1:12

Welcome back to the raising unstoppable girl athletes podcast. I'm coach Bri and elite competitor coach for female athletes. And I'm so glad that you're here, whether you are just getting, going on this sports journey with your daughter, or you've got lots of seasons under your belt, or you're somewhere in between this podcast is for you to help your daughter know how to be confident and give her the mental skills that she needs to perform well in her sport. And also so that you can enjoy this sports journey too. Right? Now, before we get into today's episode with Erica Suter, a whole about how to prevent ACL injuries in female athletes. I want to give a shout out to a mom and an athlete in our community. So Lisa, the other day posted this and our private group of moms who are going through the week theater program, she said, You said did great. She plays sports in barrels out of 24 girls. She's so happy. She told me, mom, this mindset stuff all works. I'm like, yup. It does. Now I love this because first of all, ISA is happy, right? Isn't that kind of the whole point of this is that she is enjoying her sport. Yes, there will be unhappy times in her sport, but overall, we want athletes to enjoy what they are doing because we know they play better. They perform better when they're enjoying what they are doing. Also she's noticing, Hey, this mindset stuff works. I'm doing it. I'm getting results. I'm going to keep doing it. So awesome job, ISA. Nice shot, Lisa. For providing her the opportunity to do this. Keep up the good work. All right. Let's get into this episode with Erica Suter. So Erica is a certified strength and conditioning coach. She's been on the podcast before a few times because she's just so full of knowledge. And we today are specifically talking about. ACL injury. So if you have ever wondered like me. If FEMA athletes are more at risk to ACL injuries and what factors play into these injuries? None. You will enjoy this episode. We're talking about that. Debunking, some myths. And also just talking about what appropriate load management is for your athlete daughter. How she can make sure that she is in the best position possible to remain injury free and how you can support her in this process. So I hope you enjoyed this episode as much as I enjoy talking to Erica.

Breanne 3:23

Hey Erica, welcome back to the Raising Unstoppable

Erica 3:27

Girl Athletes Podcast. Brianna, I'm really excited to be back here.

Breanne 3:32

Yeah, it's been a while, but Erica, you are a wealth of knowledge around strength training, injury prevention, all of those things. And so when I got a question from a mom in our community that was asking about a c l prevention, and if I could bring in an expert to talk about this, I immediately thought of you so. Thank you for coming back in. Can you tell our audience a little bit about what you do and what you provide for athletes?

Erica 3:58

Yeah, so I am a speed, strength and conditioning coach in Tampa, Florida, as well as remotely for female athletes. I mainly have soccer girls, but in the mix I do have volleyball track and basketball field hockey as well. I. And we're really focused on developing the physical qualities for girls to perform at a high level and also be resilient and have, a healthy sports career. And I've been doing it for 12 years. I'm in my 12th year now, and it's definitely gone by really quick, which is a good thing. And yeah, I'm excited to be here. There's a lot of new research coming out in the performance front, so ready to get into it. Cool. All right, well, let's get

Breanne 4:43

right into it. We're talking specifically about a c l, injuries and youth, female athletes. So can

Erica 4:51

you clear up

Breanne 4:52

the confusion? Because it always has been in my mind, and I'm not really sure why, that for some reason girls are more susceptible to a c o injuries or they're more at risk to them.

Erica 5:04

Is this true? Oh, that's such a great question and we're definitely going to just go on a tangent here. Okay. But when, so when you, what you open with was you, you've had a lot of moms asking about injury prevention. Yeah. I find that so interesting because. Even five years ago when I was in, starting in the performance space, I didn't get a lot of inquiries about preventing injuries. Hmm. People just wanted to get fast and strong. Now, here we are in 2023 and there's just a lot of. Fear around injury because there's this messaging being blasted out that yes, girls are more susceptible and there's marketing of injury prevention programs, and it's just become this. Preventative focus instead of, okay, let's focus on performance and actually empower you so you're not tiptoeing around this and, and you're not scared. So I just find that interesting. But, the literature does say that there are anatomical factors for the female athlete. So the numbers are girls might be two to five times more likely. To get an a C L injury compared to males, due to the structure of their hips, being wider, and then that actually places more. Force on the knee joint to rupture. but I try not to make that my focus when I'm talking to female athletes directly and even moms, because that's something that's uncontrollable. Mm-hmm. you know, you can't. Change your anatomy, it's here to stay. so we can start to actually focus on what is controllable in, injury mitigation. And I say mitigation because we can only reduce. The risk of a c l injury, if anyone promises 100% prevention with their performance program, run the other way because no one's figured it out yet. Not even the best researchers and PhDs. You can't fully prevent. You can only reduce injury by focusing on the controllable factors. And my thing is I don't want girls to think they're doomed. Because they're female. Yeah. I, I don't want them to just wave the surrender flag and be like, well, I'm at a higher risk. I'm a girl. That really sucks. No, I really want them to be empowered with some of these controllable factors that I'm sure we'll get into. Mm-hmm. Yeah.

