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The knee injury gender Gap: Why do women suffer more?

The knee injury gender Gap: Why do women suffer more?
Elizabeth G. Matzkin, M.D., surgical director, Women’s Sports Medicine Program, Brigham and Women’s Hospital. (Photo courtesy of Brigham and Women’s Hospital

Dr. Elizabeth Matzkin, surgical director of the Women’s Sports Medicine Program at Brigham and Women’s Hospital, sees plenty of young female athletes come into her practice with knee injuries. Many of those injuries are anterior cruciate ligament (ACL) tears. The reasons for this trend, she explains, are largely based on how women are built.

Dr. Matzkin’s team includes specialists in orthopedics, arthritis, endocrinology, nutrition and physical therapy. Together they specialize in treating knee and shoulder injuries in females of any age or activity level. This includes women who aren’t athletes. The majority of their patients, however, are high school- and college-aged women who have suffered sports-related knee injuries.

Gender differences in strength and structure

This rise in knee injuries among females is partly because more young women are playing competitive sports. But the more important issue is that female athletes experience ACL injuries, stress fractures and knee pain more frequently than their male peers do.

Recent U.S. research indicates that a number of factors make women more susceptible to bone and joint injuries. These factors include eating disorders, altered periods, vitamin deficits and hormone differences. However, for ACL injuries, the keys appear to be differences in body strength and structure.

Overall, a woman’s body is designed for flexibility. A man’s body is designed for strength. Thus, women tend to have weaker thigh muscles. This puts women at a disadvantage, as these muscles help stabilize the knee and absorb shock when jumping and landing, or sharply cutting, during sports such as basketball or soccer.

A woman’s hip structure adds to the problem. Wider hips cause women to land in a more knock-kneed position — angled in from hip to knee and angled out from knee to ankle — to maintain balance. A man’s legs tend to be straighter when he lands. This landing position, combined with the lack of muscle strength, produces great strain on a woman’s knees.

Building stronger muscles and teaching proper techniques

The good news, Dr. Matzkin says, is that we can combat these differences.

“We’re seeing a significant rise in the number of young female athlete injuries, but most of them are preventable,” she says. “Studies have shown that neuromuscular training programs can decrease the rate of ACL injury in women.”

Dr. Matzkin visits high schools and colleges throughout the Boston area to teach athletes and coaches about the risk of ACL injuries in women. She also can help coaches add neuromuscular training to their practice routines. These programs focus mainly on improving knee stability and training the body to automatically perform proper movements. Using a mix of exercises to improve strength and speed and weight training, the muscles that help support the knee are strengthened. To promote ideal pivoting, jumping and landing, athletes are taught proper techniques and then coached to repeat these techniques. This repetition eventually trains the athlete to perform these movements unconsciously.

Getting back in the game

Even with the best intentions, injuries still occur. But Dr. Matzkin’s team can help to get athletes of all ages and abilities back in the game — and keep them in the game. They offer surgical and nonsurgical treatments for the full range of bone and tissue injuries. This includes sprains, dislocations, strains and tears, stress fractures and arthritis. Following treatment, Dr. Matzkin’s team guides their recovery. The goals during this period are very similar to that of preventive training — improving knee stability and promoting proper techniques.

The Women’s Sports Medicine Program provides care at three locations: Brigham and Women’s Hospital in Boston, Brigham and Women’s/Mass General Health Care Center in Foxborough, and Brigham and Women’s Ambulatory Care Center in Chestnut Hill.

For more information about the services they offer, call 1-800-BWH-9999 or visit