Ten months out of surgery for a ruptured anterior cruciate ligament (ACL), Breana Derella ran a half-marathon—13 miles through city neighborhoods across knee-pounding pavement and up joint-jarring hills. She signed up for the race on a whim, even though friends thought it was too soon. She proved them wrong and finished the race without a twinge of pain.
There are two reasons Derella was able to run the race without reinjuring her ACL. First, her surgeon at Yale Medicine, Karen Sutton, MD, used a surgical procedure that allowed a quicker recovery. And then, Derella worked hard to strengthen the muscles that support her knees. While it took her a while to tackle a half-marathon, she actually started running 10 weeks after the surgery.
This combination of careful conditioning and sophisticated orthopaedic care is at the core of Yale Medicine’s approach to women’s sports medicine.
Women’s bodies are different than men’s. They’re typically smaller, of course, but, also, their bones, muscles and organs work differently, yet many are in training programs that are based on research that revolved mostly around young adult males.
This leaves women more vulnerable to sports injuries. For the ACL alone, there are an estimated 200,000 new injuries a year in the United States—requiring 100,000 ACL reconstructions. ACL injuries are two to 10 times more common in women than in men participating in the same sport.
That’s why Dr. Sutton and a core group of physicians at Yale Medicine began to pay particular attention to women’s sports injuries, including prevention and carefully targeted physical therapy after surgery. Yale Medicine’s orthopaedic practice has a large number of physicians who are women, and Dr. Sutton believes that makes a difference in the care they provide to other women. “We understand and can relate to female athletes,” Dr. Sutton says.
A key focus is on injury prevention. Dr. Sutton teamed up with Yale Medicine orthopaedic surgeons Elizabeth Gardner, MD; Michael Medvecky, MD, chief of sports medicine; and others to develop an injury-prevention strength and conditioning program, and share it with coaches and trainers at high schools and colleges throughout Connecticut.
Meanwhile, the doctors work closely with athletes they treat to help them recover from injuries more quickly and to lower their risk of re-injury as they return to an active life.
Women doctors who played college sports
Yale Medicine sports medicine specialists also work with Yale football players and other male athletes, but Dr. Sutton and Dr. Gardner feel they have a special advantage with high school and college women. In their own college years, both doctors were part of the mass explosion of women to hit the athletic fields in the decades after passage in 1972 of the federal Title IX law, which required schools that receive federal funds to provide girls and women with equal opportunities to compete in sports.
Dr. Sutton was a lacrosse captain at Duke University, leading her team to the national championship semifinals. Dr. Gardner was a lacrosse captain at Yale University, where she also played field hockey, and she has had several surgeries herself for sports-related injuries. Another specialist, pediatric orthopaedic surgeon Cordelia Carter, MD, played field hockey at Yale. All three have worked with professional athletes and teams.
While Dr. Sutton remembers lifting weights in college to build muscles, she recalls teammates who avoided the weight room because they were concerned that they would “bulk up.” While it’s becoming more clear that conditioning is especially important for women, Dr. Sutton says many now tell the doctors they avoid it because it is time-consuming and they need the time to practice their sport.
The Yale Medicine specialists say there are many things young women can do to reduce injury risk. First, it’s better to play multiple sports so they will work different muscle groups. This will make them more competitive in their key sport and also help protect them from being injured. It’s smart to work closely with a strength and conditioning coach on agility, conditioning and core muscle power.
There are already well-known strength and conditioning programs that have been scientifically proven to prevent injury. They use muscle strengthening and pylometrics (jump training), as well as sport-specific exercises that support the knee joint.
Yale Medicine’s program bases its advice on these programs. It also emphasizes such exercises as quick accelerations and decelerations—running 5 to 10 meters, stopping abruptly and repeating. This trains the body to coordinate the brain with the muscle groups so that the knee can respond quickly when it needs to. “It’s about coordination,” says Dr. Gardner, explaining many injuries don’t even involve direct contact with another player or object. “It’s that change in direction and the fact the muscles are not coordinated,” Dr. Gardner says.
In addition, the doctors encourage tailoring training to each athlete’s unique anatomy. “You need to see what their weaknesses and deficiencies are and then target those specifically,” Dr. Gardner says. For field teams, the doctors watch athletes move from side to side, so they can see which players were moving in a way that could predispose them to an ACL tear, low back pain or hamstring injury. “Then they do specific exercises on a daily basis to remedy those,” Dr. Gardner says.
Tom Davis, head coach for girls’ lacrosse at Fairfield Warde High School, says he has seen tremendous changes since he invited Dr. Sutton to work with his team about four years ago. At that time, Fairfield Warde was losing players to “a slew of ACL injuries,” Davis says. In one season alone, three girls went down. “Knock on wood, I haven’t had an ACL injury in lacrosse since that time.”
Injury prevention helps with the score
As a result of improved conditioning, Davis says Fairfield Warde’s performance is better: Three years ago the school made it to the Connecticut Class L state semifinals and last year it was in the championship game. “Staying healthy without injuries, players stay on the field and we win more games,” he says.
Experts estimate that half of sport-related injuries in children and teens may be preventable with improved conditioning and training. Dr. Sutton and Dr. Gardner don’t have extensive numbers yet to prove the success of their efforts, but “the trends are good,” Dr. Gardner says. “This past fall, you could see that days missed due to injury was well below last year in some sports.”
Dr. Sutton gives credit for any successes to the athletes themselves, including those who are willing to change and those who are doing the work necessary to heal properly. “Sports surgery is typically 50 percent what the surgeon can do in the OR and 50 percent what the patient does with their recovery,” she says. “Working together you try to reach the end goal of returning to competition safely.”
The path to better conditioning
Breana Derella had been a passionate athlete all her life, and was captain of her soccer team at Union College when she ruptured her ACL. The ACL is a major ligament in the knee that helps provide stability for the knee joint, which is important for making rapid twists, turns and pivots. Fixing the ACL can take complex surgery, and even the best operation can’t guarantee a strong return to a game like soccer.
“It’s heartbreaking for an athlete,” says Derella, who not only missed playing soccer but also the camaraderie of her teammates. “I felt I had part of my identity taken away.”
There are two ways to do the kind of ACL surgery that Derella needed. Dr. Sutton could have used tissue from the patella tendon in Derella’s knee, a strategy that would likely have provided better strength for pivoting in sports. Instead Derella preferred the option of having the tissue taken from her hamstring, which had the advantages of minimal pain and quicker recovery.
After the surgery, Dr. Sutton sent her for an aggressive program of physical therapy. Women tend to have weaker posterior leg muscles than men, Dr. Sutton says, and she wanted Derella to be able to activate those muscles quickly. “Glutes and hamstrings act to counterbalance a new ACL surgery of the knee,” she says.
Derella said the physical therapy was time consuming, but she took a methodical approach to doing her daily lunges, squats and other exercises. Eight months later, she completed an intensive yoga course to further strengthen her muscles, and she now feels she is back in excellent shape.
“Her determination helped,” Dr. Sutton says. “She showed the dedication, perseverance and mental strength that many of my athletes display in a time of hardship. There’s an inner fire that drove her to recovery quickly, yet thoughtfully.”
After graduating from college last spring, Derella accepted a job as a media and advertising consultant in New York City. She has played in casual soccer games since her surgery, and says focusing on running and yoga was a smart decision.
She offers this advice for passionate high school and college athletes: Do the strength and conditioning exercises, not just the sport itself. And pursue other sports in the off-season to work other muscles.
“It’s something you have to learn to stay on top of,” she says. “But it will set your body up so you can do the big things successfully on the field—being in the right position, scoring the goal.”
Source: Yale University