D634 Task 1 Capstone Topic and Connection Example

A Pop, Then a Season Gone: Anterior Cruciate Ligament Injuries Among High School Girls in Soccer and Basketball as a Health Sciences Capstone Topic, and Why It Is Mine

Student Name

Leavitt School of Health, Western Governors University

D634: Health Sciences Capstone, Task 1

Course Instructor

Month Day, Year

A Pop, Then a Season Gone: Anterior Cruciate Ligament Injuries Among High School Girls in Soccer and Basketball as a Health Sciences Capstone Topic, and Why It Is Mine

The Real-World Issue

Every fall and winter, girls on high school soccer and basketball teams land from a jump, plant a foot to change direction or decelerate awkwardly, hear a pop in the knee and fall. Many have torn the anterior cruciate ligament, the band of tissue in the center of the knee that keeps the shinbone from sliding forward and rotating under the thighbone. Most of these injuries happen without contact from another player. For a 16-year-old, the result is usually surgery, six to nine months of rehabilitation and a lost season, sometimes two.

This capstone addresses anterior cruciate ligament injuries among female high school athletes in soccer and basketball in Cedar Valley, a composite suburban school district with four high schools. In the past three school years, the district's athletic trainers recorded 11 such injuries among girls in those two sports and 3 among boys, although boys' teams in the same sports had slightly more players.

Why the Issue Matters

Research confirms that the district's pattern is not unusual. A systematic review and meta-analysis of injury incidence by sex and sport classification found that in contact sports, a category that includes soccer and basketball, female athletes had about three times the rate of anterior cruciate ligament injury per athlete exposure as male athletes (Montalvo et al., 2019). Researchers attribute part of this difference to how many girls land and cut, with the knee collapsing inward and the body upright, patterns that can be changed with training.

The consequences extend well beyond one season. In a follow-up of female soccer players 12 years after an anterior cruciate ligament injury, 82% of those examined had radiographic changes in the injured knee and 51% met the criteria for radiographic knee osteoarthritis, at an average age of 31; three-quarters reported symptoms that affected their knee-related quality of life, and surgical reconstruction made no significant difference to symptoms (Lohmander et al., 2004). A torn ligament at 16 can mean an arthritic knee at 30. The injury also carries costs: surgery, months of physical therapy, missed school and, for some athletes, lost college scholarships and a loss of identity and social connection that affects mental health.

The issue is also preventable. A summary of eight meta-analyses found that injury prevention training programs, warm-ups that teach athletes to land, cut and balance with better control, reduced the risk of all anterior cruciate ligament injuries by about half and noncontact injuries in female athletes by about two-thirds (Webster & Hewett, 2018). Yet programs like these are not used routinely in many high schools, including those in Cedar Valley, where each coach designs his or her own warm-up. The gap between strong evidence and everyday practice makes this a health sciences problem worth studying.

My Personal and Professional Connection

My interest began on a soccer field. In my junior year of high school, our starting center midfielder, my closest friend on the team, landed from a header during a Tuesday practice and did not get up. She had surgery a month later and spent the spring in physical therapy while the rest of us played. She returned the next season but never played with the same confidence, and she stopped playing after high school. At the time, none of us knew the injury was common among girls or that a different warm-up might have prevented it; our warm-up was a lap around the field and some static stretching.

The connection is also professional. I work as a physical therapy aide in an outpatient clinic, and some of our youngest patients are teenage girls recovering from anterior cruciate ligament reconstruction. I have watched them rebuild strength and balance over months, practicing the same jump-landing and single-leg exercises that prevention programs teach before injury. That experience led me to ask why the exercises so often come after the injury rather than before it. After graduation, I plan to pursue a doctorate in physical therapy with a focus on sports and youth athletes, and prevention will be central to that work.

Narrowing the Topic

Anterior cruciate ligament injury is a large field, spanning anatomy, surgery, rehabilitation and return to sport. This capstone focuses on prevention before injury, in one population, female high school athletes in two high-risk sports, and on one type of solution, neuromuscular training programs delivered by coaches. That focus is narrow enough to review the literature thoroughly and to propose a solution the district could realistically carry out, yet broad enough to have a substantial body of research, including randomized trials and several meta-analyses.

The focus on coaches is deliberate. In most high schools, coaches decide how every practice begins, and athletic trainers, where schools have them, cover several teams at once. Any prevention program that depends on specialists will reach few athletes; one that coaches can lead in the first 15 minutes of practice could reach every team in the district. Soccer and basketball were chosen because together they account for most of Cedar Valley's injuries among girls and because both involve the cutting, pivoting and landing that the research links to noncontact injury.

Research Question

The question guiding this capstone is: Among female high school soccer and basketball athletes, does a coach-delivered neuromuscular training warm-up, compared with usual warm-ups, reduce anterior cruciate ligament injuries, and what factors determine whether coaches and athletes use such programs consistently enough to benefit? The second part of the question matters because evidence that a program works in a trial does not guarantee it will work in a school district where coaches have limited time and athletes want to get to practice.

Conclusion

Anterior cruciate ligament injuries among female high school athletes are common, have lasting consequences and are largely preventable, yet prevention programs are not standard practice. The issue matters to me because of a teammate I watched lose her sport and patients I now help recover. The literature review in the next task will examine what the research shows about prevention programs and their use, and the final task will propose a solution for Cedar Valley based on that evidence.

References

Lohmander, L. S., Östenberg, A., Englund, M., & Roos, H. (2004). High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis & Rheumatism, 50(10), 3145-3152. https://doi.org/10.1002/art.20589

Montalvo, A. M., Schneider, D. K., Webster, K. E., Yut, L., Galloway, M. T., Heidt, R. S., Kaeding, C. C., Kremcheck, T. E., Magnussen, R. A., Parikh, S. N., Stanfield, D. T., Wall, E. J., & Myer, G. D. (2019). Anterior cruciate ligament injury risk in sport: A systematic review and meta-analysis of injury incidence by sex and sport classification. Journal of Athletic Training, 54(5), 472-482. https://doi.org/10.4085/1062-6050-407-16

Webster, K. E., & Hewett, T. E. (2018). Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. Journal of Orthopaedic Research, 36(10), 2696-2708. https://doi.org/10.1002/jor.24043