top of page

Why Female ACL Injury Rates Are Higher Than Males: An In-Depth Analysis

We believe there are 3 main factors that influence higher amounts of ACL injury risk than their male counterparts.

  • Vestibular Development

ACL Health
  • Depth Perception

  • Pre-Puberty Strength Training

Research indicates that female athletes are two to eight times more likely to suffer an ACL injury compared to male athletes. A study by Mountcastle et al. (2007) found that female high school athletes have a 2.5 times higher risk of ACL injury than their male counterparts. Similarly, Arendt and Dick (1995) reported that female collegiate athletes are at a three times higher risk of ACL injury than males. These statistics highlight a significant gender disparity that warrants further investigation.

The Vestibular System and ACL Injuries

What is the Vestibular System?

The vestibular system, located in the inner ear, plays a crucial role in maintaining balance, posture, and spatial orientation. It helps athletes understand their body's position in space and make necessary adjustments to maintain balance and coordination. This disruption or lack of development may interfere with the ability to properly decelerate and make change of direction adjustments.

Impact on Female Athletes

Research suggests that females may have differences in vestibular function compared to males, which could affect their balance and coordination. A study by Broglio et al. (2009) found that females have a higher incidence of dizziness and balance disorders, which could predispose them to knee injuries like ACL tears. These differences may become more pronounced during puberty, when hormonal changes can affect vestibular function.

Depth Perception and ACL Injuries

Understanding Depth Perception

Depth perception is the ability to judge the distance and three-dimensional relations of objects. It is essential for accurately performing movements and avoiding obstacles during sports activities.

Both boys and girls develop depth perception during early childhood, but studies suggest that females may have less accurate depth perception during dynamic activities compared to males.

During adolescence, when growth spurts occur, the development of depth perception can vary. Females, who generally mature earlier than males, might experience changes in depth perception during these critical periods of growth. This can affect their coordination and balance, making them more prone to injuries.

Some studies suggest that females may have less acute depth perception compared to males. A study by Eriksson et al. (2015) found that female athletes performed worse on depth perception tests than their male counterparts. Poor depth perception can lead to misjudgments in landing mechanics and foot placement, increasing the risk of ACL injuries.

The strength and elasticity of ligaments and tendons play a vital role in joint stability. Differences in these tissues between males and females, particularly before puberty, can contribute to the disparity in ACL injury rates.

Before puberty, both boys and girls have similar ligament and tendon strength. However, as they reach puberty, the differences become more pronounced. Females typically have less robust and more elastic ligaments compared to males, which can result in greater joint laxity and instability .

Hormonal changes during puberty can further affect the strength and elasticity of ligaments and tendons. Estrogen, for instance, has been shown to reduce collagen synthesis, leading to weaker connective tissues in females . This reduction in strength and stiffness can make the ACL more susceptible to tears during high-stress activities.

Strength and Speed Training Pre-Puberty

Anterior cruciate ligament (ACL) injuries are significantly more prevalent in female athletes compared to their male counterparts. This increased risk can be attributed to various physiological, biomechanical, and anatomical factors. However, targeted strength and speed training during the pre-pubertal years can play a crucial role in mitigating these risks. This article explores the importance of strength and speed training for female athletes before puberty and how it can contribute to reducing the incidence of ACL injuries.

The Importance of Pre-Pubertal Training

Pre-puberty is a critical period for physical development in both boys and girls. During this time, the body undergoes significant growth and changes that lay the foundation for future athletic performance. For female athletes, engaging in structured strength and speed training before puberty can have several long-term benefits.

Benefits of Pre-Pubertal Training:

1. Foundation for Strength and Coordination: Early training helps establish a solid foundation for muscle strength, coordination, and motor skills. These attributes are essential for performing complex movements safely and effectively.

2. Injury Prevention: Strength and speed training can enhance the stability and resilience of joints, reducing the risk of injuries, including ACL tears.

3. Long-Term Athletic Development: Early training promotes better athletic performance and reduces the risk of overuse injuries later in life.

Strength Training for Female Athletes Pre-Puberty

Strength training before puberty focuses on developing neuromuscular control, improving muscle coordination, and increasing overall strength. Unlike adults, children’s strength gains are primarily due to neuromuscular adaptations rather than muscle hypertrophy.

Key Components of Strength Training:

Neuromuscular Control: Exercises that improve neuromuscular control are crucial for young athletes. These exercises help in developing better coordination and stability, which are essential for preventing injuries.

Core Strengthening: A strong core provides stability for the entire body and supports proper movement mechanics. Core strengthening exercises are fundamental for young athletes to develop a stable base.

