Chances are you’re familiar with the gender wage gap, which refers to the earning differences between men and women. But you may not have heard of the gender injury gap, a phrase designed to bring attention to a sad reality: Women are far more likely to get injured while playing sports or exercising than men. “Evidence suggests that women are more likely to endure stress fractures, tear their ACLs, and have some foot and knee issues,” says exercise physiologist and certified strength and conditioning coach Sharon Gam, Ph.D, C.S.C.S. (These are just a few of the injuries women may be more susceptible to than men.)
Turns out, there are a few reasons—and solutions—for this. Ahead, experts explain six possible reasons why women may be more likely to get injured than men, and share five things women can do to help protect themselves while they exercise.
Why Women Are More Likely To Get Injured During Exercise
There’s no single reason why women are more likely to accrue sports-related injuries than men. Rather, a combination of structural, hormonal, and sociological factors come together to heighten risk.
1. Women Have Smaller, Weaker Bones Than Men
Structurally speaking, men tend to have larger, denser bones compared to women. A 2015 study in Clinical Orthopaedics and Related Research showed that women’s bones are more slender than men’s. Their bones’ cortical area—which is the strongest, more compact part of the bone—was also six to 25 percent smaller than those of men. The researchers concluded that this reduced density contributes to an increased risk of fragility fractures.
Read More: The 6 Best Types Of Exercise For Strong Bones
Women’s hormonal fluctuations throughout their life and menstrual cycle can also contribute to weakened bones, notes online performance and nutrition coach Seamus Sullivan, C.S.C.S. Estrogen has a protective influence on the bones, so when women’s estrogen dips after menopause, their bone density dips, potentially increasing risk of exercise-induced stress fractions, he explains.
2. Women Have Wider Hips Than Men
For child-bearing and birthing purposes, women have evolved to have wider hips than men. The shorter and broader structure of their pelvic cage results in a larger angle between the quadriceps (the muscle along the front of the upper leg) and the patellar tendon (the knee cap), says Gam. As a result, the kneecap and thighbone fit together less tightly in women than in men, which puts them at an increased risk of knee injuries.
Generally, women’s knees also tilt inward to a greater degree than men’s, which often results in a reduced knee bend during sport, as well as in life. Case in point: Women have been found to have stiffer legs when landing a jump, and bending your knees helps protect your knee joints from the impact of jumping, says Gam. As such, women are at a greater risk of enduring wear and tear during high-impact movements. One 2020 study published in the British Journal of Sports Medicine, for example, found that elite women’s skiers were far more likely to endure jump-related injuries compared to men.
3. Women Have Flatter Feet Than Men
Another structural difference between the sexes that can contribute to injuries lies in the feet. Anatomically, men have broader and longer feet, as well as higher arches, than women, says Gam. The lower an individual’s foot arch, the lower their ability is to absorb shock. “Over time, this can lead to more stress on the bones and other soft tissues in the foot, ankle, and lower leg,” she explains.
Research shows that females are 2.5 times more likely to report plantar fasciitis—a condition marked by inflammation along the base of the feet— than males. Additional research shows that women may be more likely to suffer from metatarsal fractures, midfoot injuries, and foot and toe contusions, as well.
4. Female Sex Hormones May Increase Risk
Also important to know about hormones: Exactly how much more likely a woman is to endure an injury compared to men may depend on where she is in her menstrual cycle. According to a 2021 study published in the journal Frontier in Sports and Active Living, women are twice as likely to acquire a muscle or tendon injury during their late follicular phase than in the earlier follicular or luteal phases. (The follicular phase begins on the first day of menstruation and the luteal phase begins at ovulation).
The culprit is changing estrogen levels. Estrogen levels are lowest at the start of the follicular, peak at the end of the phase right before ovulation, and then take a drastic dip after ovulation (when the luteal phase begins).
The reason for estrogen’s influence? “Estrogen inhibits fibroblasts, which are cells that make collagen, which gives structure to the ligaments and tendons,” says Gam. “Estrogen also stimulates an enzyme that breaks down collagen,” she adds. As such, collagen levels are lowest in the tendons and ligaments when estrogen levels are highest, which makes these connective tissues looser.
The looser your tendons and ligaments are, the more likely you are to get injured, says Sullivan. “Research has shown that women are more likely to tear their ACLs when estrogen levels are highest,” he notes.
