Awareness of Anterior Cruciate Ligament Injury-Preventive Training Programs Among Female College Athletes
Tanaka MJ, Jones LC, & Forman JM. J Athl Train. 2020 55(4) Online ahead of print. doi: 10.4085/1062-6050-150-19.
Take-Home Message
NCAA female athletes have limited awareness and experience with anterior cruciate ligament (ACL) injury prevention programs despite being willing to perform them.
Summary
Females are at an increased risk for an ACL injury. Compliance with an ACL injury prevention program can prevent 50 to 80% of ACL injuries; however, it remains unclear how well college teams have implemented these programs. The authors of this study surveyed NCAA Division I and III female athletes to see who had experience or awareness of injury prevention programs. The authors asked athletic trainers to share links to the 12-question survey with women’s teams and posted links on social media. Athletes from 31 institutions in 19 states completed the survey.
Overall, only 15% of the 440 current athletes had performed an ACL injury prevention program. Furthermore, only about one-third of the athletes knew about ACL injury prevention programs. For the athletes who reported having performed an ACL injury prevention program – the majority were supervised by an athletic trainer (39%), coach (27%), or both (11%). Almost 90% of the athletes indicated that they would perform a daily program if it would decrease their ACL injury risk. It seemed that athletes in high-risk sports, at Division I programs, who knew a teammate with an ACL injury, or who had a history of an ACL injury were more likely to be aware and have performed an ACL injury prevention program.
Viewpoints
This study is interesting because the authors demonstrate that implementation and awareness are very low among NCAA female athletes despite their apparent willingness to participate. This complements prior findings that only 1 in 5 high school coaches have implemented injury prevention programs. These new findings add to the story by showing that the athletes are willing to perform these programs, but we need to do a better job of getting the word out about the existence of these programs. It would be interesting to see if the willingness to perform a program affected compliance and adherence. It was great to see that athletes in higher-risk sports were more likely to have performed or be aware of ACL injury prevention programs. However, the overall implementation and awareness were quite poor. It would be fascinating to see whether these athletes were recently performing these programs or if they performed them a long time ago (for example, in high school). Regardless, this study and previous research highlight that we need to do more to educate coaches, athletes, and other stakeholders about the feasibility and necessity of adopting injury prevention programs. It is time to deploy one of the most effective tools in our prevention toolbox.
Questions for Discussion
Why do you think awareness and implementation are so poor? What efforts do you think that we can do to improve this?
Written by: Nicole M. Cattano
Reviewed by: Jeffrey Driban
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Answer to your question is adults coaching youth sports do not value training to play sports for female (and male) athletes. See DeBella research. I have trained 600+ teen female athletes since 1993. Adult coaches value skills training and set up a Darwinian approach. Sad part is many of the lower body injuries can be minimized with a spine-safe and age-appropriate training program featuring lower body stabilization.
Awareness and implementation may be poor due to a lack of education regarding injury prevention programs or a lack of organization and flexibility/time to implement them. I think improving athlete’s education of what injury prevention programs are and the importance of them would help increase their awareness. I also think that injury prevention programs may lack implementation due to improper organization and lack of flexibility or time. The supervisor of the program, whether an athletic trainer or a coach, should have an organized schedule of when the program is to be completed so that it can be enforced. In regards to flexibility and time, I feel that too often injury prevention programs may not be implemented because they take time and coaches may not be flexible enough to set aside the time needed to participate in them. Overall, this study was very interesting and I think it is important to continue to increase education and implementation of injury prevention programs.
Thanks for the comments! I do think education is key – do you have any ideas of how to best educate athletes or coaches regarding the importance so that time is appropriately set aside?
Although I’m a little pessimistic that education simply is the key. If we parallel injury prevention to other areas researched in sports medicine such as concussions or mental health. Education and awareness does not always equal a change in actions.
We may need to look at trying to dedicate efforts to impact societal/cultural norms to make injury prevention a “normal” part of athletics.
As a recent female college soccer athlete this study was very interesting to me. Soccer is considered a high-risk sport for ACL injury and yet all through high school and the first part of my college career, I had not participated in any injury prevention programs. My base knowledge of ACL injury and prevention came from the classroom and having teammates with new ACL injuries and reoccurring tears. I think this lack of awareness and implementation could simply be due to a lack of education or persistence from the whole sports and sports medicine staff. I think if it is included as part of regular training sessions and as part of pre-participation education, such concussion education protocols like you mentioned, it might increase participation in these programs! In regards to impacting societal and cultural norms, I was just reading a research article on the impact of peer-led education of concussions on team’s protocol adherence and reporting. An approach like this may help those athletes adhere to injury prevention, if their peers or team leaders are the ones proposing it.
ACL injuries can definitely be considered the “black horse” of injuries when it is seen or experienced by athletes from all over the world, but if this can be prevented through just knowledge, awareness, and implementation, then why not improve this? Sometimes, it is possible that previous ACL injuries and lack of knowledge when it comes to preventing these injuries can cause athletes to be very fearful of continuing their desired sport at the collegiate level, especially if their return to play experience may have not been what they expected. Implementing this knowledge and preventative training programs at an early age could lead athletes down a more confident path and have a more positive outlook in the event that they may experience this injury, female or male. The human body is an interesting phenomena and can adapt to great stimuluses placed on it, spreading awareness as a coach, athletic trainer, or even educator as early as possible could reduce the risk of these athletes losing their dream.