Females Experience More ACL Tears…Why?


Anterior cruciate ligament tears are all too common an injury among athletes. In my practice I see a higher number of female athletes with this injury.
I’m often asked the question “why does it seem girls have this injury more than boys?”

We know from various studies, females can be 3x more likely than their male counterparts to suffer an ACL tear in the same sport. Why is that? Is there any way to reduce this risk?

There are multiple factors associated with this increased risk of ACL tears in female athletes. Their hormonal differences from males as well as fluctuations in the menstrual cycle have been implicated.   There are also structural differences in anatomy that account for a greater risk of injury.  This includes  leg alignment and bone morphology around the ACL. Differences in strength and muscle imbalances can lead to a higher rate of tears. Lastly, and perhaps the one difference that we may have the most control over is what the physical therapy literature refers to as  ” dynamic valgus collapse”.


This term refers to the position that a female athlete’s knee gets into many times during athletic performance. The knee gets flexed inward with the femur  (thigh bone) rotated inward and the tibia (leg bone) rotated outward. Exaggeration of this force across the knee has been shown to be a mechanism by which the ACL gets torn.Knee Valgus

A prevention program including strengthening with plyometrics (emphasis on muscle balance) and educational reinforcement; reminding the athlete to avoid this position, has been shown to decrease the risk. This type of program is highly recommended in high risk sports such as basketball and soccer.

There is no doubt that female athletes are at higher risk for ACL tears than the male athlete. Certainly great strides have been made in attempting to understand this phenomenon as well as in prevention. We must continue to advance our knowledge in these areas so that we continue to decrease the injury rates and keep our athletes safe and “in the game”.

For more information on the diagnosis and treatment of an ACL injury, visist the SportsMED website.  We have several videos online you may want to view.

To schedule an appointment, call SportsMED Orthopaedic Surgery & Spine Center 256-881-5151.


Pitching…From the Mound or Ground?

We hosted a dinner for area baseball and softball coaches a few years ago.  I presented a program on throwing injuries and was asked a question on pitching training.  A baseball coach wanted to know whether it was advisable to do more throwing from a flat surface verses a mound. At the time I couldn’t give him a firm opinion one way or the other. So I decided to research the topic again.

The logic of training from flat ground compared to the mound is to reduce the stresses seen by the shoulder and elbow. Obviously, trying to prevent injuries is the main goal. Studies have shown lower stresses when throwing from flat ground. However, the stress reduction is not significant enough to make a substantial argument for injury reduction.

Opponents of training from flat ground argue that the mechanics of throwing have to change to accommodate the difference from the mound. Differences in stride length and velocity may lead to adaptations that have to be overcome when getting back on the mound.

Certainly, one can find favorable arguments to both implement flat ground pitching as well as train from the mound.  I am still not able to give a firm opinion either way. My recommendation is to use this training technique if you think it works good for your players, otherwise don’t jump on the bandwagon.

If you would like to read more on this topic, the Journal of Orthopaedic & Sports Physical Therapy offers an aritcle you might find insightlful.

PRP in Sports Medicine

In the field of Sports Medicine, the public and media often gravitate toward treatment options of high profile athletes.

PRPPlatelet Rich Plasma (PRP) is one such treatment receiving alot of attention.  It is being used for the treatment of  a variety of musculoskeletal injuries and conditions. In addition,  it is being used to enhance healing of damaged tissues. With reports of athletes like Tiger Woods and Hines Ward turning to this treatment,  PRP is becoming a common topic both inside and outside of Orthopedic offices.

How does it work?

The platelets contain growth factors that have the potential to help immature cells differentiate into cells that can help heal specific damaged tissue. The platelets are retrieved from the patients own blood. After the blood is drawn, it is placed in a centrifuge and rapidly spun to get a high concentration of platelets in the plasma. This platelet rich plasma is then injected into the damaged tissue or joint. As the platelets coagulate in the tissue they release the growth factors to stimulate the healing response. Since this is the patients own tissue there is no significant chance of side affects or reaction.

Currently, there aren’t many studies to corroborate the effectiveness of this treatment. However, their have been many uses for PRP that have recently emerged.  The most promising area has been in the treatment of tendonitis. It is used for several conditions including epicondylitis in the elbow, patellar tendonitis  in the knee, and plantar fasciitis and Achilles tendonitis of the foot. PRP is used when all other treatment options have failed and one is trying to avoid surgery. In an effort to speed healing response, physicians may also consider PRP for acute injuries to muscle, ligaments and bone. Surgically, it may be  used in  total knee replacements to decrease blood loss and promote quicker healing. Lastly, PRP can be used in conjunction with surgeries  such as rotator cuff repair; once again to increase the rate of healing.

Over the next few years we will have more experience with PRP along with additional studies to help determine it’s effectiveness. This is just the start to the emerging field of biologic medicine. The possibilities are potentially limitless.

Eric W. Janssen, MD

If you would like to watch a video of Dr. Janssen performing PRP please follow the link to his Youtube Page.



Why Does My Shoulder Hurt?

I recently presented a program for the employees of Intergraph here in Huntsville, Alabama. The program was a comprehensive look at various shoulder conditions, injuries and treatment options. The program can be found on Youtube. The presention is divided into 3 videos.

Part 1

I started with a general explanation of shoulder anatomy, including tendons, ligaments and bones. We then showed a video of a general office exam that I perform on all shoulder patients. I have written a previous post about the importance of a “hands on” office exam when diagnosing a shoulder injury, or any injury for that matter.

