ACL injuries are common and can lead to a long time away from playing sport. Recovery can often take 9 months. Having had an ACL injury also increases the risk of having further knee problems down the line. 

The ACL, or anterior cruciate ligament, is at the front of a pair of ligaments that form a cross. Its role is to prevent the thigh bone (Femur) from sliding too far forward over the shin bone (tibia).

Why Women and Girls are More Likely to Suffer ACL Injuries

Women are about 4 times more likely to rupture their ACL than men are. Most ACL tears in women are non-contact injuries that usually occur during an awkward twisting motion. Certain sports have a higher risk of ACL tear. Typically, sports that have rapid stopping or changes in direction, landing from a jump or cutting motions are the highest risk. This includes netball, basketball, football and volleyball. 

There are several reasons that women and girls are more prone to suffering from ACL injury. Many of these factors, such as female hormones, wider hips and more lax knees cannot be altered. Thus, focusing on preventing ACL injuries has to focus on what we can change.

Landing Differences

Two big factors can be changed to help reduce the likelihood of ACL injuries in women and girls. The first is how females tend to land from a jump. Two landing patterns that are particularly risky are landing with stiff, straight legs or landing in a knock-kneed position. These risky landing techniques are more common in women than in men and greatly increase the force through the knees as well as the risk of ACL injury. 

Hamstrung by Hamstrings

The second factor that can be altered to reduce ACL injury is what is known as neuromuscular adaptation. This refers to the strength, explosivity, timing and coordination of muscular contraction. Having sufficient strength, as well as being able to engage the right muscle at the right time during movement is crucial for knee stability. The hamstrings are particularly important in knee stability, as like the ACL, they stop the shin bone from sliding too far forward. Females take longer than males to produce force in their hamstrings and contract them more slowly. 

How To Land Well To Prevent ACL Injuries in Women and Girls

To land well and reduce the risk of injury observe yourself jumping from a plyometric box or workout step in front of a mirror. Or, ideally, you could also have a partner observe you or film it on your phone. Start and finish the jump with the knees and hips bent. Make sure you keep your knees over and in line with your second toes as you land and that the knees don’t collapse inwards.  Try to land as softly as possible on the front half of the soles of your feet. 

Strengthening To Prevent ACL Injuries in Women and Girls

Strengthening hamstrings is really important for ACL prevention. A great exercise for this is Steamboats. Having strong glutes (bum muscles) is also important. They help stop the knees from knocking together. Lateral steps using a theraband and single-leg bridges can be great for this. Stabilising the trunk through core stability exercises such as plank can also help reduce the risk of leg injuries. 

Plyometric drills such as tuck jumps and squat jumps can help with muscle explosivity and timing or muscle contraction. The core component of these exercises is the squat. it is a foundational move for athletic endeavours. Agility drills such as fast feet can also help improve power and speed while reducing injury risk. 

If you master these tips, you’ll greatly reduce your risk of ACL injury. 

Dr J Hugh Coyne

Private GP, Parsons Green