SMART targets prevention of ACL injuries in female athletes

— The knee-busting injury disproportionately affects female players —

View Newschannel 8 clip on SMART’s PEP Program…

Athletes at high risk for ruptured or torn ACLs include those who play basketball.

Tampa, FL (Jan. 24, 2008) — The University of South Florida’s Sports Medicine and Athletic Related Trauma Institute (SMART) has introduced to area high schools a program to help prevent one of the most common sports-related knee injuries, which disproportionately affects female athletes. Studies show that female high school and collegiate athletes are four to 10 times more likely than their male counterparts to suffer a ruptured or torn anterior cruciate ligament (ACL) – a central ligament connecting the thighbone to the shinbone.

The “Prevent Injury, Enhance Performance” (PEP) program has been adopted by half of the 10 high schools in Hillsborough County where SMART, a state-sponsored sports safety outreach program, has deployed certified athletic trainers, said SMART Assistant Director Barbara Morris, an instructor in the USF Department of Orthopaedics and Sports Medicine. SMART offered the program to the coaches of all girls teams this fall and initially worked with those who implemented all or parts of the training regimen.

“Preventing ACL injuries is much easier and cost effective than treating them,” Morris said. “We want to work with coaches to help decrease the incidence of ACL injuries at the high schools where we have a presence.”

The ACL helps stabilize the knee and is often stretched or torn by a sudden twisting motion while the feet remain planted. Athletes at high risk for this frequently season-ending knee injury include those playing soccer, basketball, football and volleyball – any sport with sharp changes in direction or jumping.

The PEP program was created by the Santa Monica Orthopaedic and Sports Medicine Foundation in Santa Monica, CA, to decrease the number of ACL injuries in female soccer players but can also be used in other high-risk sports. The strategic 15-minute exercise regimen is designed to be performed two to three times a week during the season. It helps strengthen and stretch stabilizing muscles around the knee, emphasizes proper posture and landing technique, and teaches players how to avoid vulnerable positions. The training drill has been shown to reduce ACL injuries by two to four-fold.

Jason Herring, the head coach for the Freedom High School girls varsity basketball team, worked with Michele McCoy, the SMART certified athletic trainer at Freedom, to integrate the PEP program into his team’s practices three to four times a week.

“We did static stretching before, but this program made more sense to me. I’m definitely pleased with the improvements I’ve seen so far,” said Herring, who in the past sustained an ACL tear while playing basketball with a recreational league. “It’s building on their muscle strength, endurance, agility and balance – all key elements needed to prepare players for the vigorous game of basketball. Injuries will happen in competitive sports, but you want to prevent as many as possible — so it’s good to be involved a safety program backed by research.”

Coaches are essential role models in persuading student athletes to recognize the importance of injury prevention training, McCoy said. “The girls on Coach Herring’s team now own the PEP program, because he was an enthusiastic proponent and his players understand why the exercises benefit them.”

“ACL injuries are a huge problem – an epidemic among young women athletes,” said Robert Pedowitz, MD, PhD, professor and chair of Orthopaedics and Sports Medicine.

“If you look at high school students who play competitive soccer and basketball, the vast majority who suffer ACL injuries end up having reconstructive surgery. This type of knee injury requires six months to a year of postoperative rehabilitation.”

Title IX legislation, enacted in the early 1970s, required publicly-funded schools to offer girls and women equal opportunities to play sports. Since then, the number of female athletes in competitive sports has jumped – and so has their incidence of ACL injuries.

Many earlier theories for why young women are more susceptible to the knee-busting injury than men, including differences in hormones and anatomy, have not proven true, said Dr. Pedowitz, who has conducted ACL research. “Many physicians and scientists now believe that neuromuscular performance – factors like the strength and coordination of muscles that make a difference in the landing styles of girls and boys when they run and jump – are driving the higher rates of ACL injury in young women athletes.”

Whether these neuromuscular gender differences are related to sports experience and training or genetics is still debated, but Dr. Pedowitz suspects as more girls train and compete in team sports at younger ages their incidence of ACL injuries may begin to decline.

USF SMART recently began tracking the incidence ACL and other sports-related injuries in Hillsborough County high schools where its certified athletic trainers work. “The purpose of SMART is to identify areas that threaten the safety of Florida athletes and do what we can to change that,” Dr. Pedowitz said. “Through our computerized injury surveillance program, we’ll have the ability to measure the impact of preventive programs such as PEP on our student athletes.”

Coaches, parents of student athletes, or others interested in more information about the PEP program can contact Barbara Morris at (813) 396-9626 or

– USF Health –

USF Health is dedicated to creating a model of health care based on understanding the full spectrum of health. It includes the University of South Florida’s colleges of medicine, nursing, and public health; the schools of biomedical sciences as well as physical therapy & rehabilitation sciences; and the USF Physicians Group. With $308 million in research funding last year, USF is one of the nation’s top 63 public research universities and one of Florida’s top three research universities.