Women & ACL Injuries: Know Risks, Steps for Prevention

August 10, 2021

Whether you’re a casual jogger or elite athlete, you’re at risk for an injury to your anterior cruciate ligament (ACL). If you’re a woman, you are at even greater risk for these injuries.

But there are steps you can take to prevent them.

“Among athletes, women are more than twice as likely to have an ACL injury than men,” says Nithin Natwa, M.D., a sports medicine specialist and primary care physician at Henry Ford Health System. “Once you have an ACL injury, you are at greater risk for having further soft tissue injuries in the future. That’s why it is important to prevent these injuries and follow your treatment plan if injured.”

What Is An ACL Injury?

An ACL injury is a strain or tear in the ACL, one of the four major ligaments that support the knee so it can flex and bend. The ACL is a strong band of tissue that helps connect your thigh bone (femur) to your shin bone (tibia). “An ACL injury usually occurs without contact when you turn suddenly while running or land off-balance on one leg. These actions overload the knee joint and cause the ACL to be torn,” says Dr. Natwa.

In the United States, 100,000 people have ACL injuries each year. Anyone can experience an ACL injury, though athletes participating in sports like football, basketball, soccer and gymnastics are at highest risk. And summer is a peak time for outdoor sports injuries.

Seek immediate care if you have any of these signs of an ACL injury:

• An audible “pop” in the knee

• Intense knee pain and rapid-onset swelling (within hours)

• Loss of range of motion

• An unstable feeling or locking of your knee

The most common treatment for ACL injuries is surgery followed by physical therapy. After treatment, you can expect to return to normal activities in 6 to 9 months. However, peak athletic performance can take up to two years.

Why Are Women At Higher Risk For ACL Injuries?

According to Dr. Natwa, the differences in athletic training techniques for males versus females have left women at greater risk for ACL injuries. “There has been more emphasis on overall conditioning and mechanics for boys participating in sports compared to girls,” he says.

As a result, women are at greater risk for ACL tears and sprains due to:

Differences in neuromuscular control: Without conditioning from an early age, women may not have the same ability to land and perform athletic motions that men do. For example, women are at higher risk for an ACL injury after landing from a jump.

Strength imbalance for muscles that support the knee: Female athletes tend to have more defined quadriceps muscles but weaker hamstrings than men, putting them at greater risk for injury.

According to Dr. Natwa, there are many theories about women’s risk for ACL injury that lack scientific evidence, including:

Width of the pelvis: Some people have suggested that the wider width of a woman’s pelvis puts more pressure on the knee joint and increases the risk for injury. However, this difference has not been shown to impact a women’s risk for ACL tears or sprains.

Knee anatomy: The ACL runs through a section of the femur called the intercondylar notch. Women tend to have a narrower notch than men. Regardless of gender, individuals who possess smaller notch dimensions appear to be at greater risk for injury than individuals with larger notches.

Hormones: Men and women have different hormone levels. But there is currently no concrete evidence that female hormones place women at higher risk for ACL injures.

Steps To Prevent ACL Injuries – Conditioning Early, Often

“The best way to prevent ACL injuries is to begin and maintain regular conditioning exercises at an early age,” Dr. Natwa says. “The more frequently you engage in proper exercises, the lower your risk for injury.”

Consult with a sports medicine specialist, physical therapist or athletic trainer to develop a training routine to prevent ACL and other injuries. Your training program should include exercises that:

Strengthen the muscles that support your knee: Add strength training to build up your calves, hamstrings and quadriceps muscles. These muscles help stabilize your knee as you move. By strengthening these muscle groups evenly, you can lower your risk for injury.

• Improve overall neuromuscular control: Focus on adding neuromuscular exercises that train your nerves and muscles to react and communicate. For example, you may work on your balance by standing on one leg or sit upright on an exercise ball for short periods of time. And core exercises can strengthen the muscles that support your abdomen and back and help improve your posture as you move. These moves can strengthen your joints and help you learn appropriate balance and technique.

“Exercise really is the best medicine. It can improve your balance and agility as you participate in a sport or prevent injury as you move through your daily activities,” says Dr. Natwa. “Consider adding these exercises to your wellness program.”

