Why women suffer more joint injuries

Knee and joint injuries occur significantly more frequently in female athletes than in other genders, especially to the anterior cruciate ligament. Why is this, and can it be prevented?

Warum Frauen häufiger Gelenkverletzungen erleiden

Economically, professional women's sports are growing four and a half times faster than men's. However, knee and joint injuries occur significantly more frequently in female athletes than in the other gender, especially involving the anterior cruciate ligament. Studies show that their risk can be two to eight times higher depending on the sport. Causes include anatomical and biomechanical differences, as well as sport-specific stresses. An overview.

A different risk

The knee joint is one of the most stressed joints in sports. The anterior cruciate ligament (ACL) plays a central role in stability and control during rapid movements. Injuries often occur during abrupt stops, jumps, or changes of direction – movements that are part of everyday life in many sports.

Sports medicine studies clearly show that female athletes have a higher risk of ACL injuries than male athletes. Depending on the study, the risk is two to eight times higher when women and men participate in the same sport.

Epidemiological analyses also confirm this picture: In an evaluation of sports injuries, the rate of ACL injuries was 1.9 injuries per 10,000 athlete exposures for women, while it was 0.9 per 10,000 for men. This means that the risk for female athletes is about 1.7 times higher.

The difference is particularly evident in football: women have at least twice the risk of severe knee injuries as men – regardless of the performance level.

A question of the sport

Not all sports place the same demands on joints and ligaments. Disciplines with rapid changes of direction, jumps, and lateral movement patterns are particularly risky.

Typical examples include:

- Contact sports: Football, basketball, handball or hockey

- Sports with rapid changes of direction: Tennis, badminton or padel

- Sports with many jumps: Volleyball or gymnastics

It is precisely in these sports that most ACL injuries occur. In basketball and football leagues, for example, ACL ruptures are among the most common severe injuries in professional sports.

In addition: Around 80% of ACL injuries occur without direct contact, for example, when landing after a jump or during an abrupt change of direction.

Anatomical differences

An important factor lies in anatomy. On average, women have a different leg and hip structure than men. A central point is the so-called Q-angle, i.e., the angle between the hip, knee, and lower leg. This is often larger in women, which can lead to a different load axis in the knee.

When landing after a jump or during a rapid change of direction, this creates greater forces in the knee joint. In some situations, this can put more stress on the ligament than in male athletes.

Structural differences in the knee joint itself also play a role. In many women, the space in the knee through which the cruciate ligament runs is somewhat narrower. This can lead to the ligament being more strained during certain movements.

Movement patterns and muscle activation

In addition to anatomy, the biomechanics of movement also play an important role. Studies show that female athletes often exhibit different movement patterns than men when landing or stopping.

These include, for example:

- less knee flexion during landings

- greater inward movement of the knee

- different activation of the thigh and gluteal muscles

These factors can lead to increased stress on the cruciate ligament – especially during jumps or changes of direction. At the same time, studies show that targeted training programs can significantly reduce this risk.

A large meta-analysis with over 27,000 female athletes, for example, showed that prevention programs with neuromuscular training can significantly reduce the risk of cruciate ligament injuries.

Examples from elite sports

The issue has long become visible in international elite sports. In recent years, numerous well-known female athletes have had to take breaks due to cruciate ligament injuries.

International examples include footballers Beth Mead (England), Sam Kerr (Australia), and Vivianne Miedema (Netherlands). The issue is also present in German elite sports. Particularly well-known is the case of Lena Oberdorf, national team player and midfielder for FC Bayern Munich, who suffered an ACL tear twice within a short period.

Such injuries are not only painful but often mean months of rehabilitation – and in some cases, can even shorten careers.

A complex interplay of many factors

Research now clearly shows: there is not one single reason why women suffer knee injuries more frequently. Rather, it is an interplay of various factors:

- anatomical differences

- biomechanical movement patterns

- muscle activation and stability

- sport-specific stresses

- training and competition conditions

Precisely for this reason, more and more research projects are focusing on targeted prevention strategies – especially in women's competitive sports.

Long-term support for joint health

In addition to targeted training and good technique, long-term support for joint structures also plays a role. In sports medical discussions, nutrients involved in cartilage metabolism, antioxidant protection, or connective tissue are often mentioned.

These include, for example:
- Glucosamine
- Chondroitin
- Vitamin C
- Vitamin E
- Selenium
- Zinc

An adequate supply of these micronutrients can help to support connective tissue and joint structures, especially under high athletic stress and with increasing age.

Conclusion

Women suffer knee and joint injuries more frequently in sports than men – especially in sports with rapid changes of direction, jumps, and intensive stress on the knee joint. Studies show that the risk of ACL injuries can be two to eight times higher depending on the sport.

The reasons lie in a complex interplay of anatomy, movement patterns, and athletic stresses. At the same time, knowledge about prevention and training is continuously growing.

With targeted training programs, good sports medical care, and a conscious approach to their own joint health, female athletes can do a lot to maintain their performance in the long term – and to practice their sport healthily for many years.