Carly Flahive knew exactly when it happened.
“I heard a pop and struggled to put weight on my leg,” the 18-year-old said of her 2014 club soccer injury. “It took a few doctors before they realized it was torn even though I could tell something was wrong.”
Flahive, who spoke with Teen Voices by text, had injured her anterior cruciate ligament, or ACL, and it wiped her out of the 2014 soccer and basketball seasons. When the Westborough High School student finally returned to the soccer field this past fall, she played hard, but was cautious.
Unlike Flahive, many girls cannot pinpoint the moment they tear their ACLs.
But Flahive has lots of company, as there are 80,000 female teens with ACL injuries every year. Teen girls are eight times more likely to tear their ACL than teen guys performing the same activity, according to Kids Health.
The injury involves soft tissue that runs diagonally across the center of the knee. Adolescent girls are more susceptible to it for reasons that range from hormones to anatomy. Recent research by Kids Health finds the injury happens more among girls who play sports that involve jumping (basketball and volleyball) or sports where cutting and pivoting are more common (soccer and lacrosse).
Though girls’ elevated risks are widely known, some athletes say their coaches are not doing enough to protect them.
Teen girls are eight times more likely to tear their ACL than teen guys performing the same activity.
Mackenzie Lucas said more ACL strengthening could have prevented her from tearing the knee ligament during a 2014 Memorial Day club soccer tournament in Westwood, Massachusetts.
“From my experience in club and town soccer my whole life, some [coaches] make time for training, some don’t,” the 15-year-old Holy Name High School student from Worcester, Massachusetts, said over the phone. “The higher the level the coach, the more prevention they do, but it still isn’t all that much. Steps should be taken so that every coach knows a lot about the injury and preventions.”
Lucas was out for one year, which is about average for recovery times, according to Kids Health.
“ACL injuries are devastating, they really are,” said Lucas. “Coaches of girls’ sports teams could be more involved with their players’ health because they know girls are more likely to tear their ACL. It doesn’t even take that long to make such a significant difference in their lives.”
There are no statewide regulations when it comes to injury prevention.
At Westborough High, Flahive’s school, each coach is allowed to design his or her own training program, based on the skills required and muscles used in the sport.
Sarah Carver, a certified athletic trainer who works with the school in all sports, uses squats, lunges, quad/calf/hamstring exercises and jumping/landing activities for the most effective prevention in ACL tears. When players come to her with aches and pains in the knee, this is what she finds to be the most beneficial for them.
Even teen girls who receive proper training risk injury when they participate in intense, year-round activities through school or an outside club. “If you participate in the same sport 15 hours a week + all year round you have a 40 percent increased risk of incurring a time loss injury,” Carver said in an email. She said she has noticed that many of the coaches in Westborough’s sports leagues focus their practice time on fundamental skills, plays and scrimmages, without focusing on the biomechanics of movement.
At the same time, Carver said all of the ACL tears in female athletes at Westborough High School have occurred outside the school athletics setting.
Taylor Powers of Westborough High School was 16 when she tore her ACL in 2014 during a recreational soccer game. “I collided with another player and didn’t realize it hurt so bad, so I played in the next game and was running and my leg gave out on me,” she said over the phone. She was carried off the field after the initial contact but the next day her coach put her in the game, and that’s when it all happened. Powers doesn’t believe her coach was the main reason for her tear, but she said her coach had never educated her team about the risks of this injury and had not assigned prevention exercises.
Her team was part of the Westborough Youth Soccer Association, which according to Wayne Taylor, who formerly oversaw the girls’ program, has no standardized injury-prevention program. Instead, volunteer coaches develop their own trainings.
Taylor said he trains male and female athletes differently. In a dynamic warm up at the beginning of practice he has the girls add exercises involving hip flexors to the routine, which helps defend against ACL tears. Girls also form a circle to stretch their knees and hamstrings.
“While coaching, I never had a girl player blow out an ACL while playing for me,” the coach said in an email. He said the girls on his team had “significantly less injuries than other teams.”
Paul Mumby, the girls’ varsity soccer coach at Westborough High, uses a gender-neutral injury-prevention training called Fifa 11+ in each of his practices but said that rest and downtime are important forms of prevention as well.
Last season Mumby’s two captains tore their ACLs, so he is familiar with the situation. Both injuries occurred outside of the high school.
“ACL injuries come a lot when the kids are tired and worn out,” Mumby said in a phone interview. “I make sure my practices aren’t more than 90 minutes because it is just too much on their growing bodies.”