Why are ACL Tears and Knee Pain More Common for Women?

Authored by Jessica Keiser, PT, DPT, CSCS with ATI Physical Therapy 

Did you know that tearing the ACL is a fairly common injury for females? In fact, women are 2.4 to 9.7 times more likely to suffer from ACL injury when compared to men of similar competition and training levels. There are many contributing factors that predispose women to tearing their ACL’s; however, the main factors include:

  • Wider pelvis
  • Larger Q-angle
  • Narrow notch
  • Smaller ACL
  • Hormones/laxity Weakness/muscular imbalance

Generally, women have wider hips than their male counterparts in order to give birth. The wider pelvis creates a larger Q-angle at the knee, which often results in a more “knock-kneed” posture in women. This posture frequently leaves the ACL more vulnerable for injury.

ATI Physical Therapy discusses increased risk of ACL injuries in womenWomen also have a smaller intercondylar notch, through which the ACL passes. Because this structure is smaller in women, it is theorized that the ACL may become weakened during higher activity movements. The ACL itself is also smaller, which may predispose it to increased fraying.

In addition, women experience hormonal changes monthly because of their regular menstrual cycle. The changes in estrogen, progesterone, and testosterone have been linked to changes in ligamentous laxity, which can be problematic when completing cutting and jumping type exercises. If a ligament in the knee is lax, the structure of the knee joint may become compromised with a loss of support, which may lead to increased injury to the ACL.

Lastly, women generally have greater weakness in their hips as compared to men. The weakness in the hips contributes to poor pelvic stability during activity, which leads to poor alignment at the knee. When the knee is not properly supported during activity – jumping, running, cutting, etc. –  it is more predisposed to injury. Additionally, most women tend to overuse their quadriceps muscles, which can create muscular imbalance. Proper strength training for glutes and hamstrings is imperative to avoid overuse of the quadriceps during exercise.

Injury Prevention

The key to avoiding knee pain with sports or exercise is maintaining adequate glute strength. Good glute strength is essential for proper knee stability during dynamic activities such as jumping, running, or cutting. Strong glutes prevent the knees from turning in a “knock-kneed” or valgus posture. Try some pilates or contact your physical therapist for appropriate hip/glute strengthening exercises.

Another key to injury prevention is the maintenance of strong trunk muscles, often referred to as the “core.” These are made up of the Transerve Abdominus, Recuts Abdominus, Internal Obliques, External Obliques, Diaphragm, and Pelvic Floor. If there are weaknesses in any of these core muscles, it is likely that the body will compensate, which could result in increased knee pain.

Lastly, the importance of good hip mobility and overall flexibility cannot be forgotten. It is crucial to maintain proper length-tension relationships of the muscles for optimal force production during dynamic activity. Proper stretching of the hamstrings, quadriceps, hip flexors, and calves are all necessary. Try a yoga class or consult your physical therapist for other stretching exercise ideas.

If you are experiencing aches and pains in your knees, or are concerned that you may have injured your ACL, stop by and ATI Physical Therapy location for a Complimentary Injury Screening.  ATI can evaluate your injury and provide you with options for continued care. You’ll be seen by a licensed provider who will provide appropriate recommendations.