Do Female Athletes Tear Their ACL More Often? 3 Myths Explained
Female athletes face a higher risk of ACL injuries, but understanding the causes, common myths, and prevention strategies can help athletes move with more confidence.
Why Are ACL Injuries More Common in Female Athletes?
The anterior cruciate ligament, or ACL, is one of the main ligaments that helps keep your knee stable. It helps control forward movement and rotation of the shin bone.
Many ACL injuries happen without contact. They often occur during movements such as:
Suddenly stopping or changing direction
Pivoting or cutting
Landing awkwardly after a jump
Losing control of the knee when changing speed
These injuries are especially common in sports such as soccer, basketball, and volleyball. [1]
There is no single reason female athletes have a higher ACL injury risk. Researchers believe several factors may contribute, including:
Differences in anatomy and knee structure
Ligament flexibility
Hormonal changes
Strength differences
Landing and movement mechanics
How the body absorbs force
Some of these factors cannot be changed, but several important risk factors can be improved through training.
Myth 1: ACL Injuries Are Just Bad Luck
An ACL tear can certainly feel like a freak accident, but many non-contact ACL injuries happen during similar movement patterns.
These may include:
The knee collapsing inward during a landing or change of direction
Landing with the legs too stiff
Relying heavily on the quadriceps instead of sharing the load through the hips and hamstrings
Reduced hip or core strength
Poor balance or body control
Fatigue later in a game or practice
The good news is that many of these movement patterns can be trained.
The National Athletic Trainers’ Association recommends injury-prevention programs that combine:
Strength training
Balance exercises
Jumping and landing drills
Agility work
Technique coaching and feedback
For young female athletes, these programs may be most effective when completed two to three times per week for about 15 to 20 minutes. [2]
Research has also shown that athletes who consistently follow these programs may significantly reduce their ACL injury risk. [2]
Myth 2: It Is All About Hormones
Hormones often come up when discussing ACL injuries in female athletes.
Estrogen and relaxin can affect ligament tissue, and receptors for both hormones have been found in the ACL. [1]
However, researchers are still trying to understand exactly how hormone changes throughout the menstrual cycle may affect ACL injury risk.
A 2024 review published in Bone & Joint Open found that there is not yet enough evidence to draw a clear conclusion. One challenge is that many studies estimate menstrual cycle phases instead of directly measuring hormone levels. [1]
Hormones may play a role, but they are only one piece of the puzzle.
Athletes can still focus on factors they can actively improve, including:
Leg and hip strength
Balance
Landing technique
Knee control
Agility
Overall movement quality
These are areas that can be trained throughout the month, regardless of cycle phase.
Myth 3: Once Your ACL Is Reconstructed, You Are Back to Normal
ACL reconstruction can be an important part of recovery, but surgery is only one step. Rebuilding strength, movement control, and confidence takes time. Research also suggests female athletes may return to sport at lower rates than male athletes after an ACL injury. One analysis reported return-to-sport rates of about 65% for female athletes compared with 75% for male athletes. [1]
Fear of reinjury and a lack of confidence in the knee can also make returning to sport more difficult. [1]
That is why structured rehabilitation is so important.
ACL rehab often includes:
Reducing swelling and restoring knee movement
Rebuilding quadriceps and hamstring strength
Improving balance and stability
Practising jumping and landing
Reintroducing running and agility drills
Progressing into sport-specific movements
Returning to sport should not be based on the calendar alone. Strength testing, movement quality, knee control, and confidence can all help guide the decision about when an athlete is ready to safely return.
How Sports Physiotherapy in Ottawa Can Help
At Pro-Action, our registered physiotherapists look at more than just where your knee hurts.
We assess how you:
Move
Jump and land
Change direction
Control your knee
Produce and absorb force
Our Test. Treat. Re-Test. approach allows us to measure things like strength, range of motion, and movement quality throughout your treatment so you can see how your recovery is progressing. For athletes recovering from ACL reconstruction, our post-surgical rehab focuses on rebuilding strength, stability, movement control, and confidence.
For athletes hoping to lower their injury risk, we can also build a knee stability program around the demands of your sport.
Treatment may include techniques such as Functional Range Conditioning to support joint mobility and control.
Frequently Asked Questions
Do female athletes tear their ACL more than male athletes?
Yes. Research suggests female athletes may be about two to eight times more likely to experience an ACL injury than male athletes participating in the same sports. [1]
The difference appears to be related to a combination of factors, including anatomy, hormones, strength, and movement patterns.
Which sports have the highest ACL injury risk for girls and women?
Sports that involve frequent jumping, cutting, pivoting, and sudden changes of direction tend to carry a higher ACL injury risk.
These include sports such as:
Soccer
Basketball
Volleyball
If you participate in one of these sports, our sports injury team can assess how you move, land, and change direction.
Can ACL injuries be prevented?
Not every ACL injury can be prevented, but certain training programs may help reduce the risk.
ACL prevention programs often include:
Strength training
Balance work
Jumping and landing drills
Agility exercises
Technique coaching
A physiotherapist can help tailor these exercises to your sport, age, and activity level.
How long does recovery from ACL reconstruction take?
ACL recovery takes months rather than weeks.
For athletes returning to sports that involve jumping, pivoting, or cutting, recovery commonly takes nine months or longer.
Every athlete is different, so return-to-sport decisions should be based on progress, strength, movement testing, and confidence rather than time alone.
You can learn more about our post-surgical rehab services.
Should I see a physiotherapist before ACL surgery?
Physiotherapy before surgery, sometimes called prehabilitation, may help:
Reduce swelling
Restore knee movement
Improve quadriceps strength
Prepare the knee for recovery after surgery
Your physiotherapist and surgical team can help determine what is appropriate for you.
Build Strength and Confidence
If you are recovering from an ACL injury or want to reduce your risk this season, the Pro-Action team in Kanata can help you build a plan around your sport, goals, and current level of activity.
We offer direct billing, online booking, and same-week appointments.
Dr. Shayne Baylis, Chiropractor
Dr. Baylis has been a chiropractor since 2008, combining chiropractic care, physio, and acupuncture in his treatments, with a focus on sports injuries and concussion management.