- I am very active.

When I was playing soccer, during school season, I was practicing every day of the week.

I do soccer stuff on my own.

I go to the SAC, workout with my dad a lot.

That's one of our things that we do is like family workouts all the time.

- [Stefanie] Sports are a big part of Grace's life.

- I usually do track, I didn't do it last year, because I was focusing on playing varsity soccer, but I've played track.

I played volleyball for a year in middle school.

I played basketball, so I've done a lot.

A lot of hangouts with friends and family.

I love watching sports too.

- [Stefanie] Watching sports is as close as she gets to playing right now after a normal practice took her off the pitch.

- It was five minutes of practice left, so we were just doing, I think it was just a short-sided scrimmage sort of thing with small goals, like very simple, and me and another girl were both going after the ball at the same time and I stepped, like I stopped myself like with a step with my right leg and it twisted weird, and I heard a pop and I fell to the ground.

At first, I didn't think it was gonna be too bad, but I stood up, and when I stood up, my leg couldn't support itself.

So every time I took a step, it would snap back and it couldn't support my weight.

So I think once I got up and started walking, I knew that it was bad, but I just didn't wanna believe it.

- [Stefanie] Grace tore her anterior cruciate ligament, more commonly known as the ACL.

The ACL is a band of tissue that connects the femur or thigh bone to the tibia or shin bone in the knee joint.

- So the ACL is one of the main ligaments in the knee, and it's not a ligament you need to do simple tasks or inline tasks.

So walking, running in a straight line, cycling, swimming, all those things you can do just fine without an ACL.

But the ACL really keeps the knee stable when you're doing cutting, pivoting, jumping and landing type activities.

So that's why we see it most commonly in those sports that involve a lot of that activity, things like soccer and lacrosse and basketball and football.

Because when an athlete goes to do a quick cut or a pivot, the ACL is put under stress, and if the forces on that knee and the way the person's moving is just not ideal at that time, that's when they're set up for an ACL injury.

- [Stefanie] With every sport and activity comes the risk of getting hurt.

But there's research that shows girls have a higher chance of ACL injuries then their male counterparts.

- ACL injuries used to be a lot more common in boys, just because more boys were involved in sports.

As the participation in girls in sports increased, we started to see that girls actually have a higher risk of injury for an ACL tear compared to boys.

And it's about a 1.5 fold increase in that adolescent or high school-age athletes.

And there have been some studies even that show up to a four or eight times risk of these ACL injuries, depending on the sport.

It has to do with a lot of different factors.

So, some of it is anatomical, that girls tend to have a smaller notch, the part of the knee where the ACL lives, and that can predispose them to the ACL tears.

They also tend to have alignment of their legs.

That's what we call more valgus, meaning their knees are closer together, like a knock-kneed appearance, and that puts you at a risk for ACL tears.

And then, they tend to have a little more flexibility or laxity in the knee, and that's even related to hormonal changes.

So, estrogen is a hormone that can have an impact on the ACL, and when the estrogen levels peak, especially during certain phases of the ovulatory cycle, that can increase the laxity of the ACL, make it more loose and potentially more prone to injury.

And then finally, we also see just the muscular balances are different between girls and boys in that girls tend to be more quadriceps dominant, and their hamstrings are weaker relative to their quadriceps, whereas it's a better balance in males.

And because the hamstring tendons are a good protector of the ACL, that relative weakness be a problem for them.

So, there are a lot of different factors that can go into it and it's always hard to predict which girls are gonna have the ACL tears and which aren't.

But we know that there is definitely a propensity for them to be more susceptible to it.

- Being active, playing sports, it's all really important for our wellbeing, but with a heavier focus on competition, more athletes are finding themselves in harm's way.

- I wouldn't say that necessarily the ratios of men to women have changed, but as overall participation has increased, the number of athletes coming through the door is higher.

There's more people playing.

The seasons are longer.

The demands, I think, are higher than they have ever been at younger ages.

And I would say the thing that I've noticed more than just people being injured more frequently is the number of younger people that I'm seeing come through with things that aren't necessarily traumatic injuries, but just use and overuse type of of injuries, especially in growing kids, kids that are really pushing the limits as their bodies are changing drastically.

- The biggest thing that's changed, I think, is the intensity of the sports participation and how often it is year round, and even starting at a pretty young age.

So, sports sampling is something that's really big in our field, especially in the pediatric sports medicine world, where we've learned that having kids, especially in their ages of growth, participate in multiple sports, so different types of sports where they use their bodies in different ways, that helps with those neuromuscular connections and development so that their body doesn't only develop in a certain way or to help them with certain tasks.

And so the sport sampling not only can help with their growth and development, physical development, but it can also reduce the risk of some types of injuries, especially the over-use injuries that tend to come when people are getting involved in a sport year round, at a high level, and when their bodies are still growing and developing.

- [Stefanie] Studies show some athletes are just more susceptible to injuries, but there are ways to help protect from them, like playing multiple sports, because different activities require different muscle movements.

- I think there are some things that we don't always focus on, because they're not seen as directly related to good performance in the sports.

