Female athletes experience dramatically higher rates of specific musculoskeletal injuries and medical conditions compared to male athletes. In particular, ACL injuries occur at a three- to six-times greater rate in females compared to male athletes playing the same sports. The combination of increased risk of ACL injury and a 10-fold increase in sports participation since the enactment of Title IX in 1972 has led to an almost epidemic rise in ACL injuries in female athletes.

Research has identified several reasons for this discrepancy. First, girls and women tend to have an imbalance in the strength ratio between their quadriceps and hamstring muscle groups. A female athlete is more likely to use the quadriceps to slow down from a sprint, thus causing instability in the knee. A male athlete is more likely to decelerate using his hamstrings to absorb the change in speed. This slight difference provides an inherent protection to the ligaments of the knee for the male athlete.

Video analysis has identified four common traits during a female ACL sprain or tear:

1. As the athlete lands, her knee buckles inward

2. The injured knee is relatively straight

3. Most, if not all of her weight is on a single lower extremity

4. Her trunk tends to lean laterally.

Additionally, some doctors think females are more likely to have an ACL injury because of the differences in the number of circulating hormones such as estrogen and relaxin. Both of these hormones give ligaments strength and flexibility and the fluctuations of the hormone may influence the function of the nerves and muscles.

In a study conducted by the American Academy of Pediatrics, research showed that female athletes could reduce their risk of a non-contact ACL injury by 72 percent with the proper neuromuscular training. By following a regular stability training program designed to focus on those gender specific differences that place females at increased risk for lower extremity injuries, they will ultimately improve core stability and balance, enhance reaction time, optimize movement mechanics, and reduce strength imbalances.