4 minute read
JORGE SUAREZ
Physiotherapist
Mail: fisio_78@Hotmail.com Twitter: @fisio_78 Instagram: @fisio_78
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Injuries affecting the knee joint are frequent in handball, being the second most common after those affecting the ankle. The characteristics of the sport, and the actions that take place during the game, place great demands on this joint, pushing it to the limit of its capabilities.
In addition, they will generally be serious injuries that will have a significant impact on the future health of the person. And, as far as sporting aspects are concerned, they will condition their performance, diminishing it, and their sporting career, shortening it.
It could be said that many male and female players will have at least one knee injury during their sporting career, which shows us the importance of the problem we are facing. Women are the ones who will suffer more knee injuries, especially those affecting the anterior cruciate ligament (ACL).
Knee Injuries in Women
Women have a higher risk of knee injuries in sport, this is a fact. In handball it is estimated that this risk is 0.7-2.8 injuries per 1000 hours of sport. Within these injuries, the most serious are those affecting the anterior cruciate ligament, followed by those affecting the meniscus (structures that are often underestimated and which have a crucial importance in the correct biomechanics and preservation of the joint).
Compared to men, there is a ratio of up to 5-7:1 higher number of anterior cruciate ligament injuries in women. As we can see, this is an important statistical difference to which we must pay adequate attention.
The anterior cruciate ligament is an intra-arNcular helical ligament that joins the posterolateral part of the femur to the anteromedial part of the Nbia. Its main funcNon is to provide stability to the knee, parNcularly in the sagical plane, together with the posterior cruciate ligament.
Approximately 50% of knee injuries involve this ligament, and its rupture consNtutes a serious injury due to its importance for the proper biomechanical funcNon of the knee.
As I have menNoned, injury to this ligament is much more common in women than in men; and in type I sports such as handball the figures are extremely high. Moreover, this is a circumstance that occurs in both elite and grassroots sport and in recent years has become a real epidemic.
Why do women injure the Anterior Cruciate Ligament more?
There are mulNple causes for this staNsNcal difference between men and women in terms of anterior cruciate ligament injuries. I will detail the specific causes that affect women, with the general risk factors being basically the same for both sexes.
• Smaller diameter of the ACL. The cross-secNonal measurement of the ligament is smaller than in men. • Shorter ACL length. The ligament is shorter than in men. • Narrower intercondylar space. The separaNon between the two femoral condyles is smaller. • Wider pelvis. The female pelvis has a wider anatomical structure than the male pelvis. • Greater angle "Q". Angle that relates pelvis-hip-knee and which, being greater, increases the mechanical stress on the structures that make up the knee.
• Physiological knee valgus augmenta-on. Knee valgus refers to the alignment of the femur and Nbia and its existence is completely normal. What happens is that in women this valgus is greater and predisposes the anterior cruciate ligament to greater tension. • Dynamic knee valgus. This is a concept related to the previous one, which is a staNc approach, although this is a dynamic approach. Women have a more pronounced valgus when performing sports acNons. • Greater ligamentous laxity. Women have more generalised ligamentous laxity. • Less generalised muscle mass. Women have less developed musculature compared to men. • Less neuromuscular ac-va-on of the hamstrings and gluteus medius. As these two muscles are "protectors" of the knee, this deficient acNvaNon puts the knee at risk. • Quadriceps dominance. The quadriceps/hamstring raNo is in favour of the former, and remember that the lacer act as protectors of the anterior cruciate ligament. • Different biomechanics of movement. Perhaps as a consequence of some of the above causes, women have less efficient biomechanics when performing sport-specific tasks in terms of the knee. • Higher Body Mass Index (BMI). This index is related to an increased risk of injury. • Hormonal varia-ons during the menstrual cycle. Hormones have an influence on ligaments and other anatomical structures, and the variaNon in hormones that occurs during the cycle means that there are phases of the cycle that are more at risk.
As can be seen, there is a diverse group of causes that increase women's risk of anterior cruciate ligament (ACL) rupture and explain the high number of injuries that occur and the difference that exists with men. Some are not modifiable and others are, and it is these that we must focus on in order to find strategies that achieve exactly that, to modify them.
It is therefore imperative to try to reduce these figures as a matter of urgency. We must do all we can to ensure that players have a successful sporting career and a healthy later life.
