Land like a Ballerina to Avoid Female ACL Injuries

by Chris Centeno, MD /

In the United States, in over a decade, we’ve seen a greater-than 900% increase in ACL injuries in girl’s sports. Interestingly, despite this epidemic, research shows that in comparison, ballerinas rarely have ACL injuries and are certainly much less likely to injure their ACLs than other female athletes. So the question is why? The answer lies in how they control their knees during the landing.

Hence it seems clear that one way to stop this epidemic of ACL injuries to teach our girls and young women to land like a Ballerina!

Why Does This Only Apply to Female ACL Injuries?

I covered a study on this a few years ago that showed that female athletes, such as soccer players, tend to let their knees adduct, or shift inward, as they land (see the image in the video above). The reason for this is simple human anatomy. Women have a wider pelvis, so compared to a man, their hip abductor muscles would have to work harder as they land to keep their knees from moving inward. The study concluded that female athletes were more than 15 times more likely to experience an ACL injury when they landed with poor knee control

A few years ago, I put together two videos demonstrating this. One showed my son’s natural landing position with controlled knees, the other my soccer-athlete daughter’s natural landing with uncontrolled knees shifting inward. Click here to view the telling videos and to find out how to perform your own landing test to help you determine if you are at risk for an ACL injury.

Ballerinas Are Trained to Land Differently

So now that we know that females who play sports tend to lose control of their knees as they land, why are ballerinas different? Ballerinas’ knees don’t adduct inward when they land. Why? Ballerinas are trained from a young age to land with the knees perfectly aligned with their hips and their ankles, strengthening those muscles early on. A ballerina’s clean, straight lines and fluid movements come from her extensive core conditioning and strong and rigorous full-body routines. As a result, they are constantly practicing controlled movement, including knee control, which helps prevent female ACL injuries.

How Female Athletes Can Train to Land like Ballerinas

If you have taken the landing test, at the link above, and determined that you are at risk for an ACL injury, the issue can be remediated before it turns into an ACL injury. You will need to learn to control this inward knee movement when you land, and this is where you can learn a thing or two from a ballerina. Here are a few ballerina training methods you can add to your sports training to address your landing issues, strengthen those abductor muscles, and lower your risk of ACL injuries:

  1. Find the right provider to work with—a physical therapist with Pilates training, a Pilates instructor, or a ballet instructor should be able to help you with your landing technique.
  2. Focus first on core strength in the spine, hips, and ankles with your instructor.
  3. Practice landing like a ballerina, with perfectly aligned hips, knees, and ankles. Do this in front of the mirror so you can see how you are landing, with your instructor present as well.

The upshot? We must train our female athletes to land like a ballerina if we want them to avoid the female ACL injuries so prevalent today. Read my “Guide to Injuries for Female Athletes,” to learn more about ACL injuries in females. If you are a female athlete, or you know one, don’t wait until you’ve shredded your ACL before you decide to properly train yourself on how to land. While we can heal most of these ACLs without surgery through a precise stem cell injection procedure that we invented and pioneered, why deal with an ACL injury if you don’t have to? And when it’s all said and done, you’re still going to have to train yourself to land like a ballerina or you’re just going to reinjure your ACL all over again!

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Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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