Preventing ACL Injury in Female Athletes

Jun 23, 2017

For female athletes, ACL injuries can have a major impact on their careers as well as overall well-being, both recreation and competitively. The problem can contribute to knee problems, and affect their future sports performance. Compared to males, females are at higher risk of ACL injury. In most cases, ACL injuries in women occur as a result of landing from a jump or sudden deceleration.

Why Females Are More Predisposed to ACL Injuries than Males

In a 2013 paper written by Natalie Voskanian, the ACL is at higher levels of stress when the knee is in extension, minimal flexion, or during internal knee rotation, which is a common mechanism in female athletes who have injured their ACL.

Females usually land from a jump in a more upright position compared to males. During deceleration or landing, they tend to rotate their hips more internally and rotate their tibia externally. As a result, they stress their knee – predisposing them to ACL injury.

Additionally, it takes longer for females to put their hamstring torque at maximum. They also have more quadriceps and hamstring activation than males.

ACL Prevention Program – What Should Be Included?

Faulty patterns that increase the risk of ACL can be prevented and corrected if female athletes participate in an ACL prevention program. Ideally, the program has exercises and drills that focus on plyometrics, neuromuscular training, and muscle strengthening, added with education and feedback about body mechanics and landing techniques.

An ideal ACL prevention also begins 6 weeks before the season, with a 20-minute duration, 3 times a week, and can be done as a warm-up.

Continuing the program may help the athletes maintain proper form.

Initiating an ACL prevention program at or prior to puberty can prevent poor neuromuscular and biomechanical patterns from developing in the first place.

Incorporating feedback to the ACL program allows the athlete to correct his/her landing technique and practice proper mechanics at the same time. This can be through having a partner athlete, coaching assistant, providing feedback, or using mirrors and video to observe movements.

Strength training should include strengthening and recruitment of the hamstrings. Improving strength to hip abductors may help reduce stress on the knee. Strengthening the gluteus should be included as well. Any asymmetry in strength and movement patterns need to be corrected.  Incorporating core strengthening can help stabilise trunk motion.

Plyometrics should include agility exercises that focus on footwork and quick explosive movements emphasising power and speed. It should also have proper muscle recruitment and mechanics, with increasing difficulty as it progresses. This can include jumping, lateral movements, followed by some disturbances to check if an athlete can maintain proper form

For coaches and athletes alike, prevention programs that simultaneously improve sports performance can further motivate them to participate on a larger scale. 

Hopefully, implementing ACL prevention programs on a wide scale may narrow the gender gap in injury rates in female athletes.

Need help in preventing ACL injury? Book an appointment at Happy Physio on 92727359 today!



  • Voskanian N. ACL Injury prevention in female athletes: review of the literature and practical considerations in implementing an ACL prevention program. Current Reviews in Musculoskeletal Medicine. 2013;6(2):158-163. doi:10.1007/s12178-013-9158-y.