There are ways to help prevent ACL tears and other sports injuries that might require surgery, and a set of guidelines to follow when dealing with concussions
By John Saccenti
With just seconds left in the game, your daughter is on the soccer field trying to get open.
She gets the ball and makes her move. She cuts right and races down the field, her leg rearing back for a shot. Her teammates, fans and even you tense up for a second, waiting to see what happens next.
But instead of a goal and the cheering that would ensue, you hear a scream and watch as your young athlete falls to the ground, a tangle of arms and legs and one very twisted knee.
Later, at the emergency room, you learn that your daughter has torn her ACL (anterior cruciate ligament), and will be out of commission for some time with surgery and a long rehabilitation program, a process that’s becoming more commonplace, especially among young women and girls.
“What we see in the clinic is a lot of ACL tears, particularly in females, who are seven to eight times more likely to have ACL tears, especially female soccer players and basketball players,” says Jeff Erickson, physical therapist and director of the Sports Therapy Institute in Princeton.
There are a variety of factors that make female athletes more prone to ACL tears, including a certain weakness at the hip, which can make the upper bone of a leg function differently, which in turn can cause tracking problems in the kneecap. Weaker hamstring and quadriceps and a lower center of gravity than males also contribute.
“What we suggest is improving quadriceps and hamstring strength,” says Mr. Erikson. “Hamstring strength is proportionally greater in males.”
So what do parents, coaches and young athletes do to help prevent ACL tears and other injuries that might require surgery? Mr. Erikson suggests the PEP prevention program, which consists of a warm-up, stretching, plyometrics and agility exercises that develop coordination of the stabilizing muscles around the knees. He also says athletes should be encouraged to get into the weight room for exercises designed to strengthen the legs.
“The PEP program is something that we go out and teach, which is an ACL prevention program,” Mr. Erikson says. “There are certain exercises, like the Russian hamstring curl, that can be done on the field.”
Other injuries Mr. Erikson sees quite a bit of are cartilage tears, kneecap issues, and any number of injuries that result from overuse.
Facing surgery at a young age can leave more time for arthritis to set in, Mr. Erikson says, and growth plate injuries could cause even more problems down the road.
“Those things are happening much earlier,” he says. “Generally, parents, coaches and athletes don’t like what I have to say, because I say take a break.”
As difficult as recovering from a knee problem can be, there may be nothing scarier than seeing an athlete go down with a concussion. Concussions can happen in any sport at any time.
“We see concussions across all sports that both male and female athletes play,” says Jill Brooks, a clinical neuropsychologist who maintains the private practice Head to Head Consultants, PA in Gladstone. “In several sports that have been studied, soccer, basketball and lacrosse, concussions are higher in female athletes than in male athletes.”
Athletes who suffer from concussions don’t have to lose consciousness.
Many concussions occur when a body is slammed to the ground, and the head whiplashes off the turf.
Symptoms can include difficulty paying attention and concentrating, confusion and short-term memory loss, headaches, ringing in the ears, sensitivity to light and sound, and coordination difficulty. Treatment for a concussion begins with removing the player from a game. Depending on the severity, medical attention is a must.
“Behaviorally we can see anxiety and depression, and it can happen within minutes, seconds or hours,” Dr. Brooks says. “Some people don’t have immediate symptoms and can have them 12 hours later, so when you think somebody has sustained a concussion the first thing you want to do is remove them from play. When in doubt, sit them out.”
With concussions, prevention is as important as education. Knowing the signs of a concussion and how to treat them are key to preventing long-term effects.
“If you have any suspicions that someone has a concussion, which is a brain injury, you want to remove them from play,” Dr. Brooks says. “If they have problems with the speed of process and reaction time, then they run the risk of getting hit again.”
She says that when a body recovers from a concussion, it removes blood flow from the brain. However, when someone is exercising, the blood goes right back to the brain and makes the symptoms worse.
“You just want to check on them,” Dr. Brooks says. “Make sure that there aren’t any changes, or that the symptoms aren’t getting worse over time. If you have suspicions and concerns, I think it’s prudent for every parent to call a family doctor.”
Making coaches and athletes and their families aware of the seriousness of concussions is important as well. Earlier this year the New Jersey State Interscholastic Athletic Association set guidelines for coaches that outline symptoms and what to do if they suspect one of their players has a concussion. Rule one is to remove players from practice or the game immediately and observe them afterward.
“It’s a set of guidelines to just be able to say that we realize that concussions are a significant healthcare problem and that we, as a medical advisory board and as a state athletic association, are really trying to effect some change,” Dr. Brooks says. “I hope it will trickle down to the recreation leagues and clubs.”

