Program targets torn ligaments

• ACL injuries plague women athletes (graphic)

By Ann Miller
Advertiser Staff Writer

Former Hawai'i basketball stars Tania Brunton, left, and Nani Cockett both tore knee ligaments. Advertiser library photo • March 28, 1998

It is a power that can destroy seasons, careers and lifestyles, or at least seriously disrupt them. Torn ACL's have become a booming surgical business, thanks — in proportionally preposterous numbers — to female athletes.

While surgery has improved dramatically, there is still no one compelling reason why female athletes are so vulnerable. One NCAA study claimed female basketball players were four times more likely to suffer an ACL tear than their male counterparts. Another doubled that. Still another put a woman's risk as 10 times more.

Several theories attempt to explain why women are so susceptible. While the debate — over anatomical, hormonal and muscle activation differences, along with strength imbalances — rages on, Kaiser Permanente is beginning to clone Mainland programs that focus on early prevention.

Tomorrow, Kaiser's third Sports Performax series, designed to "decrease the risk of serious knee injuries and enhance sports performance," starts at its Honolulu Clinic. The program is directed at young female athletes (ages 12-19) with no history of serious knee problems. Target sports are basketball, volleyball, soccer, tennis, softball and cheerleading.

The idea of an early prevention program appeals immensely to University of Hawai'i Rainbow Wahine basketball coach Vince Goo. From 1994-98 players on his teams underwent four ACL reconstruction surgeries. Sophomore April Atuaia faces another when this season ends.

"Any kind of knowledge we'd take a look at," Goo says. "The kids need to start young."

Keeping the knee steady

At Performax, a small group goes through two hours of stretching, Plyometrics (jump training) and strength training three times a week for six weeks. Ideally, athletes will learn proper jumping and landing techniques, increase their hamstring-to-quadricep strength ratio and improve their vertical jump, strength and reaction time.

"It's not as bad as soccer practice, but it will get your heart rate up," says Eryn Kishimoto, an all-state goalie who recently helped Mililani win the state championship and went through Performax last summer. "The main purpose is to keep your knee steady so it doesn't wobble around because that's the main cause of injuries."

In the first two Sports Performax programs, girls increased the height of their jump by 24 percent, or 4.2 inches, on average. Quadricep strength increased 15 percent and hamstring strength 41 percent. Most critically, stability increased.

The program's cost is $75 and it is open to non-members (call 432-2180 for information). Physical Therapist Marc Iyomasa and Exercise Specialist Andrew Tom oversee Performax, which is similar to Mainland programs that cost as much as $400. After the first two series, they are enthusiastic about the possibilities.

"It's a serious problem," Iyomasa says. "That's why I'm so excited about this. Hopefully, it will make it safer and help girls perform at a higher level.

"It's purely a prevention program. Sports enhancement is almost secondary, but they get that along with prevention. ... Athletes like to come because they see improvement in their games. That keeps them motivated. For the parents, the injury-prevention part gets them real psyched about it."

The cost of an ACL injury is high by any measure. The pain is excruciating and rehabilitation is worse, and the cost of the entire ordeal averages about $17,000. Multiply that by 30,000 — the number of serious knee injuries in 2000.

That's when Dana (Takahara) Dias, a former UH basketball player, tore her ACL while making a jump stop during a pickup game. In her years as Moanalua's girls basketball coach and athletic director she figures she's seen nearly 20 ACL injuries.

"Going through the ACL process sets you apart," Dias says. "Whenever you see somebody wearing a brace you can sympathize. It's not a club you want to join, but a lot of people have."

Dias remembers going to seminars a decade ago that emphasized proper technique, particularly for female athletes. Since then, each high school has brought an athletic trainer on staff, which she believes dramatically improved prevention.

Wrong landing

Additional help still intrigues her. "For peace of mind and frame of mind any cost is worth it," Dias says. "Rehabilitation is a very lonely journey. I'd hate to see a young athlete go through what I did."

Females nearly always experience the injury without warning or contact. Approximately 60 percent of their ACL tears occur when they land, with most others involving twisting and stopping.

That's where the educated theories come in and clearly all — from wider hips to joint laxity, late starts in sports and relatively weak hamstrings — have merit. But what Iyomasa sees in his pre-testing and videos are women consistently landing in unstable positions.

Boys — even those with no interest in athletics — nearly always land with their knees lined up over their feet, which point straight out. They also flex their knees more, absorbing force. Girls tend to land with knees pointing in and feet pointing out, straining knee ligaments.

Atuaia suffered a complete tear Jan. 26 as she picked up her dribble.

"If she had even 20 degrees of flexion when it happened it probably wouldn't have popped," said Dr. Robert Kagawa, who has helped Rainbow Wahine basketball, softball and volleyball the past six years. "When you have the leg at full extension is when the ACL is most taut. That's when it's going to tear."

Last season, 94 female NCAA Division I basketball players suffered the identical injury. Former Rainbow Wahine Nani Cockett and Hedy Liu suffered ACL tears in both knees when they played.

The injury's devastation has a huge ripple effect. When Cockett suffered her second tear (her first came her senior year at Kamehameha) it was only a few months after teammate Tania Brunton tore her ACL.

Early prevention critical

With their two best players out for the year, the Rainbow Wahine went 6-20. With them back, they were 23-6 the next season — the greatest turnaround in women's college basketball history.

Kagawa has seen four ACL injuries — all basketball players. He suffered the same injury, to both knees, playing hoops in the 1980's.

"The knee joint is tough because it's not a hinge joint," he says. "It twists and rotates. That makes it difficult."

That makes prevention difficult. But it is worth a try, particularly for young girls.

"When girls are 12, they have their growth spurt," Kagawa says. "When you are in that age group your muscles are still developing so that (early prevention) might be the right idea. That's also when sports get more intense.

"Will it make a difference? Only time will tell if it will make a significant difference. But let's put it this way: It cannot hurt. If it saves one person from getting injured, it makes a great difference."