Are Women More Likely To Tear Their ACL?

Back in Physical Therapy School, I learned that women and girls are 3-6x more likely to tear their ACL's, or Anterior Cruciate Ligaments than men.

Your ACL is a ligament in your knee that helps stabilize your knee. Once torn, if often requires surgery to repair full function of the knee.

This is actually still true, and hasn't changed in 20 years despite the medical community's distinct knowledge of it.

But what always bothered me was how it was stated as a simple fact of life. Like, we have two patella bones that make up our knee caps, and women will likely tear their ACL's playing sports because of their wobbly hormones and wide, child-birthing pelvis'.

I felt the undertone was:

"Women, out there trying to play sports like men, really shouldn't because they are anatomically ill-equipped to do so and are likely to injure themselves and therefore require the skilled intervention of a very masculine orthopedic surgeon."

There Is More To The Story

So yes, it's true that women undergo incredible hormone changes during their menstrual cycles.

It is also true that women are more likely to tear their ACL during the ovulatory phase of the menstrual cycle than they are at any other time.

We know that hormone fluctuations play a role, and that a surge in estrogen can actually increase ligament laxity and decrease collagen density.

There has also been significant attention paid to the angle between the female pelvis and knees, as the pelvis is wider than males to accommodate childbirth, this has been postulated to be the cause of greater torque on the knee during landing and deceleration.

So although all of this can predispose female athletes to more ACL tears, what else could be involved?

Energy Intake and Female Athletes

Women need to have adequate energy intake in the form of nutrition and quality rest in order to maintain hormone balance and healthy menstrual cycles.

Without enough energy intake to keep up with physical demands of athletics (or just life), women can begin to suffer from energy deficiency syndromes such as Relative Energy Deficiency in Sport, or Red-S syndrome.

Overtime this can manifest in a decrease in bone mineral density, ability to develop and maintain muscle mass, and repair systems such as collagen, decreased overall athletic performance that may predispose women to more injuries, including ACL tears.

Although we are aware that men are increasingly feeling the pressure of body image-related issues, especially in high-level athletics, historically pressure to attain incredible thinness or a particular body mass has been targeted specifically at women.

This increases their risk of developing eating disorders, which also places female athletes at an increased risk of developing issues such as Red-S and feeling the repercussions through injury and other health issues over time.

Inequities In Access To Strength Training

In addition to a predisposition to energy deficiency issues such as Red-S, we also know that female athletes are not offered the same level of strength training as their male counterparts.

Strength and conditioning is incredibly protective against injury in sport. Women need to have access to high quality coaching and cross training whenever involved in athletic activity. Historically, this has only been offered to men.

So, to view the rate of ACL tears in women compared to men as the result of muscle imbalance and weakness is to also miss the big picture of WHY are women not engaging in the appropriate exercises and frequencies of exercise to build the appropriate strength to decrease their risk of injury in sport?

The answer is it is not offered.

We also need to be looking at what opportunities to explore movement girls are being offered even as early as toddlerhood. Are girls getting the appropriate opportunity to explore different types of movements and athletics? This is a critical time for girls to be building foundational muscle mass, proprioception, and balance and reaction training.

Although this is beginning to change, we have never seen equal opportunity in this realm.

How It Relates To Pelvic Health

When we are treating the pelvis, we look intricately at muscular imbalances in the pelvis that could be contributing to symptoms. In this way, we are uniquely equipped to also help stabilize the knee as pelvic health therapists.

This is because the knee is reactionary to pelvic stability. We train our clients to not only monitor their menstrual cycles for signs of dysregulation, but we also work with out clients to even out any muscular imbalances and coach them through proper technique when it comes to squats, lunges, jumping and running.

At Holistic Pelvic Health, we have many clients that have dealt with multiple knee surgeries and chronic injuries from sports or beyond that have seen transformational change in our approach. I believe that is because we are alway looking at the big picture and asking ourselves what is really causing this?

If you have been dealing with chronic knee injuries or are looking to avoid them, book your session here today!