Female Athletes and Knee Injury

Mike Darnell, PT

August 2009

As the 2009-2010 school year begins, so does the escalation of sports participation by middle and high school female athletes.  Over the many years that North Georgia Physical Therapy has provided local area high school sports coverage, we have placed special emphasis on the prevention and treatment of knee injuries to female athletes – and for good reason.  Females are 3 to 5 times more likely to injure the anterior cruciate ligament (ACL) than their male counterparts!  Anatomy and physiology unique to the female are the primary factors responsible for the gender bias when it comes to knees.

  •  During cutting, landing and squatting tasks, females typically do not bend their hips and knees adequately enough to absorb the shock through their joints.  They also tend to bend their legs into a “knock-knee” position rather than keeping their knees aligned with their hips. (see illustrations below)
  • The female knee muscles react more slowly in anticipation of starting and stopping during cutting, landing and squatting.
  • The female ACL is smaller in length, width and volume compared to males, even after adjusting for body size.
  • The female ACL is less taut and more prone to failure, even during normal activities when there is no unusual physical stress on the knee.  This is likely due to the female ACL having less collagen fiber than males.  Collagen fiber helps “toughen” the ligament.
  • The mechanical and molecular properties of the female ACL are influenced by estrogen as well as the interaction of several sex hormones and other biochemical properties which weaken the ligament.  

So what it boils down to is that when a weaker ligament is exposed to body forces during less than desirable hip/knee/ankle positions and movement patterns during cutting, landing and squatting, then injury is more likely to occur.  The silver lining in all of this is that training methods that focus on changing muscle activation patterns and correcting lower limb alignment during cutting, landing and squatting activities will reduce the likelihood of injury.  North Georgia Physical Therapy Associates has free printed training programs available for any female athlete seeking help in this matter.  Stop in at one of our three area clinics for your copy.  Please call ahead so we can arrange for one of our staff members to be available to take your athlete through the exercises and discuss an appropriate training regimen.

Our Locations

Ellijay, Georgia
97 Hefner Street
Suite 100
Ellijay, GA 30540
Tel: (706) 635-1440
Fax: (706) 635-1439

Blue Ridge, Georgia
5425 Appalachian Highway
Suite 2
Blue Ridge, GA 30513
Tel: (706) 632-8535
Fax: (706) 632-8485

Copperhill, Tennessee
144 Medical Center Drive
Bldg. A
Copperhill, TN 37317
Tel: (423) 496-4390
Fax: (423) 496-4392

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