ACL Injuries in Athletes: Why Female Athletes Are at Higher Risk (and How to Prevent Them)
Anterior cruciate ligament (ACL) injuries are one of the most serious and common sports injuries. They can take athletes out of the game for months and may even impact long-term mobility. That sounds frustrating—and for many athletes, it is. The good news? Many ACL injuries are preventable with the right approach. In this guide, we’ll break down what the ACL does, why female athletes are at higher risk, how these injuries happen, and what you can do to prevent them naturally and effectively.
What Is the ACL and Why Is It Important?
The ACL is one of the key ligaments in your knee. It connects your thigh bone (femur) to your shin bone (tibia). Its main job is to stabilize your knee during movement, prevent your shin from sliding forward, and control rotation during cutting, pivoting, and jumping. When the ACL is injured, athletes often feel a sudden “pop,” followed by swelling and knee instability or giving out.
Why Are Female Athletes More at Risk for ACL Injuries?
Research shows that female athletes are 2–4 times more likely to experience ACL injuries compared to males in similar sports. This increased risk is due to a combination of factors rather than a single cause.
1. Anatomical Differences
Female athletes may have a wider pelvis (greater Q-angle), increased inward knee movement (valgus), and structural differences in the knee joint. These factors can place more stress on the ACL during dynamic movements.
2. Hormonal Influences
Hormones like estrogen can affect ligament flexibility and joint stability. While this relationship is still being studied, it may contribute to increased injury risk.
3. Movement Patterns (Biggest Opportunity for Prevention)
Female athletes are more likely to land with straighter knees, show inward knee collapse, and rely more on quadriceps than hips. These patterns increase stress on the ACL—but the encouraging part is that they are trainable and correctable.
4. Strength Imbalances
Common issues include weak hamstrings, weak glutes, and poor core stability. These muscle groups play a key role in protecting the knee during high-level activity.
How Do ACL Injuries Happen?
Most ACL injuries are non-contact, meaning they don’t come from a hit or collision. They typically occur during sudden stops or deceleration, cutting or pivoting, jumping and landing, or rapid direction changes. High-risk sports include soccer, basketball, volleyball, football, and skiing.
The Most Important Takeaway: ACL Injuries Are Preventable
This is where real progress happens. With the right training, athletes can significantly reduce their risk of injury.
Key Prevention Strategies
1. Neuromuscular Training
Focus on balance, coordination, and proper landing mechanics to help retrain the body to move safely and efficiently.
2. Strength Training
Build strength in the hamstrings, glutes, and core to improve joint protection and stability.
3. Plyometric Training
Helps athletes absorb force properly, control knee alignment, and improve explosive coordination.
4. Movement Awareness
Coaching proper form during cutting, jumping, and landing is one of the most effective ways to reduce injury risk.
Why Physical Therapy Plays a Key Role
Physical therapy is not just for recovery—it’s a powerful tool for prevention. A licensed physical therapist can identify movement imbalances, improve strength and stability, correct faulty movement patterns, and guide a safe return to sport. At Hohman Rehab, every patient receives one-on-one care focused on finding the root cause—not just treating symptoms.
Long-Term Impact of ACL Injuries
Without proper care, ACL injuries can lead to a higher risk of re-injury, decreased athletic performance, and early joint wear and tear. This highlights the importance of prevention and high-quality rehabilitation.
Final Thoughts
ACL injuries can feel overwhelming, but there is a lot you can do to stay ahead of them. Focusing on movement quality, strength, and control allows athletes to reduce risk, improve performance, and stay active doing what they love.
Ready to Protect Your Knees and Stay in the Game?
If you’re dealing with knee pain, recovering from an injury, or looking to prevent one, we’re here to help you on your path to wellness.
Call (407) 410-3200 or visit www.hohmanrehab.com to schedule your appointment today. 📍 Apopka: 125 S. Park Ave. | 📍 Ocoee: 11095 W. Colonial Dr. | 📍 Clermont: 236 Mohawk Rd.
References
Herzberg, S. D., Motu’apuaka, M. L., Lambert, W., Fu, R., Brady, J., Guise, J. M. (2017). The effect of menstrual cycle and contraceptives on ACL injuries and laxity: A systematic review and meta-analysis. Orthopaedic Journal of Sports Medicine, 5(7), 1–9. https://doi.org/10.1177/2325967117718781
Kotsifaki, A., Whiteley, R., Van Rossom, S., Korakakis, V., & Jonkers, I. (2023). Single leg hop for distance symmetry masks lower limb biomechanics: Time to discuss hop distance as decision criterion for return to sport? British Journal of Sports Medicine, 57(10), 633–640. https://doi.org/10.1136/bjsports-2021-105057
Sugimoto, D., Myer, G. D., Bush, H. M., Klugman, M. F., & Hewett, T. E. (2017). Effects of neuromuscular training on ACL injury risk reduction in female athletes: A meta-analysis. British Journal of Sports Medicine, 51(5), 1–8. https://doi.org/10.1136/bjsports-2015-095596
Webster, K. E., & Hewett, T. E. (2019). What is the evidence for and validity of return-to-sport testing after anterior cruciate ligament reconstruction surgery? Sports Medicine, 49(6), 917–929. https://doi.org/10.1007/s40279-019-01093-x
Written By:
Sydney Timmes, PTA
Physical Therapy Assistant
