How Female Athletes Can Prevent Knee Injury

Knee injuries disproportionately impact women and female athletes. The most common injuries are anterior cruciate ligament (ACL) tears suffered during non-contact sports. ACL tears are four to eight times more likely to occur in women than men.

"Every year, there is an increase in the number of female athletes competing in sports and that means an increased rate of knee injuries in these athletes," says Christian Lattermann, MD, co-chair of Mass General Brigham Sports Medicine and chief of the Division of Sports Medicine at Brigham and Women's Hospital.

All Mass General Brigham Sports Medicine physicians, surgeons and other clinicians have experience in managing joint-related injuries in female athletes. Additionally, our Women's Sports Medicine Program includes physicians dedicated to health issues that are unique to the female athlete.

"While women are at higher risk of knee injuries, we can help teach all athletes how to significantly reduce this risk," says Dr. Lattermann. One proven way is to integrate relatively simple injury prevention exercises into everyday routines.

The Female Athlete's Body

Women's bodies undergo anatomical changes during puberty (e.g., widening of the hips) and pregnancy (e.g., loosening of tendons and ligaments) that can weaken core and other muscle groups and reduce neuromuscular control.

"Knee injuries can sideline female athletes for months and can lead to more severe injuries and even early osteoarthritis if not treated correctly. Mass General Brigham Sports Medicine specialists design unique care and treatment plans for the injured female athlete that prioritize recovery and return to play."

Because of these changes, the mechanics of women's movement patterns—especially during common athletic exercises like jumping and running—can be significantly impacted. For example, when jumping, women typically place more weight on their quadriceps rather than their hamstrings, which can upset muscular balance and increase knee pain. Additionally, increased flexibility and a wider pelvis in women can further lead to higher loads on the knee.

"After puberty, women have a tendency to bend their knees inward as they jump and land, rather than keeping their knees parallel, and this inward positioning can lead to ACL injuries," says Dr. Lattermann.

Additionally, hormones released during the menstrual cycle, such as estradiol, progesterone and relaxin, can impact the looseness or stiffness of a woman's ligaments and potentially lead to increased risk of injury. A growing area of research is investigating the relationships between women's menstrual cycles and knee injuries.

Main Types of Knee Injuries Among Women

Knee injuries can sideline female athletes for months and can lead to more severe injuries and even early osteoarthritis if not treated correctly. Mass General Brigham Sports Medicine specialists design unique care and treatment plans for the injured female athlete that prioritize recovery and return to play. Our specialists treat knee injuries, including:

• ACL (anterior cruciate ligament) injury
• Patellar dislocation
• Meniscus tears
• Medial collateral ligament (MCL) tears

Exercises to Prevent Knee Injury

Strength training and plyometrics-paired with agility, balance and flexibility training-make up the core of Mass General Brigham's ACL Preventative Training Program, which includes tailored recommendations for female athletes and has been shown to reduce the risk of injury by up to 50%.

Examples of effective core- and glute-strengthening exercises that can be easily incorporated into everyday workouts and help prevent knee injuries include:

• Broad jump: A simple broad jump is a great way to practice muscular control and perfect your form for when you're on the field, court or track. As you jump forward, make sure that your feet leave and land on the ground at the same time and make sure that your weight remains in your heels when landing. It is also important to keep your ankles directly under your knees as you land while keeping your knees parallel rather than leaning inward
• Bridge: Bridge exercises can increase core, hip and glute strength-all of which can assist athletes in preventing knee injuries. Start with simple bridge hip raises and progress to single-leg and weighted bridges as your strength increases. Consider balancing with an exercise ball under your feet for additional core impact
• Squats: Squats are an essential movement for almost any sport. Learning proper squat technique can help you avoid overextending or placing too much pressure on your knees, thus reducing risk of injury. As you squat, make sure to keep your back straight and knees in line with your ankles. Squat as low as you can while maintaining proper form, even if this means your squat is somewhat shallow. Hold onto a wall or bar for additional support as needed. Progress to single-leg squats as your strength and technique improve