The ACL injury cycle requires a holistic and intersectional approach; for example, we cannot simply tell girls/women to ‘get stronger’ to reduce injury risk if society and the environment do not support those types of activities for everyone. (Parsens et al. 2021)
Women and girls experience a higher rate of anterior cruciate ligament (ACL) injury than men and boys. It’s time to start looking beyond biology to address the problem.
One of the most common knee injuries is a tear or sprain of the ACL – the strong band of tissue that helps connect the thigh and shin bones. ACL injuries typically happen during sports that involve sudden stops or changes in direction, like football. Depending on severity, treatment involves rest or surgery and rehabilitation. Recovery takes around six to nine months, and afterwards there is a higher risk of reinjury.
Women and girls are three to six times more likely to experience ACL injuries than boys and men. But the common focus on biological sex as the main factor overlooks the importance of social and environmental factors, specifically how gender may influence ACL injury.
The social construct of gender, and wider gender norms and about girls’ participation in sports and physical activity, can shape learnt behaviours and body movements. This can factor into injury risk, leading to girls and women being more susceptible to ACL injury.
ACL injury cycle | Social context/wider gender norms |
Pre-sport environment | Gendered play develops different physical skill sets Gendered expectations of physical abilities |
Training environment | Gendered socialisation that strength and muscle development is not for girls/women Weight rooms are highly gendered spaces favouring men and boys Strength coaches, primarily men, significantly influence athletes’ opinions of training |
Competition environment | Gendered expectations of appropriate sports for boys and girls Gendered coaching styles are associated with different exercise programs Gendered risk-taking beliefs are associated with playing while injured |
Treatment environment | Gendered difference in return to play timelines and rates Gendered bias in recommending reconstruction surgery Gendered inequities outside sport can impact rehabilitation |
As a coach, you play a significant role in training, competition and treatment environments.
It’s important to think about how sex and gender are entangled and influence each other, and how this might influence your actions.
While limited, there is evidence to suggest that with equality in opportunity, experience and training age, the disparity in ACL injury rates and risk factors between female and male athletes vastly reduces or disappears.
When coaching women and girls…
Read the full research papers (Fox et al., opens in a new tab and Parsens et al., opens in a new tab) or learn more about the modern approach to coaching on the Australian Sports Commission website.