With the second AFLW season coming to an end, the AFL is being forced to act as many top AFLW players suffer more ACL injuries.

Women are more than 6 times more likely to sustain a non-contact ACL injury.
So why is this?

There is no simple answer but there are many anatomical, biomechanical and hormonal differences between male and females that need to be taken into consideration when asking what is the cause of this discrepancy. There are some factors that we do not have control over so the focus of recent research has surrounded factors that we can modify and the results have been positive.

Many studies have found that maladaptive neuromuscular recruitment patterns and poor jumping, landing and cutting biomechanics are the leading risk of ACL injuries in females. ACL injury prevention programs have been studied and have found that neuromuscular retraining has been successful in preventing ACL injuries in female athletes, which is great news for the sporting community.

Here are some of the anatomical, hormonal and biomechanical differences that are suspected to play a role in the higher amount of ACL injuries in females:

Narrower intercondylar notch
The intercondylar notch is the groove where the thighbone meets the knee. This notch (space where the ACL sits) is generally narrower in women and so is the ACL making it more prone to injury.

Wider pelvis
Because women have a wider pelvis, the way in which the thighbone is angled downward towards the knee (referred to as a “Q angle”) is sharper than it is in men. A larger Q angle puts more pressure through the inside of the medial knee, making the ACL more prone to injury.

Lax ligaments
Women are generally more hypermobile than men. Not only do women tend to have more laxity in ligaments, their muscles also tend to have greater elasticity. Excessive joint range of motion combined with muscle tissue flexibility can leave ligaments susceptible to injury.

The gender discrepancies in ACL injuries are not seen until the onset of puberty. A few studies have found a link between injury rate and phases of the menstrual cycle, however the direct effect of specific hormones on the ACL is unclear.

Muscle balance & Neuromuscular control
Studies have found that women take longer to generate maximum hamstring torque and have more quadriceps activation than hamstring when decelerating compared to men who tend to use more hamstrings to absorb the change in speed, which provides protection to the ligament.

Cutting / landing technique
ACL’s are under the highest degree of stress when minimally flexed (or near extension) and with a valgus force (knee internal rotation + hip adduction). Females tend to land from a jump in a more upright posture than males with insufficient hip and knee flexion and have greater degree of internal rotation and hip adduction when decelerating and landing. These landing patterns combined with insufficient neuromuscular adaptations leads to greater stress on the ACL.

AFL conditioning
Another factor that needs to be taken into consideration is the fact that only in recent times, young females have been encouraged to play AFL. A lot of female AFL stars today have not been playing since such a young age compared to males. Because of this, conditioning and AFL specific recruitment patterns haven’t had as much time to be reinforced.

Using this knowledge of anatomy, neuromuscular control and biomechanics, prevention programs can be devised to correct these deficiencies that increase the risk of ACL injuries. Factors that have been studied and incorporated into ACL prevention or “prehab” programs include muscle strengthening (particularly hamstrings and gluteals), muscle recruitment patterns, proprioception, landing and cutting/deceleration techniques and plyometrics.
Many recent studies concluded that the rate of ACL injuries among women in sport are significantly reduced with sport specific conditioning alongside neuromuscular training and conditioning.

How can you tell if you have a muscle imbalance or deficiencies in muscle recruitment?

Sport specific screening tools can be used by your physio to identify muscle imbalances, muscle recruitment deficiencies and functional motor patterns that may be putting you at risk of an ACL injury.
* One indication that you may have a muscle imbalance is pulling up stiff or sore in the lower back or hamstrings after a game or training.

What we offer at Activate:


  • Knowledge of physical and technical demands of AFL
  • Thorough screening for muscle balance, muscle recruitment and biomechanics
  • Individualised prehab program
  • Collaboration with strength and conditioning coaches for supervision of exercises & incorporating prehab exercises into warm up routines and conditioning programs

Call 9384 0544 or email siobhan@activatephysio.com.au to find out how you can book in for your ACL screening today.