Breanne 7:44

Yeah. I love that you brought that up because we don't want it to, we don't wanna turn into, I hate to use this word, but like kind of a victim mindset of like, well, yep, this is just gonna happen to me. So you said the, the things that are in our control, out of our control. So yes. What are those things that are in the female athlete's control that we can hone in on and focus on? I.

Erica 8:06

So the, the literature has consistently said over the past, well over three decades. so we have a, a good amount of research, but the first one is we want to focus on building strength. The, the athletes who are really susceptible tend to have, what's called ligament dominance, which is what one of my favorite researchers Dr. Tim Hewitt talks about in a lot of his papers. And that means their muscles are weak and they're not. Firing enough during high speed movements or, uh, landing from jumps. So the forces of all those movements are going to the knee joint. Mm-hmm. So it's, it's really critical that female athletes start strength training. I say get into a formal program with the strength coach as early as. Middle school and keep that going for the length of your career and continue to do it year round. So that's one controllable factor. And then within that performance program also working on. Motor control. So how to decelerate properly. So deceleration is when we do a sprint and then quickly pump the brakes and cut and change direction. That's also when injuries happen. But if we can really make sure our athletes are not decelerating and falling forward and really like loading that knee. And they're able to keep a stable trunk and have efficient movement, that's really going to go a long way. And that should be within a performance program. And then the, the last one, and this kind of comes back to the strength piece, is really focusing on single leg strength. a lot of female athletes tend to have one side stronger than the other, so we wanna focus on unilateral training to kind of. Even that out and not have one side dominating the, the load. So those are the physical factors that we can control. And at this point, everyone should be strength training. It should be, uh, a non-negotiable. And that's even just scratching the surface of injury mitigation. There's so many other lifestyle factors like nutrition, sleep, recovery that go into it too. Mm-hmm.

Breanne 10:28

Yeah. But I think that starting with that physical component is a really, a really good place to start. And I do wanna talk about those other life lifestyle things in a second too, because I think we can eat terribly and not get enough sleep and, you know, you know, there's things that we gotta, we gotta check the box for a good foundation. But as far as the strength training programs, and you mentioned a few things that should be incorporated. What, what should a strength training. protocol look like for athletes, especially those that are potentially playing their sport year round, like there's really no, no break from it. Can you talk about

Erica 11:01

that? I'm so glad you brought this up because the, the year round sports schedule, I get it's really tough to fit in strength training, but in order for girls to really get stronger and build those muscles, they have to have. A balance of the strength training and the, the sport load. And in order for them to get the best strength adaptation out of a performance plan is they also need recovery and to have a true off season mm-hmm. From their sport load. I know that the schedule is tough, but this is when parents can really take a stand and really get clear on, okay, well, is it important that my athlete stays healthy and. The answer's usually yes. Yes. So that's when strength training does need to be made a priority. I've had athletes do in-season strength training and the in-season lifts are only 30 minutes long. So if you're, uh, Working with someone who periodize and understands the volume so girls aren't overdoing it by adding in that strength training. That's really great. There's so many great performance coaches that really take care of their athletes in season, and those lifts are just super low volume. You hit each muscle group and then you move on with your life and it's just really, really great. But it's. It is key that girls have recovery days because that's when muscle building actually happens. So if you're in season and you're plowing through seven days a week because you're jumping from one team practice to another, your school team, your club team, then skills trainer on a Saturday or Sunday, then you're not getting the most outta that strength program. I'd almost say don't even do the strength program at that point.

