As a strength and conditioning coach, my job is to help athletes get stronger. But before I do that, I look at what I can do to make sure they don't get injured. For a variety of reasons, female athletes are plagued with knee injuries. In this article, I discuss why knee injuries occur and describe some of my favorite drills and exercises that female basketball players can use to prevent them.
Why Knee Injuries Occur
We have a few theories about why women experience more knee injuries than men and how we can prevent them. Some have speculated that higher estrogen levels can leave women more susceptible to ACL injuries. Larger hip width has been speculated as a cause as well. That being said, in my opinion, the main reason is weakness, particularly in the glutes and hamstrings.
I've heard the knee referred to by physical therapists as the "black hole joint," because it is controlled by the hips and lower body musculature. To prevent knee injuries I look to strengthen the hips, which help control the knee.
Anecdotally, I've seen a lot of strong female athletes who move more via their quadriceps than through their hamstrings. When they squat or when they lunge, they tend to let their knee come forward and they place a lot of weight on their toes. One of my goals is to teach them to get their hips back and keep their shins vertical in order to place more emphasis on their hamstrings.
Another thing I see that tells me the hips need strengthening is a "valgus collapse," which refers to when the knees cave in during a squat. This is a red flag and an issue that needs to be addressed. It has been well established that valgus collapse is a risk factor for knee injuries.
Favorite Drills to Prevent Knee Injuries
Getting stronger is certainly an important factor in preventing knee injuries, but I also like to address proper landing mechanics and proper deceleration mechanics. The authors of one study state that "female athletes exhibit increased knee valgus and decreased knee flexion in cutting tasks, and increased knee valgus in landing tasks." Thus, I encourage my athletes to flex at their hips and knees when decelerating or cutting. I also teach them to keep their knees from caving in when squatting.
One drill I like involves a full sprint to teach proper mechanics when coming to a stop. This means the athlete keeps her hips and knees flexed as she slows down. I've seen a handful of female basketball players try to stop by hyperextending their legs. Here is a video in which my friend Matt practices proper deceleration mechanics. You can see that as he comes to a stop, his hips and knees remain flexed.
Next, I work on landing drills with Box Jumps. I like these more than regular jumps, because the athlete can step down off the box to reduce stress on the knees. I cue the athlete to make sure her knees do not cave in when jumping or landing. Another thing I address is the "soft landing" on the box. For a soft landing, the athlete should have her knees slightly bent. She shouldn't land by slamming her feet into the box. One trick I've found particularly helpful is to use a water bottle or coffee cup. Place the water bottle on the edge of the box and have the athlete jump on the box. If she lands softly, the water bottle doesn't move, but if she lands hard, the water bottle usually falls off. Here is an example with one of the basketball coaches at SUNY Cortland.
Favorite Exercises to Prevent Knee Injuries
Weak glutes and hamstrings can cause knee pain due to lack of control of the knees. Without a doubt, the Deadlift is one of the best exercises to train those two muscles. To get the most out of the Deadlift, you need to focus on hip extension, which works the glutes and hamstrings, rather than on trunk extension, which turns the low back into a dynamic mover rather than a stabilizer. In this video, you will see the Deadlift is more of a horizontal hip motion than an up-and-down motion. I always cue my athletes "hips back, hips forward."
The Deadlift is a great exercise, but it's also hard to master. When learning how to do the lift, you need to make sure your glutes get strong and your knees stay safe. The Weighted Glute Bridge fits the bill. This exercises is essentially a Deadlift while lying on your back. I like to have my back against a bench to increase the range of motion. The athlete puts a weight or a bar across her hips and lifts the weight up to the end range of hip extension. When the movement is completed, there should be a straight line from the knee to the shoulder. Here is an example using a barbell.
I've seen more than my fair share of female basketball players with aggravated knees. Practicing proper landing and deceleration while strengthening the glutes and hamstrings can prevent knee injuries.
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