But we're learning that they are really important to having the right body mechanics and protecting yourself from injury.

Some of those things are flexibility and core strength and stability.

So, especially, I feel like in the middle school-aged athletes and the middle-aged athletes, sometimes the stretching gets pushed off to the side.

You know, the younger kids just wanna get going and start playing their sport and doing things, and so stretching, if it even happens during a sport, is usually kind of an afterthought or rushed through.

And then in middle age, sometimes, even though we understand the need for stretching, we have such a limited time to get it done that you wanna just get going.

And then core stability is something that even came out, I think, when I was an athlete, is just becoming more of a focus in protection.

Your body weight all above your lower extremities will affect what happens to your knees, to your ankles, to your hips, all of that.

And so, people can have really strong legs, but if they can't control what happens with the top half of their body as they're moving through space and doing all these complex maneuvers, that can really throw off the movement of their joints below too.

- There's no 100% prevention, but you can substantially decrease the risk of injury by having a robust and comprehensive program that addresses the major factors that would put you at risk being strong enough, being agile enough, having good neuromuscular control and having quality movement that mitigates some of the positions or the forces that are most likely to lead to injury.

(people speaking indistinctly) - [Stefanie] Grace's injury required surgery.

She spent the past few months in physical therapy.

- I think the first time I went to physical therapy was probably a week after surgery.

A lot of the exercise I did, stationary exercises, the main ones that I did were leg lifts and then just sitting on the ground with my legs straight and flexing my quad, 'cause I lost so much quad muscle.

I think PT is really gonna help me building the muscle and getting the strength back into my legs.

And also, later in recovery here at PT, I'm gonna learn how to fall correctly so you don't injure yourself in situations where you could try to keep yourself up instead of falling, you might as well just fall and not take the chance of injuring yourself.

- The things that really need to happen in terms of recovery and successful recovery from an ACL in particular are just consistency.

It's very, very much the same as any other preparation that you would do for sport, aside from an injury, is just be consistent with the things that you need to do in order to be prepared in every facet of the game.

When it comes to rehab, it's building strength, building power, agility, stability through the system, not just through the knee, but through the trunk and supporting the hips and through the entire lower extremity, how you're transferring forces and accommodating at all different types of demands.

And she's up every day, and she's doing the right things.

She's pushing hard, and she's staying committed outside of here.

In order to have a successful rehab, it takes a lot of effort consistently over nine plus months in order to be ready psychologically once you get back to the point at which it's time to go.

- [Stefanie] Recovery time for injuries is different for everyone.

And it's not just getting back physically that can be a challenge, it can be a struggle mentally too.

But there are ways athletes can feel supported even if they can't play yet.

- Their friends are all soccer players and their teammates.

And then if they get an injury where they can't be playing with their team for half a year or a year, that has a huge toll on them, and it can lead to anxiety and depression and questioning of their identity and all those sorts of things.

It's important to reengage these athletes with their teams in safe ways along the way.

So where it used to be like, you're out of sports, you can't go see your soccer team, you need to stay away, because we don't wanna risk you doing something more than you're supposed to.

Right now, we work a lot with patients to say, "Okay, you're at a stage where maybe early on, "all you're doing is going to the practices "and helping out as an assistant coach or a manager "or just kinda bringing the balls around "and being there to support your teammates.

"But later on you may be able "to do some of your PT exercises on the sidelines, "so that you're there and stretching with them.

"And then you may be able to do "some of the conditioning with them, "but you just stay out of a contact activity."

So we try to work that in, so that they can still feel part of the team, they can still feel like it's part of their identity, but also do it without putting themselves too much at risk.

- Maybe the most important thing is just having a solid support system around you, family and friends and coaches that have your back.

If you're going through it and you feel like, man, I'm already going through this, and it's a long process to begin with and doing all this work behind the scenes, no one knows, and it can get quite lonely.

But to have friends and family and coaches that are behind you, I think, is probably the biggest, positive thing you can have going for you as someone who's trying to bounce back from a major injury.

- [Stefanie] Experts agree the benefits of playing sports, a healthy and active lifestyle, are all critical pieces for our overall wellbeing.

But, sometimes there are really important lessons that are learned off the court or the field that can also make a difference in someone's life.

- Sometimes I think these things help us grow and find new roots that we wanna follow that we may never have known about otherwise.

But I would just encourage, especially the young women, to not give up on their sports involvement when they see some of these challenges.

Let it take them wherever they're gonna go and whatever new route they may find, but there are so many huge benefits between your physical health, your mental development, your resilience, your friendships.

For me, just seeing so many women and girls engaged in sports is really an exciting thing.

- I'm trying not to focus in on it at all, because I don't want to let that fear affect me playing sports again, 'cause I'm just gonna play sports and I'm gonna enjoy it, and I'm not gonna let it make me not play sports, because it's either you sit outta sports with the fear of it or sit outta sports with it happening again, but after you've already went back to playing sports.

So I'm not letting it come into my head at all.

I'm not letting it control me.