Part 2

Here we move into non-traumatic causes of shoulder pain. These include bursitis, tendonitis, arthritis, frozen shoulder and injuries to the neck and nerves.

Part 3

In this section we discuss the traumatic causes of shoulder pain. Specifically, I discuss strains and tears including rotator cuff injuries, dislocations and fractures.

Question & Answer

After the program, I took several questions. We also have those questions and answers available on Youtube.Here you see the patient’s arm in a sling as I use the arthroscopic camera and instruments to perform the surgery.


Here you see the patient’s arm in a sling as I use the arthroscopic camera and instruments to perform the surgery.


1. After a clavicle fracture heals, can the plate and screws be removed?

2. Does age matter when deciding if surgery is the best option?

3. How can you avoid shoulder pain and injuries?

4. Do injections cause scar tissuse?

These were all great questions and helped to round out the program.

We hope you find the videos informative and we want to thank Intergraph and their employees for inviting us to their facility.


You can see the monitor we watch as the procedure is performed. If you would like to see our team performing a rotator cuff repair, click on the image.









Growing Concern Over Concussions in High School Football

With football season well underway,  no injury is receiving more attention than concussions. Covering the sidelines on Friday nights, I have already treated a football player with a concussion.

Receiving press prior to last week’s Alabama vs. Arkansas game was the question…Would Tyler Wilson, Arkansas quarterboack,  be able to return after a concussion a week earlier. His ability to play was thought to be a big factor in whether Arkansas could compete with Alabama.

This scenario highlights the dilemma we face regarding when to return the injured athlete to play after a concussion.   During the last two years the NFL has invested a lot of effort in improving the diagnosis and treatment for concussions, but more importantly the have worked to minimize potential long term consequences.


concusionWhat is a concussion?

A concussion is a brain injury that occurs either after a direct blow to the head or by indirect forces applied to the head. This disturbs the normal physiology of  brain transmissions and thus causes symptoms.

What are symptoms of a concussion.

There may be a loss of consciences which makes the diagnosis easy.  There can be personality changes such as slowness or inappropriate responses to questions.  There may also be dizziness, nausea, headache, and or unsteadiness. This is almost always a transient situation with a rare chance for permanent damage at the time of injury.  However, recognition of a concussion is essential when determining the appropriate treatment and preventing further injury.

What to do when a concussion occurs?FORSALE

Once a concussion is suspected,  an evaluation including a series of questions and a physical examination is performed on the sideline. If the diagnosis is confirmed or highly suspected, the athlete should be held out of play for the rest of the game and followed closely afterward before return to play. If the evaluation is negative, the athlete is placed through exercise on the sideline to make sure symptoms do not occur. Then he may return to play.

When can athlete return to play?

If a player has been held out,  the hardest decision  is when to return the athlete to play. Many schools are now using standardized tests. Preseason testing is performed and then compared to post injury testing. A return to the baseline test is an indication to return to play. The Alabama High School  Athletic Association now requires a physician clearance to return to play. In general, the athlete should be rested both physically and mentally until all symptoms are gone. Once symptom free,  there is a progession of return. First the athlete will being general light exersice, followed by sports specific exercise.  If there is not return of symtoms, they may return to practice followed by participation in competition.

There is still much to learn about this injury.  We know the risk of a concussion during the same season is 3 times greater after a first concussion. The risk over the athletes career may be as high as 25% for recurrent concussions. So how do we do a better job preventing them? No helmet has been shown to reduce the rate of injury. Equipment changes hopefully will make a difference in the future. We are optimistic that rule changes will result in a reduction of concussions as well. We still don’t understand the long term consequences of this injury.

It is quite evident there is a heightened awareness of concussions. As a result,  better treatment and outcomes will occur. We have come a long way in handling this injury, but much still has to be learned. As a result treatment and prevention should improve outcomes.

Eric W. Janssen, MD

Elise Morgan & WHNT Feature Local Cancer Survivors

Elise Morgan, with our local CBS affiliate, recently sat down and spoke with my famiily and me about our first hand experience with cancer.

group-meeting2In December of 2010 I went to my primary care physician because of a mass in my neck. A biopsy confirmed it was cancer and we knew there was a primary tumor that needed to be located. We soon discovered the cancer orinignated on the base of my tongue.


Eric W. Janssen, MD



Football Season and Injury Prevention

football-bwAs football season opens this week, the number of related injuries will increase. We will see many of those here in the office. Our practice specializes in sports medicine and we have treated sports related injuries for over 20 years, but we want to help with injury prevention.

I’m a member of the American Orthopaedic Society of Sports Medicine, an international organization of professionals dedicated to research, education and fellowship in the field of sports medicine. The AOSSM website has a patient portal that provides a number of educational pieces including “Football Injury Prevention” . When you follow the link, you will also find articles covering a variety of sports.

Best of luck to all those hitting the gridiron, this is when all of your hard work pays off. I look forward to seeing some of you on the sideline as we cover area games.

Eric W. Janssen, MD



Your Response Appreciated – Donations Needed







Thanks to all of you for your kind words and comments. Due to the number of responses, it is difficult to respond individually, but I appreciate each and every one.

The American Cancer Society has reopened the Summer Lights Celebration Donation center for a limited time. I hope you will consider making a donation in honor or in memory of someone you care about. As I mentioned last Saturday night, as well as in the earlier article, my specific treatment options and favorable outcomes would not have been possible without advancements that came from research…research funded by people like you. Please give what you can and challenge others to do the same. We will keep you updated.

Deadline to give, Wednesday, Sept 5th at midnight.