The gender gap in sports injuries

Robert H. Shmerling, MD
Robert H. Shmerling, MD, Faculty Editor, Harvard Health Publications

If you’ve watched any football this fall, you’ve probably seen some exciting games, some spectacular plays, and unfortunately, some major injuries. From what you see at the game or on television, you might think that sports injuries are more common among male than female athletes.

That may be true for college and NFL football players, since nearly all are male. But, women are actually more prone than men to suffer many of the most common sports-related injuries. There are a variety of reasons for this “gender gap,” and there is much about it that remains uncertain. But the recognition of this gap has led to innovative efforts to prevent injuries among women in sports.

Consider the anterior cruciate ligament (ACL). It’s a vital structure in the knee that provides stability under stress. Injuries of this ligament are up to 6 times more common among women than men. And a number of other sports-related injuries are also more common among women.

What injuries are most common among female athletes?

  • Ankle sprain. This is the most common sports injury in both men and women, but it’s particularly common among women.
  • Shoulder troubles. Examples include rotator cuff problems (including tendon inflammation, or tendinitis) and instability.ACL
  • Knee injuries. These include irritation under theknee cap (called patellofemoral syndrome) and ligament damage (including tears to the ACL), which is especially common among soccer and basketball players.
  • Stress fractures. These are especially common in the foot or lower leg (tibia) among women with the “female athlete triad,” a combination of inadequate calorie and nutrient intake, irregular menstrual periods, and bone loss. Eating disorders, including anorexia nervosa, contribute to this triad.
  • Plantar fasciitis. Abnormal alignment of the foot and flat feet may contribute to these small tears in the supporting tissues along the arch and heel.

Why are women more prone to these injuries than men?

There is probably a combination of factors that contribute to the higher incidence of injuries among female athletes. And we have more theories than actual answers. The most common explanation is that it’s due to basic differences between the bodies of men and women. For example, the typical female athlete, as compared with her male counterpart, has:

  • higher estrogen levels, along with less muscle mass and more body fat
  • greater flexibility (due to looser ligaments) and less powerful muscles
  • a wider pelvis, which alters the alignment of the knee and ankle
  • a narrower space within the knee for the ACL to travel through
  • a greater likelihood of inadequate calcium and vitamin D intake.

Women also tend to move differently than men. For example, when landing from a jump, women tend to land more upright and with the knees closer together. And when female athletes suddenly change direction, they tend to do so on one foot (perhaps due to their wider pelvis), while men tend to “cut” from both feet.

Another theory suggests that hormonal changes during the menstrual cycle make women particularly prone to injury. However, this has not been proven and research on the subject is inconclusive.

What can women do to avoid these injuries?

Fortunately, women can take steps to reduce the chances they’ll suffer these injuries. The rate of ACL injuries may go down if muscles are strengthened, especially the hamstrings (located at the back of the thigh) and the vastus medialis (a major muscle that lies along the inside of the thigh and knee). A 2012 analysis of the medical literature concluded that training programs to prevent ACL tears were highly effective, reducing them by more than 50% for women (and 85% for men).

Training to change direction from both feet (rather than one), training to land from jumps in a safer position, and weight-lifting programs that target specific muscles may also prove effective. Bracing can help limit ankle sprains. Orthotics (shoe inserts) may provide support and re-alignment for those prone to plantar fasciitis or other foot injuries. Counseling from nutritionists, primary care physicians, coaches, and psychologists can help address the “female athlete triad” and other challenges facing female athletes.

The bottom line

A female athlete may be just as fit (or more so) than her male counterpart, yet there appear to be different vulnerabilities among men and women for certain athletic injuries. Lack of recognition, an incomplete understanding of why injury risks are increased among women, and athletic training programs that don’t take these differences into account are all part of the problem. However, there are some ways to counter this. Even though anatomy and biology may not be easily modified, the difference in injury rates between male and female athletes is a reason to promote additional research so that we can understand these differences better and figure out how to prevent injuries in both genders.


  1. Coach Reynolds

    “Another theory suggests that hormonal changes during the menstrual cycle make women particularly prone to injury. However, this has not been proven and research on the subject is inconclusive.”
    If the research is inconclusive, then it is not a “theory” but a hypothesis. The term of “just a theory” needs to be eliminated. Let’s make people smarter, not negligent. This is a great article, but little things like this only deter the progression of athletes.

  2. Warren Potash

    I have successfully trained more than 600 teen female athletes since 1995 who have played every sport.

    If every female athlete trained for lower body stabilization, there would be less knee and other lower body injuries.

    For those athletes in overhead sports, train the rotator cuff as part of the training program. Use single leg balance exercises during training with knee bent and hips back.

  3. Ed Dudley

    The most common injury in female athletics is FAR and AWAY, lower back injuries.

    Take it from a guy that makes a living, training female athletes: the least talked about reason for female injuries is that female athletes are much tougher than their male counterparts. Females have a higher pain threshold and are MUCH MORE likely to play thru pain and injury. Plus add in the cultural aspect that a female athlete does not want to let her teammates and coaches down. They will go out of their way to ‘please’
    their coaches.

    Yes, sorry guys, I’ve just knocked your macho image down a few notches. Notice I didn’t say females were stronger or faster, just TOUGHER!

    Also, female athletes are ‘quad dominate’. Male athletes are hamstring dominate……which is another huge factor.

  4. Leslie

    I used to have a very severe form of plantar fasciitis… But, now I remember it only as a bad dream!

    I’m a busy person, so I had no time to see doctors, get acupuncture or physiotherapy. I didn’t know what to do and the pain was killing me, I could barely walk. So, I did a research hoping to find something that could help me. And guess what?

    I found one e-book which taught me a lot about plantar fasciitis, it’s symptoms, causes and how to cure it. I followed it carefully and I completely got rid of my plantar fasciitis in 3 days! Can you believe that? I thought it’s a miracle, but then I did some more research about this e-book and found a lot of satisfied people who also claimed that they cured they plantar fasciitis fast. What a finding!

    Have a good day 🙂