Help female athletes avoid injury and maximize performance: excerpted from "Athletic Strength for Women," with permission from Human Kinetics.

Recent research shows significant differences between the rates of injury in female versus male athletes, both for those participating in the same sports and for female athletes across the board. Several factors attempt to explain this phenomenon, including the anatomical and physiological differences between the sexes and the recent explosion in the number of competitive female athletes and their increased level of play. Both of these contribute to the number of injuries.

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* An estimated 30,000 high school and college-aged females sustained knee injuries in 2004.

* Female athletes injure their knees at a rate three to five times higher than men.

* Female basketball and soccer players sustain three to four times more knee injuries than men who participate in the same sports.

* In the 1990s, 1.4 million women tore their anterior cruciate ligaments (ACLs), two times the rate of the same injury in the 1980s.

* Data presented by the NCAA shows that women volleyball players injured their ACLs 73 percent more often in game situations than in practice.

* Most injuries occur during deceleration, when an athlete is stopping, cutting, or landing.

The fact that so many female athletes are injured during the high-intensity environment of games or competition suggests that their bodies are not ready to meet these demands. Physical preparation goes beyond general conditioning. The primary issue is muscle strength, stability, and proprioception (balance). To understand how to correct this problem, coaches must first understand the four primary reasons why female athletes are more susceptible to lower-extremity injuries (specifically knee injuries) than their male counterparts.

1. Smaller ACLs: Because a woman's ACL is smaller, and she tends to have less overall muscular strength to support the knee than male athletes do, a woman's ACL is at a greater risk of tearing because of the load placed on it during sport.

2. Different Q-angles: Men and women have different quadriceps angles (Q-angles)--the angle of the femur as it enters the hip socket. Women's Q-angles are wider than men's. Although no concrete evidence indicates that the Q-angle plays a major role in ACL tears, evidence shows that it contributes to patellofemoral tracking problems and anterior knee pain. Perhaps more important, the patellar notch on the female athlete is smaller than on men, and evidence shows that the ACL can get caught and sliced in the notch. And the wider Q-angle makes the ACL more vulnerable to tearing in the notch.

3. Quad/Hamstring Imbalance: Women tend to rely more heavily on their quadriceps muscle group for primary knee strength and stability rather than create a balance between the quadriceps and hamstrings. Women also tend to land more flat-footed and with straighter legs than men do. This practice increases the ground force and contributes to increased force on the joints--not just on the knees, but also on the ankles and hips.

4. Training Deficiencies: Coaches need to prepare young athletes for the demands of athletics with basics such as form running, fast-feet drills, stopping, starting, jumping, and strength training. Boys tend to receive this type of training earlier through organized sports than girls do. For example, in sports like gymnastics for both girls and boys, because there is a lot of physical and technical training, it may be surmised that the higher rate of injuries is most likely due to the demands of the sport and to anatomical differences. In sports like soccer and basketball, however, where there is a very high number of participants, increases in injury rates for female athletes are due more to deficiencies in physical and technical preparation. (There are also greater numbers of male high school athletes in the weight room at an earlier time in their careers.) Because of girls' anatomical and biomechanical differences, they also need strength training.

EXERCISES FOR A STRONG AND HEALTHY LOWER EXTREMITY 

The exercises that follow can be used as base strengthening work (both in-season and off-season) for any sport. As you work on the exercises that follow, keep in mind several primary goals for any lower-extremity program designed for female athletes.

* Increase the strength and stability of the joint

* Increase the athletic capabilities of the athlete by including multijoint exercises that incorporate functional movements

* Develop hamstring strength

* Incorporate exercises requiring balance

BASIC STRENGTH EXERCISES

When teaching your athletes a new exercise, focus first on technique; do not be concerned with the amount of weight an individual is lifting. When doing free weight lifts, start athletes out by lifting just the Olympic bar, perfecting their form, and then add weight. If the athlete can't maintain good technique, reduce the amount of weight until she can. Then gradually increase the weight, while always maintaining proper technique. The following fall into the basic strength exercise category:

* Back Squat

* Front Squat

* Romanian Deadlift

* Traditional Deadlift

* Leg Press With Adduction 

* Single-Leg Hamstring Curl

* Glute-Ham: Straight Leg

FUNCTIONAL STRENGTH EXERCISES

The exercises that follow are multijoint and functional. Sometimes extreme movements during competition place female athletes in precarious positions that can result in injury. These functional exercises work not only on strength, but also focus on improving the balance and body position awareness that can help prevent injury. They also mimic many of the movement patterns performed in competition.

Functional exercises stimulate the same muscles that produce athletic movements. A primary benefit is that they stimulate the nerves that affect muscle firing and provide the muscle memory needed to perform difficult tasks. Although it provides benefits, a single-joint exercise like the knee extension may not prepare the nervous system in the same way that a multijoint exercise like a walking lunge, power lunge, or weight transfer exercise does.

* Side Box Step-Up

* Side Lunge

* Three-Way Weight Transfer

* Standing Two-Way Calf Raise

* Shuffle Squat

The initial goal for any good athlete or coach is to maintain health and longevity throughout the span of a sports career. While female athletes are at a higher risk for knee injury than male athletes, fortunately, specific training is available to help them meet their goals by strengthening and stabilizing the knees, ankles, and hips. By customizing your training program to work these lower-extremity muscles, your female athletes will soar through competition with more confidence and less injury.

(Reprinted from the superlative coaching text, "Athletic Strength for Women," written by David Oliver and Dana Healy and published by Human Kinetics, Champaign, IL. It contains 248 pages with illustrations and may be ordered by calling 800-747-4457 or online at www.humankinetics.com)

By David Oliver, former strength and conditioning coach for the U.S. women's soccer and basketball teams, and Dana Healy, department head for strength and conditioning at the U.S. Olympic Committee.