The nation’s first—and only—program aimed at taking a wide-scale community prevention approach to decrease non-contact anterior cruciate ligament (ACL) tears among female high school athletes is working, and as a result, is being expanded in Rochester, NY. The program, called PEP (Prevent injury, Enhance Performance), targets the prevention of one of the most serious knee injuries that can sideline athletic careers among females, who are at six to nine times greater risk than males to sustain an ACL tear.
Organized by University Sports Medicine (USM), the PEP program is being rolled out to 119 high schools in Section V, an area that covers all Monroe, Ontario, Seneca, Livingston, Allegany, Steuben, and Wayne counties in upstate New York. The expansion, made possible by a $161,000 grant in January 2007 from the Greater Rochester Health Foundation, will cover junior varsity and varsity female athletes playing soccer, volleyball, and basketball—the three main sports with high incidences of ACL tears. USM officials expect to train about 11,180 athletes on nearly 700 teams during the 2-year program.
USM athletic trainers have worked with 1,137 female athletes on 71 teams.
“We would typically expect to see about two ACL tears per 100 participants, or about 58 non-contact ACL tears for the 2,900 athletes we have been working with,” says Michael Maloney, MD, director of USM. “To date, we’ve seen only 10 non-contact ACL tears, so this data is very promising."
The program has steadily been gaining national attention. In 2008, the NCAA posted an interactive segment on ACL injuries to its Web site, which included a feature on USM’s PEP program.
More than 1.4 million women have been afflicted in the past 10 years alone—twice the rate of the previous decade. It is estimated that more than 30,000 high school and college age females will rupture their ACL every year. In the last 15 years, ankle sprains have decreased by 86% while knee ligament injuries have increased by 172%.
Much speculation exists on the cause of the higher non-contact ACL injury rate in females, with hormones, biomechanics, and environment some of the common culprits named. While researchers have been unable to definitively pinpoint the exact cause for the increased incidence in females, they have been able to develop a series of specific stretching, strengthening, flexibility, and balance exercises that have been shown to significantly reduce injury rates.
“PEP works by retraining the nervous and muscle system in female athletes to be more efficient, and as a result, reduce the potential for non-contact ACL tears,” says Andy Duncan, PT, ATC, director of sports rehabilitation at USM.
It consists of a specialized warm-up program that must be completed two to three times a week, and includes exercises and training to increase muscle strength, plyometrics (active strengthening like jumps), agility, balance, and flexibility. The program takes about 20 to 25 minutes to complete.
“We stress quality versus quantity with the girls. These exercises are so precise that they must be done properly or they will not receive any benefit at all,” Duncan says. “In effect, we are re-teaching the muscles how to fire and respond to signals from the nervous system. At the end of 6 weeks, if the program is done correctly and consistently, these athletes will have a much better chance at preventing an ACL tear.”
Beginning in the summer of 2009 USM athletic trainers will use a “train-the-trainer” approach to educate team coaches/representatives on the benefits and components of the PEP program. The sessions will be interactive, including demonstration and participation. Videos detailing each exercise will be given to each team to help guide the athletes through the program.
Sample PEP Exercises
• Warm-ups: jog, slides, backpedals
• Strengthening: lunge walk, ball bridge, calf raise
• Plyometrics: lateral, front/back and single leg hops, rebound jumps, scissor jumps
• Agility: shuttle and pivot runs
• Stretching hamstrings, quads, calves, groin and hip flexors