Recent decades have brought a big increase in female sports participation at all levels. But along with it has come a dramatically higher rate of specific musculoskeletal injuries and medical conditions compared to male athletes. Sports that require jumping, cutting and pivoting are the most dangerous, according to Dr. Anne Hoch, director of the Froedtert and Medical College of Wisconsin Women’s Sports Medicine Program. 

“Girls and women who play soccer have four to six times the risk of injury to the ACL (anterior cruciate ligament, a major stabilizing ligament in the knee) compared to male soccer players. The risk is similar for volleyball and basketball,” Hoch says. “Studies show that before puberty, boys and girls run and jump and use their muscles pretty much the same way. After puberty, however, men use their hamstrings more and women use their quadriceps.”

When female athletes jump, they tend to land with their knees turned inward, while males land with their knees flexed, which protects the knees. Female biology is the culprit. “Females have a wider pelvis and the angle from the outside of the pelvis to the knee, known as the Q Angle, creates the problem,” Hoch says. A torn ACL usually means surgical repair and four to six months of recovery and rehab time, she adds.

Avoiding these knee injuries means re-educating women about how to jump and land in a different fashion, says Dr. Todd Swenson of the Blount Orthopaedic Clinic in Milwaukee. “It is possible to avoid injury by strengthening what we call the core — the lower back, lower abdominals, and pelvis with stabilization exercises. It’s also important to strengthen the hamstrings,” he says. 

An ACL prevention program is ideal for this type of strengthening, says Hoch. “Many coaches have their own programs. We offer a six-week program at Froedtert, and we know that those who complete this kind of program have an 80 percent decrease in risk of injury,” she says. 

Female athletes are also at high risk for stress fractures of the foot and the lower leg, according to Dr. John England of Orthopaedic Associates of Waukesha. “The vast majority of these are treated nonsurgically, with the patient stopping activity for a period of time and doing some rehabilitation,” he says. “Shoulder instability injuries are also fairly common in young women athletes. The fix for that is therapy, as well,” he says. 

The Female Athlete Triad — three separate but interrelated conditions of eating disorders, amenorrhea (lack of menstruation) and osteoporosis — is another area that needs attention in young female athletes. “We often see this in runners in their high school and college years. If all three occur together, the individual is at high risk for injury,” Swenson says. 

“The Triad syndrome is a big problem that many people are unaware of,” Hoch says. “We did a study at Divine Savior Holy Angels High School in Milwaukee and we found that many of the varsity players had at least one of the triad symptoms. For female athletes to be injury-free, we need to do a lot of re-education and retraining.”