Written by David Hardy, Volleyball Trainer (learn more about David at the end of this article).

ACL injuries are a concern for many female volleyball players. Most, if not all, female volleyball players know a girl or know of a girl that has sustained a non-contact ACL injury. The idea of such an injury can be scary for young girls, especially with people making the claim that it’s happening more frequently than it used to.

While it definitely is (and should be) a concern for female players, it isn’t necessarily a new or sudden issue, as it’s sometimes touted as. I’m going to go over some of the reasons why these injuries happen more often in females than in males and why the number of these injuries has likely seemed to increase in the last few years.

WHAT OTHERS ARE GETTING WRONG

One phrase that I hear regurgitated in conversation, or copied and pasted in text, so often is:

“Non-contact ACL injuries have become more and more prevalent among female athletes, specifically among volleyball players.”

And while it’s possible that the amount of these injuries could be slightly higher compared to that of the past, there are two factors that are rarely mentioned by the people making those claims that should be taken into consideration:

1. The growth of the sport, and

2. The way information is spread and received.

To all of our benefit, the sport of volleyball has grown and advanced exponentially over the years. Anyone who has spent a considerable amount of time in the volleyball world knows that the sport is bigger now than it was 10 or even 5 years prior. And it was bigger then, than it was 10 years before that, and bigger 10 years ago than it was 20 years ago, and so on…

WHEN GROWTH OF A SPORT BRINGS NEW PROBLEMS

The increase of involvement and recognition of the sport is a great thing, and as a result there are more opportunities for more girls to participate. At the time this is being written, there are more school programs, more camps/clinics offered, and more clubs than ever before. I’ve worked with a club that had eight different teams for a single age group!

All of this equates to more girls playing volleyball. But as the number of players increases, other numbers increase as well. This includes the number of tournaments held, the number of games played, and unfortunately, the number of injuries sustained. When comparing the frequency of injuries now vs injuries in the past, it’s important to consider the overall number of athletes playing both now and then. If out of 100 girls playing, 1 girl tears her ACL, that is 1% of the players injured. Now if out of 400 girls playing, 4 girls tear their ACL, that is still 1% of the players injured.

Even though the second number of injured athletes is 4 times greater than the first, the percentage of injured vs not injured is the same, when you factor in the overall number of players. So as the number of female volleyball athletes increases, we should expect the number injuries to follow suit (for reasons I’ll touch on shortly), at least to a certain degree.

OUR CONNECTED WORLD

The second factor, as I mentioned, is the speed and distance at which information is able to be shared and received. In this day and age almost anyone, even a young child, could open their smart device and send a message to another person on the other side of the planet. This is an act that was unheard of not too long ago.

To give you an example, I heard about a girl tearing her ACL at a tournament 300 miles away just a few hours after it happened. This is something that probably wouldn’t have happened 10 years ago, and DEFINITELY wouldn’t have happened 20 years ago. We are so connected that you will inevitably hear about more injuries from more people, and this information can be shared almost instantly. This can contribute to the false assumption that something is happening more frequently than it had in the past, simply because you’re being exposed to it more.

ANATOMICAL DIFFERENCES

Even taking those two factors into consideration, the fact still remains that female athletes are more likely to sustain such an injury than male athletes. There have been many studies done to get to the bottom of the how’s and the why’s behind this, and it all seems to correlate to the anatomical differences between males and females. The two biggest factors appear to be the difference in neuromuscular control and differences in the pelvis between males and females. While certain types of training (as mentioned in a previous article) can decrease the likelihood of these injuries occurring, the predisposition to these injuries as a result of those anatomical differences is still pertinent for female volleyball players.

Regarding the pelvis, the female’s is typically wider than the male’s, comparatively speaking. And so the acetabulum (area where the femur or thigh bone inserts into the pelvis) is wider in females. This causes the femur to rotate and slope inward at more of an angle, increasing the amount of stress placed on the knee (and its supporting ligaments) during motion. This, in and of itself, does not guarantee a knee injury. But more stress during each movement equates to more overall stress over time. And like with most things (extending beyond just anatomy), wear and tear increases the likelihood of damage and decreases the time it takes for damage to happen.

Neuromuscular control is, simply put, is the ability of your muscles to control your body and maintain proper joint alignment during motion. In my last article, I discussed the importance of muscles in motion. To recap: all motion, as well as the stopping and/or slowing of motion, from within the body is dictated and controlled by muscles. Males, generally speaking, have a higher degree of muscular development (and by default, neuromuscular control) than females.

This extends beyond just the muscles that affect motion of the knee (muscles controlling the knee + the hip and ankle), and into the core musculature that is responsible for stabilization and balance. So if we accept that most non-contact injuries are a result of inefficient deceleration and that the muscles are responsible for that deceleration, it would make sense that females (with less natural neuromuscular control) would be more susceptible to these injuries.

Despite everything said above, it’s always important to acknowledge the outliers. Some males have wider pelvises than females of their same height/weight, just as some females have better muscular development and neuromuscular control than males. A trained female, having worked to strengthen her muscles and increase neuromuscular efficiency, is very likely to have better neuromuscular control than an untrained male. But when it comes to males and females participating in the same sport and having similar training methods over a similar period of time, more often than not males will have better neuromuscular control, though that isn’t always the case.

It is also important to note that while females are more likely to sustain these injuries than males, males are not immune to this occurrence. A quick google search will show you multiple male athletes, at the professional level with the top genetics and top training methods, who have torn their ACL.

OVERVIEW

In summary, female athletes are far more likely to tear their ACL than their male counterparts. But to say that it’s become more prevalent in recent times may be a bit of a stretch when you factor in the increase in the involvement of the sport and the rate and distance that the news of these injuries is spread.

The reason females are more prone to this particular type of injury is largely attributed to the anatomical differences between males and females, but this isn’t a new phenomenon. These differences have always existed in males and females, before the inception of volleyball, and female athletes have always had a predisposition to these types of injuries. But even though males are less likely to sustain this kind of injury, it can and does happen to males at the highest and most elite levels of athletics.

DAVID HARDY

NASM-CPT, PES, CAFS

David Hardy has been a volleyball trainer in Northwest Indiana since 2014. A staff member of Trademark Performance Corporation, David trains youth volleyball players of all ages and can often be found on weekends watching his athletes play in local tournaments. Follow David on Instagram and Facebook, or call (219) 319-0110 to book a training session with him today!