• Dan Kao

Blog Series- Why are Female Athletes Are More Prone to ACL Injuries? (Part 3)

Updated: Apr 21

Welcome to Part 3 of our Blog Series where we talk about why female athletes are more prone to ACL injuries and what we can do to minimize risk!

Miss the early parts? Check out the links below to catch up!

Blog 1: Overview

Blog 2: Non-Modifiable Factors

In the last blog, we saw which factors could not be physically altered to decrease ACL injury risk in females. But today we’ll look at what we can train to not only prevent injury, but improve performance as well!

Neuromuscular Imbalances

As mentioned way back in blog 1, neuromuscular control is the connection between the brain and muscles telling which muscles to fire and when, and the muscles, tendons, and ligaments providing feedback to the brain. A decrease in neuromuscular control makes an athlete vulnerable because improper or even delayed firing sequencing in muscles lead to compensations in movements or reductions in reaction time which will make the athlete more prone to chronic stress and injury.

Men and women are created differently; we all know that. On top of having a general decrease in muscle mass, strength and power compared to men [1]; most females are also quad dominant meaning they heavily utilize the quadriceps muscles during actions that require quads, hamstrings and glutes. This is important to note because if the muscles are not firing in the proper sequencing there could be greater risk of injury. For example, the hamstrings control eccentric forces and help an athlete to safely slow down after accelerating. If there is a delay in the firing of the hamstring complex (where the quads fire first causing forward stress on the knee) then that muscle group is not able to fire quickly enough to help the athlete safely slow down, stop, or change direction; causing the ACL to take over in attempts to stabilize and most likely will sprain or tear. It is ideal for the hamstring complex to be at least 60% strength of the quads [2].

A decrease in neuromuscular control is common in women and puts passive stress on the ligaments in the knee [1]

Women are also more likely than men to have leg dominance issues. Leg dominance occurs typically when the dominant leg is stronger and/or more reactive than the non-dominant leg. Most athletes have a dominant leg that they kick, throw or shoot with but female athletes are more likely to have a difference in strength from the dominant leg to the non-dominant leg.

Any time there are discrepancies on one side of the body versus the other, the athlete is more prone to injury because of the change of efficiency of the mechanics involved in certain motions performed. This can happen when one leg is stronger than the other, when one leg is more flexible or mobile than the other, or as discussed previously; when an injury results in decreased reaction time on one side versus the other. This is important to note because any athlete who has had a previous injury and especially any athlete who has had an ACL surgery is going to be more prone to experiencing leg dominance and another ACL injury [3].

For more information on these topics, find my book Surviving 7: The Expert’s Guide to ACL Surgery on Amazon.

Check out Part 4 here!

Jenna Minecci

9x Surgery Survivor/Strength Coach/Author/Athlete

B.S., CPT, CES, PES, FMS, MWod Pro




Jenna Minecci is a passionate Personal Trainer and Strength Coach dedicated to helping others prevent injury, prepare for surgery and recover exceptionally from any surgery they have. After having 4 ACL reconstructions fail on her as a teenager, she has now had 9 surgeries and counting. Her goal is to educate and empower others facing difficult surgeries and recovery journeys. She currently works at Lifetime Fitness in Atlanta, Georgia where she specializes in Corrective Exercise, Knee Rehabilitation and ACL Injury Prevention.

She is also the author of the book Surviving 7: The Expert’s Guide to ACL Surgery.

Follow Jenna on social media @Jennactive.


Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!



  1. Voskanian, N. (2013, June). ACL Injury prevention in female athletes: review of the literature and practical considerations in implementing an ACL prevention program. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702781/

  2. Boden, Sheehan. Torg, Hewett. “Noncontact anterior cruciate ligament mechanisms and risk factors.” Sep, 2010. https://insights.ovid.com/pubmed?pmid=20810933

  3. Imwalle. Myer. Ford. Hewett. “Relationship between hip and knee kinematics in female athletes during cutting maneuvers: a possible link to noncontact anterior cruciate ligament injury and prevention” Nov. 2009.

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