ACL injury in Females

The following discussion is a small excerpt taken from Female Specific Strength & Power Training for Aussie Rules. Certain parts have been abbreviated and edited, so that it makes sense to someone who hasn’t read the rest of the book, however the discussion remains largely the same.

The structural and anatomical differences (as well as a little contribution from hormonal differences) that exist between males and females, and the effect that they can potentially have are no better illustrated than in the incidence of ACL (anterior cruciate ligament) injuries, which are far more prevalent in female athletes than they are in male athletes.

When it comes to engaging in high impact joint loading like playing a sport like footy, coaches and physical condition experts are almost unanimous in raising their concerns about this, and indicating that a specific emphasis must be placed on conditioning specifically to reduce the likelihood of this happening with their female athletes.

We are going to look at various comments from several world renowned coaches as well as rehabilitation and conditioning experts regarding the higher incidences on ACL injury in female athletes and their opinions on what should be done about it, and then discuss these comments in regards to what it means in terms of your footy strength training.

‘A possible underlying mechanism for why women have more noncontact ACL injuries than their male counterparts is growth without sufficient power. Men experience a significant increase in neuromuscular strength and coordination as skeletal growth and maturation progresses, a so-called neuromuscular spurt not often observed in women. As bone length and body mass increase in men, they also demonstrate greater neuromuscular control of the knee joint than women, allowing men to better absorb loads. In lay terms, growth results in larger machines in both sexes, but a male subjects mature, they adapt with disproportionately more muscle ‘horsepower’ to match the control demands of their larger machine.’

‘As a result of insufficient neuromuscular adaption, female knees are exposed to greater ground reaction forces and high external knee abduction moments (load), particularly in landing, pivoting, and deceleration sports.’

‘Increased bone length and body mass, in the absence of matching adaptions in neuromuscular strength and coordinated muscle recruitment, exposes the female knee to greater load and likelihood of ACL injury.’
Timothy E Hewett & Gregory D Myer
Prevention of knee injury in women
Functional Training Handbook

What Timothy and Greg are highlighting here ties in with the fact that prior to puberty, incidences in ACL injuries between the 2 genders show no real difference in frequency in similar populations, yet post this maturation stage is when the larger number of female ACL injuries start to occur in comparison to the men. They are indicating that the difference that occurs here is that whilst females bones and muscles grow in size and length just as the guys do during this growth and maturation stage, females do not experience an equal natural growth in strength and neural control over this increased size.

I have been an advocate for years for strength training being even more important for females than males in all populations that I work with. This often surprises people given that weight training is more often associated with men. However this strength and neural deficit is a classic example of why I believe this to be the case.

‘The improved ability to handle body weight and control the body is crucial in the prevention of injuries, especially in the lower extremity.’

‘Female athletes are usually deficient in strength for a number of reasons. Therefore there is room for improvement – a huge upside.’
Vern Gambetta

Paul Gamble also discusses in Strength & Conditioning for Team Sports that ACL ligament sprains are the second most prevalent injury in footy behind hamstring injuries. He also highlights the large body of statistics that identify the great majority of these ACL injuries as being non-contact in nature. So when you combine this being a common injury in footy, together with it being far more common in women’s sport than in men’s, and the fact that these statistics that already show a high incidence of this injury are men’s statistics – it isn’t too far a stretch to say that these injuries will become a lot more common as women’s footy grows, unless more is done to prevent it. And specific functional conditioning can certainly play a strong role in achieving this.

Indeed Paul Gamble says that ‘the process of specific training prescription should begin with a needs analysis of the particular sport, including research into the injuries commonly sustained during competition.’ In Female Specific Strength & Power Training for Aussie Rules we go one better than this - and place a priority on the prevention of those that are not only most common in footy, but also most common in female sport.

Aside from a deficit in neuromuscular strength and control, there are other factors that are believed to contribute in various degrees, to the higher incidence of this injury in female athletes;

• A wider pelvis, and the therefore a larger Q-angle
• A higher incidence of joint laxity and stabiliser weakness
• Quadriceps dominance

These issues are all things that we have touched on elsewhere in the article section, and that we delve into in far greater detail in Female Specific Strength & Power Training for Aussie Rules. However, at this stage, it is fair to say that there is far more than 1 singular reason why female players experience a greater incidence of ACL injuries than males. Rather, the reality is that there are various reasons that contribute in their way to this – and the extent to which each of these things contribute will differ from female to female – and indeed just how interrelated all these things are will become abundantly clear after you have a read of the female specific footy conditioning book.

But what exactly can you do about this ACL risk? We will cover that in part 2 of this article.


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