the left. But don’t twist and toss – twisting your back when handling heavy snow can lead to injury. Don’t forget the first tip: rely on your legs when possible.
  5. Keep the shovel close to your body as you work. The further the shovel is from your body, the heavier it will feel and the more strain it will put on your back.
  6. Have a plan. Try to get out and shovel every three inches or so to avoid the snow building up. Don’t forget to bundle up in warm layers and stay hydrated.

Watch this short video to see how Dan puts some of these tips into action while shoveling:

Meet Kim Huser

Tx:Team turns 40 in 2023!

Founded in 1983, Tx:Team will celebrate a big anniversary in May, 40 years in business. Because it is such a major milestone, we felt we should celebrate this achievement throughout the year.

Thank you to all Tx:Team associates throughout the decades for his or her part in our success.

Meet Kim Huser and hear her story of her time with Tx:Team:

Tx:Team Welcomes Liz Kotroba, Director of Rehabilitation Services at Frederick Health

We are pleased to announce Liz Kotroba, PT, DPT, MBA as our new Director of Rehabilitation Services for Tx:Team partnered with Frederick Health.

Liz joins Tx:Team with an extensive background in both rehabilitation and healthcare leadership. She attended The University of Scranton in Scranton, PA, where she earned her Bachelor of Science in Health Sciences, her Master of Physical Therapy, and her Doctor of Physical Therapy. Liz went on to receive her Master of Business Administration from the University of Maryland – University College in Adelphi, MD. She has held leadership positions as Clinic Director, Inpatient Manager, Outpatient Manager, Director of Outpatient Therapy Services, and was promoted to Associate Vice President of Operations and Hospital Administrator with Adventist HealthCare Rehabilitation.

Liz is passionate about rehabilitation services and will continue to advance clinical and operational excellence, innovation, and community engagement throughout the continuum of rehab care at Frederick Health. She has a wealth of knowledge in program assessment, development, and implementation, clinic start-up, mentoring and developing teams, financial management, and regulatory compliance. It was clear throughout the interview process that Liz’s skillset and experience were an ideal fit for this role.

On behalf of Tx:Team, we are delighted to welcome Liz to our team. We look forward to serving our patients and our partners in the Frederick community.

New Year Fitness Goals

“New Year, New Me”  – Does this sound familiar? The start of a new year is often a time for people to want a fresh start. For some, it may be a fresh start with healthier habits, being more responsible with money, or working to become a better person. Many people welcome the new year as a time to start fresh with a new fitness routine. Whether it be going for a daily walk, trying out a new class at the gym, or starting your marathon training, here are a few tips to help you succeed with your New Year’s fitness resolutions.

  • Start slow. If you are trying a new activity, ease into it to avoid excessive soreness or injury.
  • Make it a habit. Schedule time in your day for exercise when it is convenient for you and put it on your calendar. They say it takes 21 days to form a habit, so don’t give up too soon!
  • Fuel your body. Adequate sleep, healthy diet, and drinking plenty of water are important for effective workouts.
  • Have fun! Choosing an activity you enjoy will help you stick with it. Try a dance class, listening to your favorite music at the gym, or going for a walk/run on a trail with good scenery.
  • Rest is just as important as the work. Our bodies need rest days to recover from exercise, especially if you are performing a new activity or exercising for the first time in a while. Don’t feel guilty if your body needs a rest day – or – scale back your program and try going for a light walk or performing a gentle stretching or yoga routine if you feel you need a break.
  • Buddy up! Grab a friend to try a new class at the gym, ask your spouse to exercise with you, or take your dog for a walk! The buddy system helps us stay accountable.
  • Listen to your body. If you are feeling sore or tired, you may be over doing it and need a little rest or a modification to your program. If you are experiencing any pain – reach out to your Physical Therapist for advice.

Whatever your New Year’s Resolution may be, give yourself some grace and remember to strive for progress not perfection. There is no ‘one size fits all’ program so do what feels best to you and be proud of yourself for taking steps to become a healthier YOU. Now, get up and move your body in a way that feels good!

Sara Sermershein is a Physical Therapist in the Employer Based Setting for Tx:Team.  She has worked in outpatient Physical Therapy for the last six (6) years treating patients of all ages and various orthopedic conditions. She holds certifications in dry needling as well as vestibular and concussion rehab.