Dr. Nithin Natwa is a sports medicine doctor who sees patients at Henry Ford Macomb Health Center in Chesterfield and Henry Ford Macomb Orthopedics and Wound Care in Clinton Township.

Want to learn more? Henry Ford Health System sports medicine experts are treating the whole athlete, in a whole new way. From nutrition to neurology, and from injury prevention to treatment of sports-related conditions, they can give your athlete a unique game plan. To find a sports medicine physician at Henry Ford, visit henryford.com or call 1-800-436-7936. 

Symptoms of a Meniscus Tear — and When to Seek Treatment

April 2, 2024

Meniscus tears are not one size fits all: Sometimes they cause no pain, other times they’re excruciating.

Henry Ford HealthOnce in a while they heal or adapt on their own, but more often than not they require physical therapy or surgery.    

“Your meniscus is a fiber elastic cartilage that acts as a shock absorber for the knee,” says Ahmad Bazzi, M.D., a sports medicine physician at Henry Ford Health. “It also helps stabilize the knee joint. But when it tears — which can occur in young athletes after a pivot injury or in older people who have arthritis — it can be painful.”

Here, Dr. Bazzi shares symptoms of a meniscus tear and when to see a doctor. 

What Does A Meniscus Tear Feel Like?

Depending upon the level of injury and type of tear, meniscus tears can either be asymptomatic or cause symptoms like:

  • Locking. When the meniscus tears, a piece of it might move into the knee joint, causing mechanical issues like stiffness and locking of the knee joint.
  • Catching or clicking. This often feels like a sudden ‘click’ in the knee joint, where it suddenly gives out while you’re walking or doing certain movements. 
  • Localized pain on the inner or outer part of the knee. In young athletes, a meniscus tear often causes an impaired range of motion and localized pain on the inner or outer part of the knee. 
  • Pain and swelling. In older people, a meniscus tear often causes swelling and an overall aching pain in the knee.  

Treatment Options For Meniscus Tears

A meniscus tear can only heal on its own if the tear is on the outer part of the knee where it has better access to blood supply. If you’re experiencing pain a few days after injury and you have limited range of motion, instability and/or swelling in the knee, Dr. Bazzi recommends seeing a doctor to get an examination and, if needed, an MRI for diagnosis. 

“It’s hard to tell what type of meniscus tear you have if you haven’t seen a doctor,” says Dr. Bazzi. “If you have a mechanically unstable tear and it goes untreated, it could lead to worsening range of motion and stiffness, or worsening arthritis. It’s important to get seen by a doctor to get an accurate diagnosis and the proper treatment. It may take one to three months for a full recovery.”     

Here, Dr. Bazzi shares treatment options:


If someone is having mechanical symptoms like locking or catching, surgery may be considered right away, especially if it’s an athlete younger than 40 years old. “Meniscus tear surgery has a shorter recovery compared to other knee surgeries,” says Dr. Bazzi. “Surgery could either consist of a meniscectomy, which is partial or complete removal of the meniscus, or sometimes just a meniscus repair.”  

Hyaluronic acid or cortisone injections

Non-operative treatments are often recommended for older people who have degenerative tears due to arthritis. “This is because meniscus surgery doesn’t often relieve their pain since they have underlying arthritis, meaning they have cartilage loss in the meniscus,” says Dr. Bazzi. 

Instead, a cortisone injection, which is an anti-inflammatory medication that can be injected into the knee, can reduce inflammation, swelling and pain caused by arthritis.

A hyaluronic acid injection may also be considered, which adds cushioning in the knee. “Hyaluronic acid is one of the substances that make up our cartilage, so this injection helps us mimic the lost cartilage,” says Dr. Bazzi. “It also has anti-inflammatory properties.” 

Physical therapy

Physical therapy is another great option, especially for older people who need non-operative treatment options. It can help the knee adapt to the tear, reduce pain and encourage full range of motion. “Physical therapy for meniscus tears focuses on balance exercises and exercises to strengthen the muscles around the knee,” says Dr. Bazzi. “This helps to uphold the knee joint to achieve full range of motion and strength while being pain-free.” 

To find a sports medicine provider at Henry Ford Health, visit henryford.com/athletes or call 313-651-1969.

Reviewed by Ahmad Bazzi, M.D., a sports medicine physician who sees patients at Henry Ford Medical Center – Fairlane.