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Why are female athletes more prone to certain injuries?


by Heather Cichanowski, MD, CAQ, primary care sports medicine physician

I work at TRIA as a primary care sports medicine physician. Every day, I see a wide range of active females – from high school basketball players to avid aerobics enthusiasts – all with their own degrees of aches and pains.

Of course, each woman’s case is unique, but certain sports injuries definitely appear in my exam room more often than others. Which begs the question – why are certain injuries more common in women than in men?

Let’s take a look at the injuries that I see happening frequently to active women – especially ACL injuries, kneecap pain and stress fractures. I’ll go into the reasons why certain injuries may be more common and what women and girls can do to protect themselves.

What types of injuries are more common in female athletes?

Let’s start with the injuries that physicians are seeing more frequently in active women:

  • ACL tears
  • Kneecap pain
  • Stress fractures
  • Tendonitis
  • Shin splints
  • Ankle sprains
  • Plantar fasciitis
  • Joint pain due to joint hypermobility

Of course, plenty of men visit exam rooms with these injuries, too. However, physicians like me are seeing a larger amount of active women with these ailments than men.

Why are female athletes more prone to these injuries?

There are plenty of factors why – some widely understood, some still being researched. But for every injury, regardless of the situation, it all comes down to a simple truth: women are just built differently. From bone structure to hormone makeup to general movement, women have bodies that are both similar to and distinctly different from men.

And while our knowledge of the male body is vast, we’re only beginning to truly understand how the active female body works – especially how her different systems interact with each other. It’s these findings that are answering the questions of why certain female sports injuries are more common.

A shot right to the knee – ACL injuries and kneecap pain

When it comes to one of the more common women’s sports injuries, all I need are three letters: A, C and L. The anterior cruciate ligament, or ACL, runs through the middle of your knee, connecting your thighbone to your shinbone. Working with other ligaments, the ACL is a major stabilizing structure of the knee.

As you can imagine, a lot happens at this intersection. Think of the impact this joint takes when jumping, pivoting or doing other movements. It all puts a lot of stress on the ligament.

But it’s not just your ACL – your kneecaps can also bring you to your … well, knees. I also see a good amount of unstable and painful kneecaps in women. Your kneecap rides in a track that’s located at the bottom of the thigh bone. If this track is shallow, which is seen more often in females, certain motions can cause the kneecap to start to jump the track leading to instability.

Why are kneecap and ACL injuries more common in female athletes?

Not only are ACL injuries common in women, they’re much more frequent compared to men. In fact, studies show these injuries are up to six times more common among women than men.

How women land from a jump may be one reason why. Female athletes tend to land a jump with their bodies more upright and their knees pointing inward. This type of landing puts more stress directly on the knee joint, taxing the ACL inside.

Beyond the knees, the muscles involved in landing a jump add another factor. Female athletes tend to rely more on the quadriceps during a landing. Bypassing the hips and hamstrings, your quads provide only a narrow target for impact. Unfortunately, your ACL and kneecap get hit with the extra energy that the quads can’t fully absorb.

Researchers are also looking into other possible causes like bone structure and muscle development. However, for active women like you, knowing how to protect your knees from injuries is at the heart of the issue.

Preventing ACL and kneecap injuries 

Fortunately, there are several things you can do to avoid the pain of knee injuries:

  • Watch your landings – Take note of how you land on your feet after a jump. Try hitting the ground with more flexibility in your hips and knees to help cushion the impact. Keep your knees pointing forward and try to use your hamstrings along with your quads to absorb energy.
  • Add exercises for your hips and glutes – Strong hips and glutes can help protect knees from injury.
  • Wear the right shoes – Don’t rely on just your body to take the blows. Wear shoes with good support and shock absorption. In addition, exercise on surfaces with some give.

These are the breaks – stress fractures

I also see plenty of girls and women with stress fractures in my exam room. These are the small cracks in bone that make life miserable, caused by repetitive movement and abrupt changes in training. For female athletes, stress fractures show up more in the lower legs and feet than anywhere else.

Why are stress fractures more common with women?

As with ACL injuries, stress fractures can happen more frequently in women due to a variety of reasons, including body movement, muscle imbalances, hormonal influences, bone health and nutrition.

Bone health is so important for women, especially as they age. Women already face a dual whammy – smaller, thinner bones than men, and the role estrogen plays in bone development and maintenance. That’s why eating right and having a good training balance are both important.

Enter the female athlete triad. You also may have heard of Relative Energy Deficiency in Sports (RED-S) syndrome, a newer concept that expands on the female athlete triad and includes male athletes, too.

This syndrome is a combination of underfueling (also known as undereating), menstrual cycle irregularity and low bone mineral density. In short, when a woman isn’t getting enough food and nutrients to replace what she takes out through exercise, a domino effect happens that throws her body’s systems out of balance.

Left too long without treatment, this combination of conditions can cause a reduction in bone density that increases the risk of stress fractures in women. But the good news is that, if caught early, this and other potentially serious health issues can be prevented.

Preventing stress fractures

Many of the same things that can help prevent knee injuries also apply here – taking note of how your body moves, adding the right strength exercises and wearing the right gear. Here are some additional tips to help avoid stress fractures:

  • Eat the right fuel – Like we mentioned, underfueling can lead to stress fractures in women. Make sure that you’re eating the right number of food for what you expend through activity. Keep that intake balanced with an adequate amount of carbohydrates, proteins and fats.
  • Make sure you’re getting the nutrients you need – Calcium and Vitamin D are absolutely essential to good bone health. Dairy, leafy greens, fish and eggs should all be on your plate.
  • Switch up your routine – Many stress fractures are caused by the same force applied repeatedly to the same area of the body. When bones receive constant force without time to rest and recover, they become weaker and more prone to fracture. Make sure that your workouts have a diverse mix of movement and conditioning across all areas of your body so that other parts can rest and regenerate.

What to do when – or before – you get hurt

Fortunately, our Women’s Sports Medicine team is ready to help with whatever concerns or injuries are on your list. You don’t need to be an elite athlete to take advantage of specialized sports medicine and orthopedic care. Whether you’re experiencing something new or recovering from an injury, we have the expertise and compassion to help you excel at doing what you love.

To make an appointment with a dietitian, give us a call. To make an appointment with a sports medicine physician, call or make an orthopedic appointment online.

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