Before stepping onto that soccer field or lacrosse field — ladies, take extra precautions. You’ve trained hard, learned all of the plays, and committed to your sport, but it only takes one wrong turn to undo that hard work.

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Ongoing research continues to show that women are up to six times more likely to suffer an anterior cruciate ligament (ACL) injury than men. Women — younger women in particular — are also more likely to suffer a subsequent re-tear.

Most ACL injuries come from non-contact sports.

There are certain genetic predispositions that leave females more vulnerable to knee injuries, specifically of the ACL. And this ligament’s got a big job — its main function is to provide stability to the knee, as well as rotational stability.

Most ACL injuries come from non-contact sports, according to Dr. Duong Nguyen, an orthopedic surgeon from Toronto, Canada, who specializes in elbow, shoulder, and knee reconstructive surgery. He said these kinds of injuries often result from sharp movements: The foot is planted on the ground and an athlete quickly changes directions.

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A variety of genetic factors lead women to be high-risk for a tear or re-tear. Estrogen levels, bone structure, and muscle strength can have an effect. Females often have upper stability problems that make them more susceptible to ACL injuries. Women also have different muscle patterns and a different muscle foundation than men, Dr. Nguyen told LifeZette.

Women are more at risk for kneecap dislocation and meniscus tears as well, he said.

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A report from the University of Colorado Hospital, “Why Do Females Injure Their Knees Four to Six Times More Than Men … And What Can You Do About It?” found the latter of the three was perhaps the most important factor in injury prevention: muscle strength.

Weight lifting and certain training drills that require balance, power, and agility will strengthen the muscles surrounding the knee.

Many women have an imbalance in strength between their quadricep (the muscle in front of the thigh) and their hamstring (muscle behind the thigh). Knowing this, doctors have studied videos of female athletes who suffered from ACL injuries in motion.

They found four common components that lead to improper form and an increased risk of injury:

1.) When female athletes land, their knees buckle inward — this can be because of a woman’s wider pelvis.
2.) The injured knee is relatively straight.
3.) Most, if not all, of a female athlete’s weight is on a single lower extremity.
4.) A female athlete’s torso tends to be tilted more toward one side.

Hormones also play a role in ACL injuries. Women have fluctuating levels of estrogen and relaxin throughout the month. Both hormones give ligaments strength and ability, but the changes can also affect the function of the nerves and muscles in the knee.

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Female athletes are advised to take steps to prevent this knee injury when at all possible — it takes a long time to recover from an ACL tear and it’s a painful injury that can stick with you the rest of your life. Athletic trainers say weight lifting and certain training drills that require balance, power, and agility will strengthen the muscles surrounding the knee, decreasing chances of an ACL tear.

Plyometric exercises such as jumping and balance drills also help to improve neuromuscular conditioning and muscular reactions.

Dr. Nguyen recommends ACL injury prevention programs — and he stresses being educated on how to prevent ACL tears and re-tears. He works with many female patients and uses motion tracking and mirror feedback. This allows women to see the way their bodies move and learn how to prevent a re-tear of the ACL, which is even more devastating than the initial tear.

“If you just focus on surgery and not rehab, the risk of re-tear is higher,” Dr. Nguyen said. “You need to fix the mechanics.”