2018 has been a big year for women. So much light has been shed on gender differences in pay scale, opportunity and general treatment.  Workplaces, homes, and communities all over our country are opening their eyes to gender inequalities.  Women are speaking out and standing up for their rights as our world strives to treat men and women equally. It’s awesome.

But what if I threw out the notion that maybe there are some instances in our culture where the gender differences between men and women do need to be acknowledged. Maybe the fact that we have treated girls and boys the same has actually perpetuated a problem that can be debilitating and often times life and career altering for some.

What I am referring to is a great “gender gap” we see in adolescent youth and injury rates. Adolescent females are injured more than males.

A few of the problems:

According to the National Institute of Health, adolescent female athletes are 6x more likely to incur an ACL tear or sprain compared to their male counterpart.

Young ladies are shown to suffer from a greater number of injuries including plantar fasciitis, ankle sprains, patellofemoral pain syndrome, shoulder and knee pain in their middle school and high school years.

One study showed that 151 out of 291 young, female athletes suffered from incontinence (involuntary leakage of urine). These women had not had babies yet.

For some reason, girls are getting injured at a significantly higher rate than boys.

Luckily, the question of “why?” has attempted to be answered. A few explanations have been studied and identified to help us combat this issue:

More girls playing: there has been an over 600% increase in girls participating in organized sports since the 70s. With more girls playing, it is guaranteed more injuries are going to be reported than in the past.

Understandable, but this doesn’t explain why injury rates are higher than boys. 

Our hips don’t lie: Genetically, women are born with a wider pelvis. This alters the positioning of our ligaments that support our knees, hips, and ankles. Our hips are the foundation of general leg control so this contributes greatly to potential positioning, deceleration, and control during athletic endeavors.

Incorporating hip specific strengthening and stability work is a vital part of training that is not currently addressed well in general athletics or strength and conditioning programs.

Hormones: With a greater amount of estrogen in our bodies, our general composition is much different than men. Women have less muscle mass as well as higher levels of fat which can affect tissue and make us more susceptible to injury.

Things such as volume and weight need to be assessed and changed accordingly when programming for females compared to males. Nutritional education is also non-existent which plays a huge role in the regulation of our hormones, especially when training.

Greater elasticity:  Girls are generally more flexible than boys and this is true in not just our muscles but our ligaments as well. Without proper stabilization, our ligaments are at a greater risk of tear due to increase amount of movement.

The ratio of stretching/flexibility training to stabilization training should not look the same in a boys program compared to girls. 

Different mechanics: Inherently, girls tend to do things differently than boys. Imagine that. We find this in landing mechanics and balance strategies. Girls gravitate to more of upright landings with knees closer together. While in some instances, this isn’t a problem, this can be contributing to the greater knee/hip/ankle injury rate.

Incorporating more sport specific skill training on mechanics needs to be a higher priority in female programs than in males. 

So what’s our deal?

We know the issue. We know reasons why there is an issue, but strength and conditioning programs (if even present at all) at schools and athletic clubs continue to do what they have always done. They program out for a general population without much consideration in the differences we see in males and female needs.

Very little education is given on technique in the weight room and on the field, leaving us exposed and vulnerable to poor habits and inefficient training. Just this past month I had a high school female athlete tell me her coach asked them to deadlift in the weight room. When they questioned how to do it correctly (they hadn’t performed this lift before) he pointed to other athletes in the gym and said: “just watch them.” This was the extent of their training on a technical, and potentially dangerous lift if not performed correctly. Eye roll.

“Pre-hab” programs are non-existent in helping educate women on simple and easy exercises they can do to address the weaknesses we are predisposed to. Most female programs have them in the weight room on a voluntary basis 1-2xweekly with no direction or programming. I’ve had some local female coaches report “the weight room just isn’t our thing.” Double eye roll.

Pelvic floor and core stability knowledge are scarce in our culture in general, much less in our schools and athletic departments. Discussing pelvic floor friendly ways to train at an early age will set young women up to be more successful in their athletic endeavors and maybe even change their outcomes once they do start to bear children.

What do we do?

I understand that time and funds are not unlimited in our local schools to provide everything I have discussed. But can we look at current programs or at least the general knowledge of our coaches and trainers who already have programs set up for our girls?

I encourage you to find a program for you, your daughter, granddaughter, niece, etc that you know can address the above mentioned. Supplement your school/club training with accessory work specific to you, that keeps your gender, your body, your tendencies and your goals in mind to keep you injury free.


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  1. Renstrom P, Ljungqvist A, Arendt E, et al. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med. 2008;42(6):394-412.

  2. Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR. The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study. Am J Sports Med. 1999;27(6):699-706.

  3. Thyssen, HH. Urinary incontinence in elite female athletes and dancers.  2002;13(1):15-7.