ACL injuries in girls

As we move to warmer weather we can now really begin to enjoy the outdoors, which means lots of youth sports.  I say great–but I also will take a moment to discuss concerns about the absolute epidemic of anterior cruciate ligament (ACL) injuries in adolescent female athletes.  Over the past generation we’ve seen increasingly frequent ACL injuries by up to 900% due largely to the explosive growth of girls sports since Title IX; anywhere from 20,000-80,000 occurrences yearly.  Soccer, basketball, and gymnastics cause the most injuries; girls are up to 8x greater risk compared to boys.

Some background: the ACL is inside the knee and keeps the tibia (shin) from sliding forward relative to the femur (thigh) during ambulation.  >70% of injuries result from no contact with other players but rather from some sudden, awkward movement.  One example: a girl plants her right foot with extended knee and then tries to quickly cut right.  With sudden deceleration her weight is back with leg straightened moving under her upper body as her torso turns right and out and her thigh rotates inward(counterclockwise) and POP!! (there is often a loud snap that everyone close to the injured girl will hear when the tear occurs).  This is a common mechanism of injury.

There are many physiologic factors contributing to girls’ ACL risks:

  • Hormones–testosterone surge in boys makes for greater muscle development allowing boys to control movement more with muscle strength; girls tend to rely more on bones and ligaments.
  • Menstruation-the ACL actually gets slightly longer and more lax mid-cycle creating greater risk
  • Neuromuscular factors–quadriceps (front thigh):hamstring (back thigh) muscle strength ratio is greater in girls compared to boys.  This puts greater strain on the ACL.  Girls also tend to have one leg stronger than the other compared to boys more symmetrically distributed leg strength which creates more problems in the weaker leg.
  • Girls tend to run and land relatively flat footed.  Boys are up on their forefoot more which is a better shock absorber.
  • Girls have relatively less core body strength.
  • Wider pelvis makes for more uneven landing

Note that for both boys and girls being overweight increases risk.

There are many steps we can take to avoid ACL tears.  Proper fitting quality footwear for their sport is a nice start.  Core strengthening is key–lots of sit-ups and planks.  Neuromuscular training is a very important component.  Here is an excellent program.  A variation on that program is demonstrated here.  So besides dribbling, passing, shooting and SCORING, make these exercises a regular part of your daughter’s training routine, especially off and pre-season.

Chance of ACL injury does not at all mean that your daughter should shrink from enthusiastic participation and aggressive competition.  Like all risk it must be balanced by advantages and can largely be controlled by proper lifestyle.  Sports will help make her more confident, stronger, healthier and so often happier.  And most importantly–IT’S FUN!!  So get out there and play.

Send along questions and comments, and thanks for following.


Drug addiction–medicine disposal

Most of us have become aware of the terrible scourge of drug abuse that grips our nation.  Here in Ocean County, heroin kills one person every 48 hours.  Statewide we have seen a 214% increase in drug use since 2010 with approximately 128,000 New Jerseyans struggling with addiction at last count.  As a community, Toms River ranks 8th statewide in the rate of heroin addiction and overall Ocean County ranks 2nd in that sad list with 157 heroin deaths in 2015.

The problem is not just heroin, of course, but also prescriptions pain killers as well–including frequently used drugs like oxycontin, hydrocodone, and fentanyl(note–available as a dermal patch).  Many may have these drugs in their medicine cabinets left over from ailments like dental work, back pains, or surgical procedures.

What can we do with these medications when the problem is resolved but there are pills left over?  It’s NOT as simple as one might think.  The risks here are obvious–adolescents are impulsive and can be foolish: parents should never be too confident and should NEVER take anything for granted here.  And we must note that other youngsters visit and that just adds another variable to that safety equation:

  • Do NOT discard medicines in the trash
  • Be careful about flushing medications down the toilet
  • Best to discard at a reputable center
  • When in doubt, check with your pharmacist
  • When disposing pill bottles, be sure to scratch off all identifying information
  • Do not crush pills, but you can break them into halves or quarter
  • If you are going to discard pills, mix them with undesirable substances like dirt, kitty litter, or coffee grounds and discard in trash in sealed plastic bags

One last suggestion:  ask me about keeping a prescription  for naloxone (narcan)–available as a nasal spray–for your home.  Naloxone is an absolute antidote for opioids, is easy and VERY safe to administer.  Because “you never can tell,”

Please send along questions and comments, and thanks for following.


Probiotics can often be a good natural remedy for simple–if annoying– gastrointestinal complaints.  They are defined as ” live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.” These products have been tried in a variety of situations.  The medical literature is actually quite extensive but, at the same time, conclusions are rather spotty.  Nevertheless I think they are useful in the right setting and, in particular, (“naturally”) I favor their use over most medicines in many instances.

Historically, probiotics have been among the top 3 non-vitamin, non-mineral supplements given to children ages 4-17.  They seem to be most helpful in 2 clinical situations: acute gastroenteritis (AGE) and in the prevention of post-antibiotic diarrhea.  For these conditions the data is quite strong.  For instance, in the latter, probiotic use in one study of over 3,000 children showed a 52% reduction in the risk of diarrhea.  The efficacy of the treatment seems most tied to 2 things.  Firstly is the organism used and the second parameter is the dose of treatment.  The most extensively studied organisms–and those with the best “track record” –are Lactobacillus rhamnosus GG and Saccharomyces boulardii.  For both, 5 billion CFU (“colony forming units”) once or twice daily for 2-4 days seems to be enough to be helpful.  Both of these treatments are available as commercial products in either chewable or packet form and can be purchased in pharmacies or health food stores (I do not list brand names of products in my blog posts).

People have also tried probiotics for a number of other medical conditions like community acquired infections, colic, eczema, and even more severe medical problems like Clostridium dificile (“C dif”) infections and inflammatory bowel diseases like Crohn’s or ulcerative colitis.  Here there is considerably less evidence to support their use so I do not recommend that you rely on probiotics for those problems.  Additionally, many brands of yogurt are touted as a useful source of probiotics.  However, recent studies have not shown significant benefit of yogurt as a probiotic in any of the above medical conditions.  Food experts postulate that there probably aren’t enough “CFU” organisms in yogurt to be effective.

Lastly, we should recall that this treatment utilizes living organisms.  Therefore, use in infants or immunocompromised children–those with HIV, cancer, or receiving other immunosuppressive treatments or with other immune compromised conditions–is not recommended and could even be quite dangerous.

Much of the above information is summarized from a very useful article I found in a professional journal “Infectious Diseases in Children” written by Edward Bell, PharmD at Drake University, Des Moines, Iowa.  So a “shout out” to Dr. Bell for his help here.

Please send along questions and comments, and thanks for following.