Breanne 12:48

Yeah. Which then is not great overall either. So, okay. That's, that's good to consider. And also just realize like what the ultimate goal here is that's for healthy athletes who can enjoy their sport for a long time. And so yeah, building in that and having a good solid strength training program to follow I think is, is key. Can you talk about those other lifestyle factors just hit on on those? What else? What else plays into this that we might be potentially

Erica 13:14

overlooking? Yeah, so strength training's definitely the first piece. And even just with that, again, you can reduce ACL by over 60%, um, but to help yourself even more than you have proper nutrition coming into the mix. So making sure that. You're fueled enough for games, you're getting enough of those simple carbohydrates for energy. because usually under fatigue is when bad things happen. So nutrition on game day and practice is extremely important. And then recovery, nutrition is also important because, Every activity that an athlete does, strength training, playing games, going to tournaments, their muscles are always in a catabolic state, so they're constantly in breakdown mode and the only way to build back up again is that recovery piece, but also getting protein. Mm-hmm. That's when your muscles really start to repair. And I recently just had a dietician on my podcast and she said, girls should be aiming for anywhere from. 20 to 30 grams of protein, which I know not a lot of them are getting, but those are like per meal, right? Per, yeah. Per meal. Per meal, yeah. Um, and those are like the bare minimum amounts to really get the most out of that recovery and that muscle repair. Mm-hmm.

Breanne 14:36

Yeah, yeah, no, I've heard, I've heard similar, like 20 to 30 per meal or like 0.8 to 1.0 per body weight, like gram body weight. and that's a lot. But it's, I think that's important, you know, like, it is, but I, I think that prioritizing that, like you said, Under fatigue is usually when, I mean the injuries that I've sustained in my sports career is because I was tired and under fuel, and you're in that state where you're not. Yeah. At a hundred percent. So,

Erica 15:03

and the other thing with protein is if you're getting all essential amino acids, which you get from like, Meats and eggs and fish, or like if you do like a whey protein shake or chocolate milk, that actually helps to up build collagen in the body. and collagen is a part of the structural integrity of your, your joints and, and your knee. So it's really important to get that protein for healthy joints as well. Yeah. Oh, that's a great

Breanne 15:31

point. let's talk out, we've talked in the past about menstrual cycle and how that impacts just overall training and of course it's, fascinating and empowering. can you talk about, how menstrual cycle impacts an athlete's female athlete's risk to injury?

Erica 15:47

Or does it? So, yeah, so we actually don't know. And it's, yeah, it's, it's pretty crazy even just going through all the papers, because every paper will say further research is needed to come to a conclusion. literally every discussion says that. And there's some papers that say female athletes are more susceptible during ovulation, some say during. The follicular phase, some say the LAL phase, we don't know. I mean, there's three phases up for grabs. and even in just one female athlete who has a regular menstrual cycle, even from month to month, she experiences different symptoms and a different phase. So it's, it's not the same for even a, a single regular athlete. so it's just, it's super fascinating, but. my advice on that front is just focus on what we know and what we know is you do need to strength train. You do need to learn proper motor control and you need to fuel your body appropriately. of course during certain phases in the cycle. And if you. Pay attention to your symptoms. If you maybe have more fatigue, then you might need to really make sure you're getting to bed early or, or you're getting more magnesium and leafy greens in your diet, so you're, you're getting good sleep. or maybe. your joints don't feel as good during a certain phase and you or your muscles, and you might need to up protein. Mm-hmm. those are some things you can do. But my, my question is, and this is something I'm always wrestling with, if we did know for sure what phase a c l risk was the highest, What would we do? Mm-hmm. Right? Because each girl's gonna be different. Yes. Would we just sit those girls out? Would we be able to field a team? So that doesn't make sense. It, it's not practical. So the onus is on the individual to have good lifestyle habits and make sure their hormones are in balance. And I would even go as far as to say, focus on being healthy the whole year. And not just when. One week in the month comes and you feel like crap, don't be as reactive about it. Be proactive, and just be a healthy athlete. Mm-hmm. Yeah.

Breanne 18:13

There is so much that can be done to build that foundation and then re, like you said, realize that, okay, yeah. If leading up to my period I am more fatigued, so which would put me at injury risk, then to get more sleep or magnesium or, those things that are in our control. Knowing that about our bodies. And so that's where I find it's empowering and not like, oh, I'm on, you know, I'm on my period, or I'm in the stage and so I'm just probably gonna tear my acl.

