How to Worry Less About Your Female Athletes Getting Injured

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Over the years, we have known females to be at higher risk for injuries to the lower extremities. Still, now more so than ever, we really need to be concerned and applying the best practices of "pre-hab" work to keep them healthy.

With the rise of the global pandemic, many have had our training take a back seat because of canceled seasons and games being washed. Many athletes have found themselves locked in their homes. Writing in the International Journal of Sports Medicine, the researchers and sports physicians express their fears that injuries could increase once competitions resume and make recommendations for restarting training.

Some even pointed out that stopping an activity is often even more stressful for athletes than for other people. It is common for athletes to develop what is known as "detraining syndrome." This is characterized by insomnia, anxiety, and depression can directly affect their physical fitness and delay their resumption of training.

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Over the years, we have known females to be at higher risk for injuries to the lower extremities. Still, now more so than ever, we really need to be concerned and applying the best practices of "pre-hab" work to keep them healthy.

With the rise of the global pandemic, many have had our training take a back seat because of canceled seasons and games being washed. Many athletes have found themselves locked in their homes. Writing in the International Journal of Sports Medicine, the researchers and sports physicians express their fears that injuries could increase once competitions resume and make recommendations for restarting training.

Some even pointed out that stopping an activity is often even more stressful for athletes than for other people. It is common for athletes to develop what is known as "detraining syndrome." This is characterized by insomnia, anxiety, and depression can directly affect their physical fitness and delay their resumption of training.

When it comes time to hit the field or courts again, the risks can be even more significant than they currently are. A recent study by the National Institute of Medicine explains that females involved in high-intensity sports are at a 4 to 6 fold greater risk of an ACL injury than males.

It's essential to train eccentric loading and to eliminate knee instability and valgus (refers to a moment during a squat or jumping movement where the knees cave in toward one another) in young women. By training the muscle in the lengthened position (so on the way down from a squat), you can recruit more muscle fibers and create more growth. All while reducing the risk for injury.

Athletes with an ACL injury had a 2.5 times greater knee abduction moment and 20% higher ground reaction force. This means the more they noticed the knees being unstable, the more chance they had an injury. The force at which they landed was not controlled as much to those with stronger supporting muscles.

These days, many athletes are forgetting about the importance of single-leg work and working on strengthening the muscle in the lengthened position(going down on a squat).

Although weight training, in general, can be beneficial, bilateral squatting(two legs) and deadlifting will not be the saving grace to preventing knee injuries. Control eccentric loading, landings, and preventing the knees from caving in is key while increasing stability around the joint.

We get strong when protein synthesis (the process in which cells make proteins) exceeds protein breakdown. Specific "main muscle" groups can take over during many compound movements like a two-leg squat, which can leave out the underdeveloped guys. Think of big-box gyms like Planet Fitness compared to a small boutique gym like Over-Achieve Fitness. Just because Planet is large and populated doesn't mean that Over-Achieve should be thrown to the curb and forgotten about. Single leg exercises are the same and shouldn't be tossed aside. They can selectively target underdeveloped muscles, improving muscular symmetry. They can help athletes control their bodies during in-game action.

Knowing eccentric strength (refers to tension being applied to a muscle as it lengthens) can help build muscle. This leads to mTOR activation (more oxygen and nutrients getting to the cells. This helps them grow quicker). Your next move would be to prioritize some of these exercises in your training to keep your knees healthy!

12 Exercises to Improve Knee Strength, Health and Motor Control


Spanish Squats

The band helps you keep your body more upright while increasing the stress placed on your quads, which is why this can be a knee saver for those experiencing anterior knee pain. Elevating your heels better targets the quads by increasing the range of motion your hips and knees travel.

Create a substantial distance to give the band some tension and try completing 5 reps with a 5-second descent, 5-second hold at the bottom, and 5 seconds concentric. That's it! Just remember a couple of things with heels elevated work.

  1. Keep your torso upright.
  2. Drive your knees forward while keeping your weight evenly distributed.
  3. Slow the heck down and let the band do the work.

Single-Leg Kang Bulgarian Split Squat

Bulgarian Split Squats and ALL their variations are great for building single-leg strength, improving imbalances, and improving lots of muscle recruitment. They clearly have a perfect turnover to athletes because being on one leg is a large part of the process in nearly all sports.

The "Kang" variation does a couple of things. First, you descend in more of a "hinge" by driving your hips back, primarily targeting the posterior chain in a lengthened position. This slow progression then transitions to a more upright torso and vertical push to the starting point focusing more on concentric strength using the adductors, glutes, and quads.

It works so well because of its slower tempo and recruitment of multiple muscle synergies. This allows all the surrounding muscles and tendons of the knee to get stronger without heavy loading or joint stress.