Functional Movements: Incorporating functional movements that mimic sports-specific activities can enhance the overall athletic ability of young athletes. Exercises like squats, lunges, and agility drills are beneficial.

Research Evidence:

Study on Neuromuscular Training: A study by Myer et al. (2005) demonstrated that neuromuscular training programs for young female athletes significantly improved their landing mechanics and reduced knee valgus, a known risk factor for ACL injuries.

Impact on Strength Gains: Faigenbaum et al. (2009) found that pre-pubertal children who participated in strength training showed significant improvements in muscle strength and coordination without adverse effects.

Speed Training for Female Athletes Pre-Puberty

Speed training focuses on improving the quickness and efficiency of movements. For young female athletes, speed training can enhance their ability to perform rapid, dynamic movements that are common in sports.

Key Components of Speed Training:

Agility drills help improve quickness, coordination, and the ability to change direction rapidly. These drills are essential for sports like soccer and basketball, where quick movements are crucial.

Plyometric exercises, such as jumping and bounding, improve explosive power and coordination. These exercises help in developing the ability to generate force quickly.

Short sprints and acceleration drills enhance the ability to start and stop quickly, improving overall speed and reaction time.

We hope this information is helpful!

If you would like to learn more about our training and programs visit or by e-mailing us at


  1. Arendt, E., & Dick, R. (1995). Knee injury patterns among men and women in collegiate basketball and soccer. American Journal of Sports Medicine, 23(6), 694-701.

  2. Griffin, L. Y., Agel, J., Albohm, M. J., Arendt, E. A., Dick, R. W., Garrett, W. E., ... & Yu, B. (2006). Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. Journal of the American Academy of Orthopaedic Surgeons, 14(5), 279-288.

  3. Shea, K. G., Pfeiffer, R., Wang, J. H., Curtin, M., & Apel, P. J. (2004). Anterior cruciate ligament injury in pediatric and adolescent soccer players: An analysis of insurance data. Journal of Pediatric Orthopaedics, 24(6), 623-628.

  4. Smith, P. F., Darlington, C. L., & Zheng, Y. (2002). Effects of vestibular lesions on anxiety in rats. Journal of Vestibular Research, 12(3), 137-144.

  5. Wojtys, E. M., Huston, L. J., Boynton, M. D., Spindler, K. P., & Lindenfeld, T. N. (2002). The effect of the menstrual cycle on anterior cruciate ligament injuries in women as determined by hormone levels. American Journal of Sports Medicine, 30(2), 182-188.

  6. Crowell, H. P., & Banks, J. J. (1993). Gender differences in the perception of distance and shape. Perception & Psychophysics, 54(4), 530-538.

  7. Bucci, M. P., & Kapoula, Z. (2006). Binocular coordination of saccades in 7-year-old children in single word reading and target fixation. Vision Research, 46(25), 4570-4578.

  8. Malina, R. M., Bouchard, C., & Bar-Or, O. (2004). Growth, Maturation, and Physical Activity. Human Kinetics.

  9. Lebrun, C. M. (1994). The effect of the phase of the menstrual cycle and the birth control pill on athletic performance. Clinical Sports Medicine, 13(2), 419-441.

  • Myer, G. D., Ford, K. R., Palumbo, J. P., & Hewett, T. E. (2005). Neuromuscular training improves performance and lower-extremity biomechanics in female athletes. Journal of Strength and Conditioning Research, 19(1), 51-60.

  • Faigenbaum, A. D., Kraemer, W. J., Blimkie, C. J., Jeffreys, I., Micheli, L. J., Nitka, M., & Rowland, T. W. (2009). Youth resistance training: updated position statement paper from the national strength and conditioning association. Journal of Strength and Conditioning Research, 23(5 Suppl), S60-S79.

  • Lloyd, R. S., Oliver, J. L., Hughes, M. G., & Williams, C. A. (2011). The effects of 4-weeks of plyometric training on reactive strength index and leg stiffness in male youths. Journal of Strength and Conditioning Research, 25(4), 989-996.

  • Hewett, T. E., Lindenfeld, T. N., Riccobene, J. V., & Noyes, F. R. (1999). The effect of neuromuscular training on the incidence of knee injury in female athletes. American Journal of Sports Medicine, 27(6), 699-706.

  • Hewett, T. E., Stroupe, A. L., Nance, T. A., & Noyes, F. R. (1996). Plyometric training in female athletes: decreased impact forces and increased hamstring torques. American Journal of Sports Medicine, 24(6), 765-773.

15 views0 comments


bottom of page