When Don Jones, the Jordan High School girls varsity soccer coach, called down the bench, and Taylor Ray, a talented mid-fielder who tore her second A.C.L. (anterior cruciate ligament) at the end of last year, motioned for me to come help her warm up on the sidelines, I turned to look at her parents, Rusty and Janet, and could see the trepidation in their eyes. “I was just hoping and praying to get through this moment,” Janet would later tell me. After an extensive active warm-up and a few more minutes of calming Taylor’s nerves, she bounced up and down on the sideline waiting for the ball to go off the field. A few seconds later, the referee signaled her in, and Taylor jogged out to join her teammates. Once play resumed, she quickly fouled a girl, aggressively defending from behind. “Not much has changed,” I said to a nearby parent, referring to Taylor’s trademark fearless style of play. I then looked over at parents and smiled knowing that Taylor had taken a giant step in her rehabilitation.

Taylor, destined for High Point University on a soccer scholarship next fall, first tore her left A.C.L. in August of 2005 when she went to cut and twisted awkwardly in a club soccer game. After she had surgery that month at Duke Sports Medicine by Dr. Claude T. Moorman, and then had six months of rehabilitation with me at ActivEdge Fitness & Sports Performance, she was able to play most of the spring 2006 season for Jordan High School. Unfortunately, due to the rigorous demands of club soccer and the constant traveling to practices and games, she was left with little room to regularly continue to strengthen and protect not only her injured knee but her non-affected limb as well. Without the consistent practice of correct cutting mechanics, she fell back to old patterns. Then this past November, she tore her right A.C.L. in another non-contact cutting movement during a State Cup match in Greensboro. This time she dedicated herself to even more intensive strength and conditioning. With a focus unlike any other athlete I have ever worked with, she was able to make great progress and her physician signed off on her full return to the field at less than 5 months.

Dr. Moorman, head of the department at Duke Sports Medicine, states that his group does 500 A.C.L.’s in a year and he himself does about 125. The most common technique that he uses for contact sport athletes, and what Taylor had done in both knees, is the Patellar Tendon Autograft. At Duke, Moorman sees about 50% male and 50% female clients, but recent studies are concluding that women rupture their A.C.L.’s at rates as high as five times that of men when controlling for sport (meaning comparing athletes within the same sport: basketball, volleyball, and soccer).

There are many theories to explain this connection, some more rational than others. As boys and girls go through puberty, hormone levels change and the prevalence of testosterone in boys leads to a stronger, more supportive skeleton, whereas the escalation of estrogen in girls tends to add more fat and contribute to increased laxity across the joints. While this is not necessarily a problem, it becomes one if there is not enough strength to stabilize the increase in range of motion. These strength differences produce high-risk movements in running, cutting, jumping, and landing mechanics. Coupled with anatomical differences such as wider hips that can cause increased stress on the knees, can lead to an increase in the incidence of A.C.L. ruptures in females.

The question that many parents and athletes ask me is, “Is there anything we can do to prevent this trend?” The answer isn’t so simple. Since Title IX was introduced in the 70’s, the amount of young women playing high-level sports has significantly increased over the years. While this is a sign of growth and equality, it has led to a viciously competitive field where coaches are encouraging young children to pick one sport early on. Taylor was lucky enough that the Christian middle school that she went to, Trinity School of Durham and Chapel Hill, allowed her to participate in basketball, volleyball, and swimming without pressure from coaches. Furthermore, it gave her body many different movement variations that were constantly changing and allowing her the greatest structural growth. Once she decided exclusively on soccer at the age of 14, she played it year round often overlapping seasons with various club and high school commitments. This type of repetitive and constant use of the same muscles and movement patterns, especially if incorrect, leads to many of the injuries that we see today and may have contributed to Taylor’s first A.C.L. tear.

At ActivEdge, we evaluate each athlete that comes into the clinic, whether for physical therapy or sports performance, and check for improper movement patterns that may cause injury. For the knees, we often use video analysis techniques that were created by Dr. Frank Noyes and the Cincinnati Sports Medicine group. Dr. Noyes’ prevention and strengthening program called Sportsmetrics is infused in many of our athlete’s workouts and rehabilitation exercises, especially those displaying poor jumping and landing mechanics. There are several studies that use prevention techniques such as the Sportsmetrics program, as well as others, which have shown a significant reduction in A.C.L. ruptures. The biggest problem is getting coaches to implement the techniques and spend the extra time in practice to work on them. The best time to start something like this is at a young age so they can develop good mechanics early. As the athlete ages, troubling patterns become more difficult to break and require a concentrated effort for several months before the body’s neural pathways learn the “new” correct movement.

Taylor Ray’s story of a female athlete that has multiple torn A.C.L.’s is becoming more and more common. What is not is Taylor’s remarkable courage and dedication to come back, as a senior captain, and play despite the risk. I watched with joyful tears in my eyes as she was not only able to play and win against a talented Chapel Hill team on her Senior Night, but was also able to help lead her Jordan team to a 4-A state tournament birth. Despite an early loss in the first round, she played with passion and heart and walked off the field injury-free, head held high. Taylor has a long road ahead of her as she continues to balance a busy club summer season with strength and conditioning and rehabilitation. When I discuss her coming schedule each week, she usually lets out a long sigh… Willing to give up time spent with friends and hanging out at the pool, she is grateful and feels blessed for the opportunity to continue to play a game she loves.