Front Foot Elevated Squat

I love this version of the squat simply because of one word. TENSION. Often times in

our sport, we are jumping, twisting, turning, bounding, and cutting. We rarely work a muscle by putting lots of stress on it in both lengthening and shortening.

The front foot is elevated does this to the extreme! The elevation allows the trailing knee to drop below the front foot. This allows for a deeper range of motion, and the hip and knee to both get this is never a bad thing, especially for people who may have poor squat mechanics (common in athletes). This can be a game-changer!

Key points are to keep the chest tall, avoid the back from collapsing by bracing those abdominals, and let that back knee drop straight down to the floor.

Isometric Holds

Nothing beats the good old isometrics! Why are they so effective? They require no joint stress. You are recruiting more muscle fibers simultaneously, so you are building strength while keeping your body in a low-risk zone for injury.

Not only are they low risk, but isometrics are super metabolic and require a lot of energy to sustain! Don't believe me, try 3 sets of 45 seconds or more for these single-leg versions! On a final note, they can clear up wrong movement patterns or posture, so get your daily dose of iso's in!

Key points here are to focus on keeping your spine neutral, core braced, and torso upright. Avoid leaning, falling to the side or twisting, and/or coming up onto your toes.

Single Arm Isometric Hollow Hold Press/Psoas March

The psoas muscle is located in the lower lumbar region of the spine and extends through the pelvis to the femur. This still can be called "single leg" since you are effectively isolating each side at a different time. It serves excellent as a stand-alone exercise to challenging your anterior core, obliques, and hip flexors. If you want to get extra fun with it, you can start off with 10 single-arm hollow hold presses and then go right into 10 isometric psoas marches. This will be pretty brutal, to a point you may need to take 20-30 seconds before you hit the other side! It is so effective because of the added work it gives to your hip flexors! They are essential to your hips' strength (think sprinting) in athletes, so the stronger you can make them, the better chance you have at eliminating injuries! The same goes for your core!

I couldn't stress enough for my athletes to build a well-rounded core to help them perform and stay safe. This exercise serves every purpose!

Single-Leg Assisted Drop Squat to Romanian Deadlift

This one is a pretty advanced combination that includes a single-leg Romanian deadlift and a pistol squat. A few reps of these and your 500-pound squat might humble you quite quickly. A solid degree of ankle dorsiflexion is required for this one as you descend off the box. It works by building unilateral leg strength while increasing the range of motion your squat gets, advancing your mobility and strength.

Programming these as fillers, assistance work or even primers work for 2-4 sets of 3-5 reps each leg.

Depth Jump to Lateral Jump

Depth Jump to Split Stance

Depth Jump(Regular)

Depth jumps are all about elastic energy. In all sports, producing force as fast as possible in the least amount of time is imperative.

Depth jumps are your ticket to getting better here! They also benefit from truly focusing on landing mechanics, something many athletes struggle to grasp. Stressing the muscle upon landing rather than the joint is key, which can then, in return, treat your power like a rubber band to produce countering force.

  • The initial drop off the box should typically be performed down at a 30-45 degree angle (not straight down in a 90-degree fall). To ncrease the contribution of the posterior chain of the jump, and promote some forward-moving reactivity. Variations of depth jumping may include lateral drops off the box with a straight fall and reaction, or jumps for distance off a box, which are taken into reactive jumps for distance.
  • At the end of the drop, the athlete will hit the ground as softly as possible, and then reverse the movement into a jump upwards. The ground contact time present in the jump should be a reflection of the desired outcome of the movement, whether it is speed- or strength-oriented.

Single-Leg Reverse Lunge to the Romanian deadlift

Not only will it up your posterior chain, a few reps of this will get your heart rate soaring and have a solid metabolic effect as well. Remember, training one leg at a time is twice as demanding as training on two! So your work rates will be elevated automatically, which is why some normal old school bodybuilders hate doing things on one leg. The key here is to keep a majority of the weight on the working leg. Try going for 3-4 sets of 6-8 reps per leg.

Band Walks

Reverse Band Monster Walk NT Loop

Band walks are essential for athletes to add to their training! Weak hips and glutes certainly put you at a higher risk of injury, so adding these couple variations can serve you well. For the lateral version, the key is to not bring your feet all the way together when moving. This takes the stress off the muscle, and one of the most common errors I see in doing it, so keeping that shoulder-width stance will make this much more effective. The reverse walk is a posterior chain activator for sure! Externally rotate your feet slightly and open up your stance to fire up your glutes more, and try adding these in as primers before your main strength work.


Topics: ACL INJURY | COVID | ATHLETES | FEMALE