Strength training and working to improve balance are ways to try to prevent ACL tears, Rinehart says. Flexibility is important, and Rinehart recommends a good stretching regimen before and after any sports.
Blair recently led a semiweekly Performance Enhancement program for six weeks at Total Rehab Care. The program - designed to improve speed, agility, strength, jumping ability and awareness of posture, movement and balance - is aimed at long-term injury prevention.
Several high school athletes and one "nontraditional" student attended - working to increase their vertical jump, learning better landing techniques, building skills and awareness - all with an eye on preventing injuries.
By the fourth week of the program, Ashley Plume had added an inch to her vertical jump. The 15-year-old Williamsport High School sophomore played on the school's junior varsity volleyball team last year.
She had a stress fracture of her tibia at the beginning of the season but ignored it because she wanted to play. A cyst built up and needed attention. She couldn't play for six weeks.
Ashley says she came to the program to "strengthen up" and prevent that from happening again.
Jenna Smith, 14, will be a freshman at Broadfording Christian Academy. A soccer player, she's already experienced a strained ACL. Despite having to wear a brace to protect her knee when she plays, Jenna says she can't see not playing sports.
Neither can Caitlin Nicewarner, 15, who plays volleyball and basketball at South Hagerstown High School. She's also been injured - a pulled ligament and dislocated kneecap in 2001. "It's not getting any better," she says. "It's been hard to jump."
Caitlin, who has been playing basketball since she was 8 or 9 and volleyball since she was 10, wants to learn how to land. "I can't imagine not doing sports," she says.
Krista Bonds can. Although Title IX, the 1972 law that prohibits sex discrimination in federally funded education, already was in effect, opportunities were not equal by the time Bonds graduated from Clear Spring High School in 1987. There was no girls' soccer team, so she tried out and made the cut for the boys' squad when three guys didn't.
"It's supposed to be for enjoyment and competition," she says. But she says she was harassed, so she opted not to play.
Bonds, 33, a former "Lady Blazer," played basketball on the girls' team at Clear Spring High School. She also went on to play basketball at Garrett Community College in McHenry, Md.
Bonds, married with four children ages 5 to 12, signed up for the program at the rehabilitation center because she wants to be a coach.
"I want to make sure I know what I'm doing before I jump in there," she says.
"This (learning about training and injury prevention) is a big difference from when I was in high school," she says. She had sports injuries, got taped up and played. She recalls wearing a brace, being swollen and black and blue, being iced before and after games in college.
Title IX has enabled the increase of women's participation in sports by more than 400 percent at the college level and more than 800 percent at the high school level over the past 30 years, according to information on the Web site of the Women's Sports Foundation at www.womenssportsfoundation.org.
If conditioning and training are inadequate, injuries can increase along with participation.
The Performance Enhancement program placed a strong emphasis on home exercise and total fitness - not just a twice-a-week workout.
"I see a low level of basic fitness in a lot of female athletes," says Marlys Palmer, professor of health and physical education at Hagerstown Community College. Palmer coached the school's volleyball team for 21 years and will start her 24th season coaching HCC women's basketball this year.
She's seen a low level of conditioning in some of her players. Some think they can slide into a sport without preparation. They don't do anything other than playing the sport in the sport's season, assuming that the sport will condition them. That sets them up for injuries, she says.
Good health and strength require a year-round effort.