Why Women Are 2-10 Times More Likely Than Men To Tear Their Anterior Cruciate Ligament

Anterior cruciate ligament (ACL) injuries are a common and debilitating injury in sports, and unfortunately young women are more susceptible to a torn ACL compared to men. But Why?

Why are we seeing more and more female athletes tearing their anterior cruciate ligament?

What can women do to reduce their risk?

In this article, we uncover the factors behind this gender disparity and provide valuable insights into what women can do to reduce their risk. By understanding the anatomical, hormonal, neuromuscular, and biomechanical factors at play, as well as the importance of training and prevention strategies, we can pave the way for safer athletic experiences and a lower incidence of ACL tears in women.

Let’s take a closer look at these variables:

Anatomy and hormonal differences

There are anatomical and hormonal variations in women that affect the knee joint. With a wider pelvis, a greater Q angle, and hormonal fluctuations at the forefront, the delicate balance of ligament laxity is noticeably affected, making women more susceptible to the dreaded ACL tears.

A larger Q angle, between the natural width of the hips and the narrower knee position, is thought to place more stress on the knee than a more vertical hip-to-knee-to-foot alignment. This added stress, combined with the forces already placed on the ligaments during twisting and playing sports, may increase the risk of tearing in women with a larger Q angle.

Hormonal fluctuations, particularly related to the menstrual cycle, are also thought to contribute to susceptibility to ligament tears. Research has yet to confirm this theory, although many experts believe there is some correlation, even if it is not yet fully understood.

Neuromuscular imbalances:

Neuromuscular control refers to the communication between the brain (nervous system) and muscles and is responsible for actions such as responding to a stimulus or controlling body movement. Neuromuscular control deficits are more pronounced in young females compared to their male counterparts… and these imbalances can create a perfect storm for injury. Most commonly seen is a relative weakness in the hamstrings compared to the quadriceps, decreased core stability, and less controlled mechanics during landing. These imbalances place added stress on the ACL during dynamic movements, contributing to a greater likelihood of a tear.

While the ideal ratio of quadriceps to hamstring strength is around 3:2, certain women typically exhibit a range closer to 3:1. This lack of hamstring strength hinders the muscle group’s ability to contract effectively and maintain proper knee joint alignment, a problem that is particularly prevalent in adolescent women. Implementing exercises to improve neuromuscular imbalances is crucial to reducing your risk of injury.

In scenarios where the core, hamstrings, and hip stabilizing muscles do not have sufficient strength and stability to maintain optimal joint alignment, female athletes subject their knees to significant forces while performing cutting, pivoting, and landing maneuvers. A force on the ACL that exceeds its capacity will result in a ligament injury.

Biomechanical differences:

Biomechanical differences in women can affect optimal sport-specific movements such as landing mechanics. A common occurrence in women is an increased tendency for knee valgus, an inward collapse of the knee, during actions such as landing or cutting. This alignment places excessive stress on the ACL, increasing the risk of injury.

Research also suggests that women may have relatively smaller and weaker ACLs compared to their male counterparts. This disparity in size and strength may compromise the ligament’s ability to withstand the forces encountered during dynamic movements, making it more susceptible to injury.

Sports participation and injury risk:

Women’s involvement in high-risk sports such as soccer, basketball, gymnastics, and skiing significantly increases the risk of ACL tears. These sports, characterized by activities

Movements such as cutting, planting, pivoting and landing naturally increase susceptibility to injury.

The problem is further compounded by the fact that many young women participate in these risky sports without proper training or preparation, further increasing the risks.

Training and prevention strategies:

Training opportunities and injury prevention strategies may not be accessible to all athletes. It is critical for female athletes to have access to specialized training programs that prioritize improving neuromuscular control, strength, and proper movement mechanics when they begin participating in sports, because even the right exercise, done incorrectly, can actually set you back more susceptible to injuries.

Historically, men have had the advantage of getting stronger earlier, leading to a lower risk of injury in their careers. When female athletes are given the same opportunity to strengthen and train their bodies, they also experience a lower risk of injury.

So…How do I reduce the risk?

Understanding the factors that contribute to the increased susceptibility to ACL tears gives female athletes the opportunity to proactively implement measures to prevent these injuries. (For more insight, download the FREE report on why injury prevention programs are ESSENTIAL for female athletes playing collegiate sports.)

By emphasizing the importance of tailored training, promoting neuromuscular balance, and implementing injury prevention strategies, women are empowered to minimize their risks and pursue their athletic ambitions with unwavering confidence.