Looking beyond biology to reduce ACL injuries in women and girls
The recommendation
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.
What we know
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 |
Training environment | Gendered socialisation that strength and muscle development is not for girls/women |
Competition environment | Gendered expectations of appropriate sports for boys and girls |
Treatment environment | Gendered difference in return to play timelines and rates |
Insights for Coaches
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…
- Be conscious that some movements, particularly in contact and high impact sports, are often new movements being introduced at a much later stage of life for girls and women than for boys and men.
- For high impact and contact sports, include proper warm up, body weight training and warm down in training and game days to prevent injury.
- Think about your coaching style – do you have different approaches, programs and expectations based on gendered assumptions?
- Make sure weight and resistance training is inclusive for women and girls as an important activity for effective ACL injury prevention.
- Consider risk factors as ‘modifiable’ or ‘non-modifiable’, and how you can address factors by modifying the environment, not just the individual.
- Ensure women and girls returning to sport post-injury are made to feel as integrated into the team as possible to nurture a sense of belonging.
More information
Read the full research papers (Fox et al. and Parsens et al.) or learn more about the modern approach to coaching on the Australian Sports Commission website.