Male and female differences in 4 common sports injuries |

Male and female differences in 4 common sports injuries

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The incidence of ACL tears of the knee is two to eight times higher in females compared to males participating in a variety of sports.
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By Dr. Richard Cunningham, MD
Brought to you by Vail Summit Orthopaedics

There are differences between men and women in the incidence and types of common sports injuries. For instance, in one study, males had higher injury rates compared to females in 11 of 13 sports. Males are more likely to suffer acute traumatic injuries such as fractures. Physiologically, males on average have greater bone mass, greater muscle mass, and greater lean mass than females. Females are more likely to develop overuse injuries compared to males. Females are 3 times more likely than males to develop patellofemoral or knee cap pain in the knee. Females have a higher quadriceps to hamstring strength ratio than males and this muscle imbalance contributes to knee cap pain.

STRESS FRACTURES: Females are more likely than males to sustain stress fractures. In a study out of the military, females had a stress fracture incidence three times more than that of males. Stress fractures are often seen in conjunction with hormonal and dietary irregularities. Some may have heard the term “Female Athlete Triad” which was coined in 1992 and refers to disordered eating, amenorrhea, and low bone mineral density. The percentages of female athletes with these 3 findings is alarmingly high in several studies. The outcome is an increased risk of stress fractures, keeping these female athletes out of sports. However, the bigger concern is failure of young women to build their bone mass sufficiently at these younger ages when this normally occurs and then being more likely to suffer more insufficiency fractures later on in life.

ACL Tears: The incidence of ACL tears of the knee is two to eight times higher in females compared to males participating in a variety of sports. Because there is a higher rate of sports participation amongst males, the overall number of ACL tears is higher in males than females however. There are modifiable and non-modifiable factors that contribute to ACL tears. One modifiable factor is the way an athlete lands from a jump. Females tend to exhibit valgus or knock knee alignment when landing which predisposes to ACL tears. Working on gluteal and hip muscle strengthening exercises is critical to help correct one’s landing mechanics. Changing levels of hormones associated with a female’s menstrual cycle has been postulated to play a role in susceptibility for ACL tear but this remains unproven.

SHOULDER INSTABILITY: Females have a higher rate of atraumatic shoulder instability, meaning that females can have shoulders that more easily just pop out of place without there being a hard fall or significant trauma to the shoulder causing the dislocation. On the other hand, having a shoulder dislocate due to a hard fall is twice as likely to occur in males compared to females. Shoulder dislocations are 7 times more common in a military cadet than in aged matched male patient. Traumatic dislocations most commonly occur in males in their teens and early 20’s. Moreover, this same population has a 90% chance of having a second dislocation after having one dislocation and this usually occurs within 2 years.

CONCUSSIONS: Concussions in sports have become more common. Several studies have actually shown a higher incidence of concussion in females compared to males and the reason for this is unclear. One theory for this is that females have a smaller head compared with males and thus sustain greater forces when they strike their head. Women also tend to have weaker neck musculature and this may play a role.

Dr. Rick Cunningham is a Knee and Shoulder Sports Medicine Specialist with Vail-Summit Orthopaedics. He is a Physician for the US Ski Team. Visit his website at For more information about Vail-Summit Orthopaedics, visit

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