Erica 18:41

Yeah, yeah. And there's even some more like definitive studies where maybe during the. The lal phase or the follicular phase when estrogen is rising muscles might be a little bit weaker. Mm-hmm. But we, we still have to strength train within that. We still need to make sure we're getting recovery. it's just key to just do the basics first. you can just let the rest of us dive into the papers, but yeah, do the basics. and you'll, you'll be good. And you'll find that if you do that year round. And you are strength training and nourishing, getting your sleep in recovery, your hormones will eventually reach more of an equilibrium mm-hmm. Each month. and you'll find that maybe you're not as tired or moody during pm s maybe you're not as, bloated or getting these, painful cramps. And it eventually, hormones do balance out, but you have to be consistent with your lifestyle. Yeah. Yeah.

Breanne 19:40

That's such a good point. so we've gone over kind of a lot on what should what, what can help prevent a c l injuries. And for the moms and the parents that are listening, you mentioned a few things, but where, what role does the parent play in all of this? And I know it probably depends on the age of the athlete. Like we serve athletes as young as nine and all the way through college, and so. Their dependency on their parents obviously varies throughout that whole like time span. but what, what are some key things that parents can be doing on this front to help their athletes?

Erica 20:12

I think just coming back to the performance first idea and just not scaring your daughter about acls and saying, oh, well, we're signing up with a trainer because it's preventative. No, you're, you're signing up with a trainer because you, you want to get better. You want to perform at a high level and, and be confident. And that could be the focus, because imagine you say to a 10 year old girl, oh, well, a c l injuries are, are at a high risk. So we're signing you up with a trainer just to make sure like you're okay. Mm-hmm. Imagine how scary that is to the 10 year old girl, like psychologically that's not going to, to be good for her. and it is kind of a victim mindset. And it's actually disempowering girls. Uh, and I want girls to be like, no, like I'm, I'm a female, which means I'm capable of, of getting strong and becoming faster and becoming more resilient. I think parents should focus on that first, and then if the performance plan is good, then injury reduction is a great byproduct, but it doesn't have to be the thing you mentioned.

Breanne 21:23

Yeah. Oh, that's good. The messaging around everything. I mean, we talk about that when parents are also introducing mental training to athletes. It's like, oh, you know, I'm gonna do this because you definitely aren't confident out there and you're really struggling. And they, it's like, oh, okay, this is, we're not fix you. And like, yeah, this is all about like, no, we, I want to empower you to do your best. You wanna get to this next level. In order to do that, you need to be strong. You need to know how to handle pressure. You know, you know, like all of these things that empower female athletes. So that messaging is. I'm really glad you brought that up.

Erica 21:54

and I think another thing is, parents also have to realize that injury can't be fully prevented. because there have been some instances where girls, they say they did everything right. And maybe they strength trained and ate well, but like, it, it is hard to do everything right because mm-hmm. We haven't even gotten into the load management piece and not playing year round. Mm-hmm. And making sure that athletes are built up to even handle that load from a running perspective. So it, you're not going to do everything right perfectly, and there is, is going to be bad luck. That might happen, but I don't want. Athletes or even parents to think, well, it was a waste to do all that. It was a waste to strength train because she tore her a c l anyway. No, it's never a waste. Mm-hmm. Because your daughter learned strength training. She learned discipline and Things happen and, and I've seen it to, to some athletes and it's, it really is devastating. But I don't want them to think that all the work. Put in was a, was a waste, and you, you just can't fully prevent it. there's so many factors at play. so you just have to try your best with the basics, right? Yeah. That's good.

Breanne 23:07

And you did mention load management a little bit, and we hit, we hit on that a tiny bit with k, the year round thing. Can you talk about that? Like you could be doing all the right things, but if your load management is off, it's all not actually

Erica 23:18

going to be helping. Yeah, so in order for us to get load management right, is we need to have objective data, so that requires wearing g p s sensors. So this just opens a whole nother can of worms. and you, you can't truly manage load unless you know exactly what's going on, how many miles they're covering in competition and practice where their heart rate is at. How many high speed runs they did. And once you know that information, then you can start to build them up for that amount of load in the off season. So you wanna build them up for that amount of mileage. And for athletes who play three games a week in the high school season, It's, the schedule does suck. I don't agree with three games a week, but if you have an off season to build up to that, they're gonna have a much better chance at being healthy and being able to plow through that crazy season. So load management becomes more about building the athlete up to handle loads that are leaving them at a high risk for injury.

