Movement mechanics
This page highlights anatomical differences between females and males which can influence movement mechanics, explaining why gender needs to be taken into consideration when planning training programmes. It highlights relevant research and which prevention strategies are proven and appropriate. Note that these factors need to be taken into consideration as part of a holistic approach to training and injury prevention.
Key takeaways
- The female Q angle alters the direction and force applied to the knee.
- Increased knee valgus increases injury risk and is linked to higher ACL rates in female football.
- Females may have different muscle activation patterns which influence landing technique.
- Neuro-muscular training (NMT) positively impacts injury risk, including in adolescent females.
- NMT programmes such as the FIFA11+ warm up are effective in reducing injury risk.
Structure
Females on average have larger Q angles than males which alters the direction and force applied to the knee. The result is reduced quadriceps strength and power for leg extension. As the angle increases, more force is applied laterally (sideways). This can lead to excess strain on ligaments of both the knee and the ankle. With a larger Q angle, females therefore have increased risk of injury to the knee and ankle. This is shown through increased rates of ACL injuries within football for females compared to males.
Knee valgus
Females show more valgus positioning (knee collapsing inwards) at maximum knee flexion during landing. This is combined with smaller knee and hip flexion compared with males. Females who demonstrate these larger knee valgus angles have less energy absorption at the hip during deceleration. This knee valgus position has been linked to an increased risk of knee injuries especially in jumping, landing and cutting actions.
Female knee injuries are complex with limited research compared to male athletes. Additional factors including ligament laxity, excessive internal rotation at the hip plus leg dominance have also been suggested as factors in knee injuries in females. It is clear that female injury risk is multifactorial encompassing structural, hormonal, and biomechanical factors, including poor landing mechanics.
Female football research (ACL). One interesting study found 67% of non-contact ACL injuries in female football players occur in the non-dominant leg, despite this limb often having stronger quadricep muscles compared to the dominant leg. This appears to contrast the findings in male athletes.
Muscle activation
Recent football research: Note that one recent study specifically completed on football players found that while jumping patterns are sex dependent, its was the different patterns of hamstring activation (lateromedial ratio) and not the ratio of hamstring to quadriceps activation that was found to be significant. However further studies on this population was suggested before firm conclusions can be drawn.
The female structure translates directly to football performance with increased injury risk in landing and cutting (change of direction) within the game. Females have less muscle mass and a weaker posterior chain (hamstring, glutes, back), resulting in quadricep dominance relative to hamstrings when jumping and landing. With weaker hamstrings and decreased hamstring activation, females use quadriceps to stiffen and stabilise the knee joint more in comparison to males. Females also show a decreased knee flexion angle in preparing to jump, another factor in non-contact knee injuries.
Eccentric training (muscle lengthening while generating force) of the hamstring has been shown to be effective in preventing hamstring injuries in females with exercises such as the Nordic hamstring curl or Romanian deadlift.
At present this is the dominant view though recent research has questioned the exact mechanisms and clinical relevance while recognising a gender difference.
Neuromuscular Control Training
Research show that neuromuscular training (NMT) is effective in reducing injury rates. NMT should be a part of multi-component athlete development that includes mobility, stability, coordination and plyometric exercises to develop physical literacy.
Preventative NMT requires time (>15 mins) and commitment with training 2 to 3 times per week over a significant period. Lack of compliance is a significant factor amongst athletes. NMT reduced knee injury risk in female team sport athletes, with compliance ≥75% indispensable. ≥15-minute sessions delivered 2-3 times weekly can optimise the outcomes.
Technical training of proper landing technique within training programmes is also advised from an early age. Elements of strength training should be included in all training programmes with exercises to strengthen muscles around the knee alongside core stabilisation. These should be combined with sport specific drills.
Recognised NMT programmes FIFA+ injury prevention warm up The FIFA+ is potentially most well known programme incorporating NMT exercises into a warm up. This comprehensive warm-up program was designed to replace standard warm-ups and targets trunk muscle endurance, strength, balance, and agility while emphasizing proper biomechanical movement patterns. Research have confirmed an overall risk reduction when using FIFA+ programme. Other injury prevention tools specified include; the Prevent injury and Enhance Performance programme (PEP) and the Landing Error Scoring System (LESS)
Page references
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Exercises linked with NMt development
The exercises should emphasize proper biomechanics and muscle activation patterns - Plyometric exercises: Single-leg squat and Lunge 180-degree jump Broad jump stick landing Controlled landing drills Jump mechanics optimisation Eccentric Strengthening Exercises: Nordic hamstring exercise Assisted Nordic curls Romanian deadlifts Diver exercise Glider exercise Strength Training Exercises: Split squats Lateral lunges Single leg Romanian deadlifts Single leg squats Step ups Balance and Neuromuscular Training: Single-leg balance drills Perturbation training Dynamic stability exercises Core and Stabilization Exercises: Planks TRX rows Landmine rotations Targeted Muscle Group Exercise: Gluteus medius strengthening Gluteus maximus exercises Quadriceps strengthening Hamstring exercises for balance