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IFAC Reflections Part 2
January 22, 2019
A review of Jerome Simian’s workshops on physical preparation for sport. I had to choose between different “strands” of coaching topics at the IFAC conference in Loughborough. A difficult choice, not wanting to miss out on some excellent speakers. I chose to attend Simian’s because of a quote I heard on the HMMR podcast: “I […]

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How to reduce the risk of ACL injury for females.

Why are Females at Higher Risk of ACL Injury?

Female athletes have a 4-6 times higher incidence of ACL injury than do male athletes participating in the same landing and pivoting sports” (1)

Hormonal changes: Hormonal changes during the menstrual cycle can have a direct effect on neuro-muscular performance.

Anatomical differences: Females have a smaller intercondylar notch, therefore a smaller ACL.

An Increased Q Angle will influence landing technique negatively.

Slower reaction times: Females have slower and less efficient reaction times due to different neuro-physiology i.e.differences in spinal motor control.

Poor landing mechanics: Reduced leg power will cause an increased reliance on the quadriceps and ligamentous structures at the knee and ankle .An increased Q angle in females has a direct impact on landing mechanics.

Less power: Females have reduced power and muscle development.

Implementation of practical neuro-muscular warm-up strategies can reduce lower extremity injury incidence in young, amateur female athletes.” (2) 

Reducing the risk of ACL injury

This diagram summarises the key factors found in recent research on preventing ACL injuries in female athletes.

ACL injury prevention


Screening: Musculo-skeletal screening can help identify specific problem areas for each individual athlete

Footwear: Wear appropriate and good quality footwear to facilitate good foot/ankle mechanics and help control ground reaction forces.

Conditioning: Functional conditioning work, related to individual screening outcomes and specific to sport requirements. To include stretching, strengthening, plyometrics, review of landing techniques, sports specific drills and balance exercises.

Warm Up: Use practical neuro-muscular warm-up strategies (see conditioning work).

Oral Contraceptives: Use of oral contraceptives pre-competition has been shown to have an effect. Reearch is hampered by ethical concerns.

Further Reading: 


  1. Hewett et al American Journal of Sports medicine March 2006 34(3) 490-498
  2. Herman et al BMC Medicine July 2012 19 10(75)
  3.  Stojanovic et al Research in Sports Medicine July 2012 20(3-4) 223-238
  4.  Walden et al British medical Journal May 2012 344 e3042
  5.  Irmischer et al Journal of Strength and Conditioning Research November 2004  18(4) 703-707

 Sarah Marshall  Chartered Physiotherapist


  1. […] have covered injury prevention a lot on the previous support days (our whole training programme is well designed to help prevent […]

  2. […] Lower body strength and stability are also vital to reduce injuries due to the high impact and regular changes in direction. The risk of injury is especially high for female players. […]

  3. […] is primarily a female sport, which due to their anatomical construction are prone to knee injuries in sport before adding in the complications of landing, jumping and multi directional […]

  4. level1 says:

    This is a very intresting read and it makes lots of sense it would be intresting to investigate if it is more common in specific female sports and if we can tailor drillls/ practices in female specfic sports to decrease this risk.

  5. level1 says:

    This is a very informative article and links areas that I had considered but fully impacted. This will form part of future validity and varience in training and specific advice to female players.

  6. level1 says:

    It is quite interesting to know the key areas of why women seem to be more prone to this type of injury. It would be great to do more research within this area.

  7. JON says:

    Interesting points – I didn’t know women were more prone to ACL injuries.

  8. level1 says:

    I was unaware of this-an interesting read. Also great to be given ideas on how to prevent this.

  9. level1 says:

    As a girls coach this is very interesting article, great to be able to look at preventative measures

  10. Steve says:

    I agree with the above. Really interesting to find out women are more prone to ACL injuries

  11. Ian says:

    I actually knew a little about this as having severely injured my knee whilst playing rugby the ACL injury rate for men and women was discussed during my rehab. This is compounded with people with hypermobility in their knees too

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