Are My Wider Hips Causing Higher Risks of ACL Injuries?

A few months ago, a friend told me she was having ACL surgery. She’s not an elite athlete. She’s just someone who enjoys regular training and sport. Then another friend mentioned the same surgery. And then another.

At first, I thought it was a coincidence. Maybe they just pushed too hard. Maybe they landed funny. But when I started to read more, it became obvious: this isn’t about bad luck. It's about anatomy, training culture, and a silent disparity in how women learn to move.

Learning Through the Body

No one told me this in P.E. No one told my friends. We learned how to stretch, how to sprint, how to squat, but not how to protect a body with a hip angle that moves differently. We were never taught how to land from a jump in a way that protects our knees. We were never told that girls, even those who will never go pro, still deserve sports training that acknowledges their anatomy.

Then those of us who do go on to get tailored sports training, most of the time it’s based on research conducted on male bodies. Male biomechanics. Male risk profiles. We’re taught to move like men in systems that weren’t designed for us. Ignoring anatomical reality means injuries like ACL are becoming the norm.

ACL Injuries: A Gendered Disparity

The anterior cruciate ligament (ACL) provides knee stability during movements like pivoting, twisting and landing. Most ACL tears are non-contact meaning your knee fails to load without a collision.

Studies show that women are 2 to 8 times more likely than men to suffer ACL injuries in sports like football, basketball and skiing.

You don’t have to be a pro athlete. You don’t even have to be pushing your body to the limit. ACL tears often occur during completely routine movements like landing a jump. This means the girl at netball or the women in her HIIT class are all vulnerable to the same injury as these elite football players.

Why Are Women At Greater Risk?

Several anatomical and biomechanical factors contribute to women having a higher risk of ACL injuries:

• Wider Q-angle: the angle between the hip and knee.

• Low limb alignment: how staright or angled the bones of your legs are when you stand - whether the bones are lined up directly with each other or if they angle inwards or outwards at the knee or ankle.

• Ligament laxity: hormonal influences such as oestrogen may increase joint looseness.

• Weaker hip and core muscles

• Delayed or altered muscle activation: disruption of normal timing in muscle firing.

• Less exposure to strength training and conditioning in youth

Expanding on the Q-angle

Image Source: Champion Performance & Physical Therapy

One example that stood out to me is the Q-angle. The Q angle is the alignment between the hip and knee and is typically wider in women due to our broader pelvises. This seemingly small angle changes the way we move, load our joints and fire our muscles.

A 2024 study found that those with angles above 19 degrees are linked to more ACL ruptures in female athletes. This is because a larger angle will:

• Increase lateral pull on the knee

• Increase susceptibility to the knees collapsing inwards during landing

• Higher stress on ACL in deceleration or pivoting moves

Why isn’t this taught?

Multiple studies confirm that neuromuscular training – a mix of polymetric, strength, balance and technique drills – can significantly cut ACL injury risk in female athletes.

So why isn’t this part of every PE curriculum? Why aren’t young girls taught this, or rather why is what is taught still based on male physiologies?

Thinking about my own school experiences, no one ever said: “Your Q-angle means your knees might drift inward. Let’s strengthen your glutes and teach alignment.” And even now, competing at a university level, no coach has said this either.

Is it because this is only taught at a more elite level? Or is it because this knowledge is still seen as niche when it should be fundamental?

Knowledge Sharing

Sometimes equality isn’t about giving everyone the same. A one-size-fits-all approach, especially when that size is based on the male norm, is not equality. It’s negligence.

This isn’t just about elite athletes. This is about the girl on her school football team. The jogger doing couch-to-5k. If female bodies come with different risk factors, then female training should come with different instructions.

Organisations like FIFA have introduced the 11+ programme, which has shown some promise in reducing injuries in youth players. But this implementation is uneven and often poorly funded.

ACL injuries will continue to rise until we change the system. That starts with education – teaching girls about their q-angle. The most dangerous part about all of this isn’t the injury itself. It’s the fact that we have most of the answers already, but they’re just sitting, waiting to be taught.

References

Al Attar, W. S. A., Bizzini, M., Alzahrani, H., Alarifi, S., Ghulam, H., Alyami, M., Alzhrani, M., & Sanders, R. H. (2022). The FIFA 11+ Kids Injury Prevention Program Reduces Injury Rates Among Male Children Soccer Players: A Clustered Randomized Controlled Trial. Sports Health: A Multidisciplinary Approach, 15(3), 194173812211092.

Douglas C.A. Taylor, & Bevier, C. R. (2023). Relationships Among Knee Injuries, Q-angles, and Competition Levels in Female Ski Racers. MedRxiv (Cold Spring Harbor Laboratory).

Ewing, L. (2025, June 30). Can training and technology solve the ACL crisis in women’s football? Reuters.

Lewis, T. (2000). Anterior Cruciate Ligament Injury in Female Athletes: Why are women so vulnerable? Physiotherapy, 86(9), 464–472.

Mancino, F., Kayani, B., Gabr, A., Fontalis, A., Plastow, R., & Haddad, F. S. (2024). Anterior cruciate ligament injuries in female athletes: risk factors and strategies for prevention. Bone & Joint Open, 5(2), 94–100.

Saber, B., Bridger, D., & K. Agrawal, D. (2024). A Critical Analysis of the Factors Contributing to Anterior Cruciate Ligament Injuries in Female Athletes. Journal of Orthopaedics and Sports Medicine, 6(4).

Stevenson, J. H., Beattie, C. S., Schwartz, J. B., & Busconi, B. D. (2014). Assessing the Effectiveness of Neuromuscular Training Programs in Reducing the Incidence of Anterior Cruciate Ligament Injuries in Female Athletes. The American Journal of Sports Medicine, 43(2), 482–490.

Sugimoto, D., Myer, G. D., McKeon, J. M., & Hewett, T. E. (2012). Evaluation of the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a critical review of relative risk reduction and numbers-needed-to-treat analyses. British Journal of Sports Medicine, 46(14), 979–988.

WHAT IS A Q ANGLE? (2016, March 9). Champion Performance & Physical Therapy.