Breanne 24:29

Hmm. Okay. And I mean, we see that the higher levels, I mean, we've, we've obviously seen that in baseball for years and years and years, like pitch count and in volleyball they're starting to, have the, a jump count, like a similar type of thing so that they're getting data on that. but for the athlete that's In high school and, potentially playing three games a week in volleyball. This can be like a whole, whole weekends of tournaments. And then also during the week, I don't know, maybe you're seeing something different, but I, I don't feel like they are prepared for that load.

Erica 25:00

No, no one is okay. and it's because, you know, not a lot of people are looking at or have access to that data, they don't use GPS sensors. I use Beyond Pulse. It's a chest strap that gets heart rate and tracks your distance and high speed running. It's, it's super easy and amazing to use, but, mm-hmm. Um, when we started to implement it, like I had an idea of how bad the high school season was, but when I actually looked at the numbers, I looked back at my off-season program and I was like, whoa. I could have really prepared them a little bit better because I didn't know the context of the mileage they were covering. Mm-hmm. It was, it, it was well over 15 to 20 miles a week in the high school season, and we like barely scratched that in the off season. but now we're gonna do better. But it's just like when you see it. It really puts things into perspective with how much you actually have to prepare for and train for, and that means taking a break in the off season and giving the athlete a new stimulus, a new running stimulus, a strength stimulus to build up for that again. Yeah.

Breanne 26:09

Yeah. Good. Yeah, I mean that data is important, but I also assume there's some rest that needs to come in there too, that we can't just build them up to this level that were there machines that never.

Erica 26:21

Yeah, and, and honestly, like I wish I could change the high school schedule. I mean, I wish there weren't two to three games a week, but I just don't know if it's changing anytime soon. So the only thing I can do, parents can do is make sure they take that off season in the summer or winter whenever it is for you, and really prepare for that. And then have one or two seasons where it's like go time and it's like higher load. Mm-hmm. Yeah. Love that. But it's hard.

Breanne 26:50

It is. I know we were talking offline about, like when I started coaching volleyball like 10 years ago, there wasn't asthma. I mean, they would play my athletes mostly play club, but it would be done, early spring. And then it just had like a natural flow. They had natural breaks built in. We could do some strength training. Yeah. Supplement. And now it's like they're playing club until late July and then volleyball starts in August for school and.

Erica 27:14

It's crazy

Breanne 27:16

this year they tried out for club. I mean, I know it's different everywhere, but like, they started club two weeks before our high school season ended. and I'm like, what, when did this overlap happen? Like, we used to have like a, a at least three weeks of, of break, but yeah.

Erica 27:29

It's, it's crazy. It's like we look back on like, when we play, it's like those were the good old days. Yeah, totally.

Breanne 27:36

It was, I like missed, I had like an opportunity to like miss volleyball

Erica 27:39

back then. And that's key too, that that mental side of it is eventually you can burn out from something you enjoy doing. Um, and kids do need that mental break to miss their friends, miss their sport, miss practices, and then come back with more passion than ever before.

Breanne 27:58

Yeah. Yeah, totally. The good old days. Okay, well, we'll just do, we'll work with the changing landscape and, yeah. Well, thank you, Erica. Is there anything that I. Didn't ask that I maybe should have on this call. I mean, you have a welcome information.

Erica 28:15

I, I think that that really covers it and just Yeah. Really encouraging parents to get their girls to just work on the basics, focus on performance, focus on empowering them and don't, don't walk around fearing injury. Mm-hmm. It's, it's going to destroy them mentally and it's not going to show well on the field or court either.

Breanne 28:38

Yeah. Yeah. I mean that just quickly to, we see down the mental side too, when you try to avoid the mistake or avoid the injury, you actually put yourself at more risk because now you're hesitating, you're using different form that you wouldn't normally do. Yeah. You put yourself in situations that actually bring the, the injury or the bad thing

Erica 28:58

on, so it's so true. Yeah. The, the mental manifest into the physical and it just, it doesn't end well. Yeah.

Breanne 29:05

Cool. Well, thank you again, Erika. Where can our parents

Erica 29:09

find you? I'm just on Instagram and Twitter at Fit Soccer Queen. And then from there you can buy my website.

Breanne 29:17

Cool. Awesome. Well, thank you again and look forward to chatting. We'll probably bring you on again for another topic in this area because you, again, like I said, have a wealth of knowledge, so thank

Erica 29:27

you. Thank you.