Written By: Morgan Vasiliu

There is no doubt that rupturing an ACL is one of the most common injury rates in athletes, as it accounts for more than 50% of all knee injuries. 1 But is not often mentioned that females incur a 3-6x higher rate of suffering from one of these season-ending injuries than their male counterparts.

In fact, rates of females tearing an ACL have not changed in 20 years, yet we have seen a steady drop in male rates of injury. 2 This difference in occurrence has often been chalked up to the anatomical differences from male to females – females have different hormones, different structural build, and overall different anatomy than males. While this may be true, it doesn’t quite tell the whole story.

ACL injury can be broken into two categories: contact and non-contact. Contact injuries occur when there is a direct contact resulting in the rupture. Non-contact injuries occur indirectly when the athlete is slowing down or when they try to plant a foot and change direction because these multi-directional movements place a high strain on the ACL. And research would support this. Between male and female athletes, the biomechanics at the moment of injury tear is nearly identical. 2

So why do we continue to see 3-6x higher injury rates in females if the mechanism for injury is the same?

Reasons Why ACL Tears Are More Common in Women

Not only do females have different anatomical and physiological structure than males, but they also face different obstacles when it comes to training and preparing for sport:

• Strength training: females are less likely to participate in strength training: only about 24% of college age women in the US meet the strength training recommendations compared to 43% of men 3

• Avoidance of weight gain: females often avoid weight training due to negative associations gaining muscle and “getting bulky” with weights vs. the positive societal association with cardiovascular training and losing weight. 4

• Lack of female strength & conditioning coaches: Strength and conditioning coaches are largely male (83.5% vs. 16.5% of female coaches) and research shows that same-gendered coaches and athletes not only have better relationships, but it also improves the athletes overall physical performance. 5

Why Women Need Strength Training

So where does the importance of strength training come into play regarding sport and specifically ACL injury in women? Specifically in females, weaker lower extremity muscle strength has shown to be a predictor of traumatic knee injury – specifically the ACL. 2 There has also been some evidence to suggest that the ACL volume has a significant relationship with quadricep muscle volume. 2

Further, women who undergo ACL reconstruction are shown to have greater knee laxity, lower reported knee function, and a lower chance of returning to sport in comparison to men. 6 So not only is getting them in the weight room and training on a more consistent basis going to decrease their risk of injury, but it will impact their ability to stay and compete in their sport.

ACL Tear Prevention for Women

Get females athletes in the weight room early and often

If the primary difference between men and women is their training environments and the frequency of women being in the weight room, the primary focus moving forward should be to enable female athletes to get in the weight room.

This includes encouragement from coaches to have athletes in the weight room in both the off-season and even during season, as well as encouragement from other adults in the athlete’s life – parents, health coaches, teachers, etc. so that female athletes understand the importance of training early and often.

Check-ins with your healthcare team

Not only should athletes be having an annual physical with their primary care physician, but they should also be getting an annual check-in with their physical therapist. The primary purpose of this would be to ensure that an athlete is not only healthy to compete but does not have any glaring movement limitations, such as decreased strength or range of motion that could lead to potential injury down the road.

Change the narrative

Much of the difference in ACL injury rates from females vs. males have been attributed to factors that cannot be changed. What I hope you took away from this article is that there are many modifiable factors that we can affect to decrease female’s risk of rupturing an ACL, and it is time we start to change the narrative around female athletes ACL tear rates, so that in the next 20 years, we see this rate drop.

To learn more about Move Strong Physical Therapy in Hudson, MA, visit our About Us page. We invite you to read more on ACL injury prevention.