Why ACL Injuries Hit Women Harder

If you're a woman recovering from an ACL injury, or trying to prevent one, you're not alone. Studies show that female athletes are up to eight times more likely to tear their ACL than their male counterparts. But why is this the case? And what does it mean for recovery?

In this blog, we’ll break down:

Why ACL injuries are more common in women
How menstrual cycles can influence injury risk and recovery
What female athletes and active women can do to rehab smarter and prevent reinjury

Why Are Women More Prone to ACL Tears?

There’s no single reason, but rather a combination of biological, biomechanical, and hormonal factors that contribute to a higher ACL injury rate among women:

Hormonal Fluctuations
Estrogen and relaxin levels vary throughout the menstrual cycle. These hormones can influence ligament laxity and joint stability. Some studies suggest that injury risk peaks during the ovulatory phase (around days 10–14 of the cycle), when estrogen is highest and ligaments may be more prone to stretching. During the luteal phase (days 15–28 of the cycle), progesterone levels rise, which can contribute to increased fatigue and joint discomfort.
Anatomical Differences
Women tend to have a wider pelvis and a greater Q-angle (the angle between the hip and knee), which can affect knee mechanics and increase the risk of inward knee collapse during movement. This collapsing of the knee is a common mechanism for ACL injuries due to the increased strain that it puts on the ligament.
Neuromuscular Control
Research shows that women often activate muscles differently during dynamic movements, like jumping or cutting, leading to more stress on the ACL. Women generally tend to be more “quad-dominant”, meaning the quadricep muscles out-work the hamstring and glute muscles, leading to muscular imbalances and a lack of support in the knee.
Movement Patterns
Women may be more likely to land with less knee flexion or in valgus (inward knee collapse), which increases ACL strain. These patterns are often ingrained from an early age and can be modified with training.

What Recovery Looks Like for Women

While the recovery timeline doesn’t dramatically differ by gender, tailored rehab strategies can make a big impact for women. Here’s what we focus on at our Oakville clinic:

1. Targeted Neuromuscular Training

We emphasize retraining proper landing, cutting, and pivoting mechanics. This includes:

Single-leg balance work
Plyometric drills with form correction
Core and hip stability training

2. Strengthening the Right Muscles

Women often have relatively weaker hamstrings compared to quads, a known risk factor for ACL injuries. Rehab focuses on:

Hamstring strengthening
Glute activation
Quad symmetry restoration

3. Aligning Rehab with the Menstrual Cycle

Emerging research suggests tailoring rehab intensity based on menstrual cycle phases may improve recovery outcomes:

Follicular phase (Day 1–14): Often associated with higher estrogen levels and more ligament laxity. Rehab may emphasize neuromuscular control and movement quality.
Luteal phase (Day 15–28): Progesterone rises, and some women report more joint discomfort and/or overall fatigue. Strength and power phases can be introduced with adequate recovery and nutrition.

By tracking symptoms and menstrual phases, rehab plans can be adapted to align with hormonal patterns, reducing injury risk and improving adherence.

4. Addressing Confidence and Mental Recovery

The psychological side of recovery is often overlooked. Women may experience higher levels of fear of reinjury, particularly when returning to sport. We support our patients with:

Gradual exposure to sport-specific drills
Goal setting
Collaborative rehab planning that empowers progress

5. Education on Injury Prevention Post-Recovery

After recovery, we work with patients to:

Implement injury prevention warm-ups
Continue strength and conditioning
Encourage regular screening for movement deficits

What Women Should Know About Returning to Sport

Returning to sport is not just about time, it’s about meeting specific physical and psychological milestones. For women, we recommend:

Strength testing to ensure symmetry between legs
Hop tests and agility drills for functional readiness
Confidence and readiness assessments

A rushed return increases the risk of reinjury. We typically aim for 9–12 months post-op before full return to pivoting sports.

How to Reduce the Risk of a Second ACL Injury

Reinjury rates can be alarmingly high, especially in young female athletes. To reduce this risk:

Stick with a maintenance program (even after discharge from physio)
Continue neuromuscular and strength training
Don’t skip warm-ups or recovery days
Get regular movement assessments

The work doesn’t stop when rehab ends, it progresses.

Real Talk: ACL Recovery Isn’t One-Size-Fits-All

Every ACL rehab journey is unique. And for women, that means understanding your body’s needs, mechanics, mindset, and hormonal patterns.

At our Oakville clinic, we design ACL recovery programs that are not just personalized, but also proactive. We recognize the unique risks women face and tailor our rehab to build strength, confidence, and long-term resilience.

Let’s Move Forward, Together

Whether you're just starting rehab or trying to prevent a second injury, we’re here to help. Our experienced physiotherapists and athletic therapists in Oakville specialize in ACL recovery for women and active individuals.

📍 710 Dorval Dr Unit 520, Oakville, ON
📞 (289) 835-2949
💻 https://www.elevaterehabilitation.com/

Women and ACL Injuries: What You Should Know About Recovery