I watched at least 10 girls basketball games today, and girls should not play basketball. The movement skills of these players was so poor that the actions of basketball put nearly every player at severe risk for injury.
Dozens of neuromuscular training programs and ACL injury prevention programs have been developed over the last decade, yet the injury rate has not declined (Agel, 2005). Injuries to the knee can account for up to 91% of season ending injuries and 94% of injuries requiring surgery in female basketball players. Season ending knee injuries can occur at a rate as high as 1 in 10 athletes annually at the intercollegiate level, which can account for 15,000 female athletes lost each year to athletic participation (Ford et al. 2003).
The popular perception is that girls lack the requisite strength to resist the forces and play safely. However, I saw the same movement issues yesterday with a college player who has well-developed strength and a 28-inch vertical jump. Strength is not the only issue.
Before playing, girls (and boys, as I see more and more young boys playing basketball with plenty of movement issues) need to develop basic motor programs for the execution of basic skills like running, jumping, bending, squatting, landing and stopping. Strength and stability certainly will enhance the development of these motor programs.
However, after one develops the requisite strength and stability, she needs to re-learn the correct motor program. Many players have developed and used poor movement patterns for so long that they are stuck in these programs even after adding strength. The same occurs after injury.
I worked with a male college player yesterday. I watched him shoot free throws. I asked him about his left ankle injury, which happened in December, and guessed that he had a right knee issue too, which he did. I did not even know his name (he joined a workout with another player for a couple drills) and had never seen him play. However, his shooting technique showed evidence of poor motor programs likely as a result of injury. His range of motion on his left foot was limited, which often occurs when players sprain an ankle and do not rehab completely.
The ankle had healed; he no longer had a sprained ankle. However, whether because he never rehabbed fully or because he returned to action with a limited range of motion, his new motor pattern reflects an injured ankle.
When girls shot free throws today, the majority could not bend to a half-squat without some movement abnormality. Most had valgus knees (knock-kneed), which is believed to be a factor in ACL injuries. If they have valgus knees on a free throw, a closed skill with few forces to control, what happens when they jump stop or land from a rebound with much higher forces? Other players showed limited range of motion at the ankle, as they were unable to bend to shoot without their heels coming off the ground. Limited ankle mobility and flexibility may contribute to ACL injuries, but almost certainly contribute to patellar tendonopathy or “Jumper’s Knee.“
Basketball is a high impact sport, and the body must control and use high forces in actions like jumping, sprinting, stopping and landing. When the body cannot control these forces – when the load exceeds the capacity – the body breaks down, either through acute or chronic injuries.
Currently, we do little to improve basketball players’ capacity to handle the loads of the game. In such a state, these players risk injury every time they step on the floor, evidenced by the approximately 7000 ACL ruptures in high school female basketball players in the United States on an annual basis (Ford et al., 2003). These are not minor injuries, either, as the cost of reconstructing and rehabilitating the ACL in these athletes has a conservative cost of $17,000 per patient which would amount to $119 million annually spent on female high school basketball players alone (Ford et al., 2003).
If we – as coaches, league administrators, parents, athletic trainers and strength & conditioning coaches – who work with young female basketball players cannot teach proper motor programs and develop adequate levels of strength to handle the forces inherent in basketball, the prevalence of injury, the costs associated with injury and the psychological and physical toll of the injuries are too high to continue supporting female’s participation in basketball.
Rather than forfeit participation, we need to be more aware and more proactive in our approach to coaching and training athletes, especially female basketball players. I mentioned to a coach today that his entire team was at risk of serious knee injury because of their undeveloped strength and poor movement patterns, and he said that he knew that they needed strength and laughed. This coach also blamed a disappointing season last year on his best player tearing her ACL. Yet, nothing changes.
Would spending 10 minutes each day at practice doing some of these exercises really make your team any less competitive?
Coaches throw up their hands and curse their fate, yet they do not analyze their players’ movements, teach basic movement skills or incorporate any type of strength program. Instead, at this school, the off-season program is run by a P.E. teacher who has all the out-of-season athletes training together running laps around a track while he rides his bicycle. Besides cross country, what sport is that preparing these athletes to play?
Before players learn to shoot, they should learn to bend and squat properly. Before they dribble, they need to run and stop. Before they play defense, they need to know how to shuffle and change directions. Before they rebound, they need to develop landing skills. These are skills: running, stopping, jumping, landing, squatting, bending, etc. are skills.
Personal trainers do not take a seven-year-old who weighs 60 pounds and put her in a squat rack and have her squat 180lbs. That trainer would be sued immediately for malpractice when the bar crushes the poor girl. However, some studies have shown that females land with the force of 3-5 times their body weight, yet when a coach tells the same seven-year-old with terrible movement skills to play basketball and jump stop, rebound, etc. over and over, nobody questions the coach.
Some children develop movement skills naturally. Some develop skills through mirror neuron system by watching others, though the amount of mirror neuron activation correlates positively when the athletes are already proficient in performing that skill, suggesting that it may not be wise to rely on beginners to learn by watching others (Benjaminse & Otten, 2011). Other children develop flaws in their movement patterns and need feedback to correct these patterns. By starting young, when these patterns are varied and inconsistent, athletes can learn the proper movement patterns and practice those, creating the desired patterns.
Before focusing on sports participation, we need athlete preparation. Children need to play basic games where they have to solve movement problems; games like hop-scotch and tag. Once they reach a formal team, they should be screened with a Fundamental Movement Screen or similar tool. Any weaknesses or abnormalities should be addressed before these children engage in practicing and training for a specific sport. Each year, players should be screened for their movement skills to catch any issues that may have developed as the child matures, grows and develops. Tests could include various single-leg balance tests, overhead squat, hopping and more to get a baseline for the athlete’s general capacities to perform the tasks in the game.
If we are unprepared to develop athletes first and basketball players second, the game becomes too risky for female athletes. These athletes need better coaching and training at the youth, high school and college levels that focuses beyond just sport-specfic technique and strategy and emphasizes the basic motor skills at the foundation of each sport skill. Until these athletes develop these motor skills, and develop the requisite strength along with the motor skills, season-ending injuries will remain the norm, not a freak occurrence. With season-ending injuries as the norm, the game may no longer be worth the risk.