5. Girls Have Less Exposure To Sports Growing Up
No doubt, more and more girls are being introduced to sports at a young age than even just a few decades ago, “but girls still tend to have less exposure to sports at an early age, compared to boys,” says Gam. One report shows that, in the United States, 4.5 million school-aged boys participate in sports, while just 3.4 million school-aged girls do.
“Playing sports gives people an opportunity to practice proper movement patterns at a young age,” explains Gam. By grooving sound movement patterns into your muscle memory when you’re younger, you increase the likelihood that you move soundly as an adult, she says. “Because women are less likely to have experience moving their bodies as kids, they may be at an increased risk of injuries when they play sports as adults,” she says.
6. More Women Fall Short On Proper Fuel
Due to a combination of pervasive myths about how much grown women should eat and what they should look like, the vast majority of women under-eat, according to Gam. And one of the many downsides of under-eating is that it can increase your risk of sports-induced injury.
Read More: 6 Signs You’re Not Getting Enough Calories
Sullivan explains: When you don’t consume enough calories throughout the day, your body does not have the energy it needs to adequately repair the damage you accrued at the gym or on the field. When your muscles are in a consistent state of not getting repaired, they become weaker and less resilient against injury. Per research, undereating is also associated with decreased bone strength, as well as increased risk of fall injury or fracture.
How Women Can Reduce Their Risk Of Injury While Exercising
Exercise may increase women’s risk for certain injuries, but the net benefits of exercising still far outweigh the injury risks. Here are five things women can do to reduce their risk of exercise-induced injury.
1. Strength Train
Strength training doesn’t just up muscle strength, it ups bone strength, too. Your muscle meat is attached to your bones, so when you use your muscles while you strength train, they create a tugging sensation on your bones, Gam explains. This pulling propels the cells that help lay down new bone tissue (called osteoblasts) into action. The more often these cells are activated via physical activity, the stronger your bones become over time, which makes them more resilient to fractures.
It’s important to work all the major muscle groups and go as heavy as you can safely handle when you lift, says Gam. “But because women are more prone to lower leg injuries, strength training exercises that target the muscles around the hips and legs, like squats, deadlifts, lunges, and calf raises, are especially important,” she says. Since moving with proper form is key, Sullivan suggests hiring a fitness professional to teach you how to move safely.
2. Do Unilateral Strength Work
In addition to compound exercises like those listed above, Gam also recommends that women incorporate single-leg plyometric and balance drills like single-leg hops, single-leg lateral jumps, and single-leg Romanian deadlifts into their workout routines. “Strengthening the muscles that support the ankles and feet by doing single leg drills could help prevent ankle sprains,” she says. Intentionally working on movement during controlled hopping and change-of-direction drills at the gym can help make your body more resilient when it has to execute those movements on the field and in real life, explains Sullivan.
3. Get Outside
The reason milk is known as the bone-strength-boosting beverage is that it contains high amounts of calcium, which is one of the key ingredients in bone. However, in order to properly absorb the calcium in milk (as well as in other foods), the body needs vitamin D, Gam explains. Dubbed the sunshine vitamin, most people can get adequate vitamin D intake from just 15 to 20 minutes outside at midday. (No, your body cannot make vitamin D from sunlight exposure through a window.)
If your work schedule or decreased light hours prevent you from sneaking into the sun, Gam suggests trying a vitamin D supplement. The National Institutes of Health recommends 600 IU per day of vitamin D for women (and men) one to seventy-one years old. (Good to note, though: Many experts believe most people need more than this.)
4. Notice How You Feel Throughout Your Menstrual Cycle
Yes, women may be more likely to accrue an injury at some points in their menstrual cycle than others. But the solution here is not for women to forgo exercise every time their estrogen levels are high. Instead, most experts simply recommend that women simply track their menstrual cycle.
Tracking your cycle and noticing how it impacts how strong, coordinated, energized, and explosive you feel while you exercise will help you become aware of your personal patterns, says Gam. This will then help you make decisions about your training and recovery protocols that best support your body, she says.
Worth noting: Some data suggests that going on an oral contraceptive may be associated with reduced risk of injury, likely because these pills release a steady flow of hormones, keeping estrogen levels steady. That said, other research suggests that there are potential athletic downsides to going on birth control, so talk with a holistic healthcare provider about whether or not you’re a good candidate for an oral contraceptive.
5. Work With A Nutritionist
Whether you have serious fitness aspirations or not, Sullivan says it can be helpful for women to work with a nutritionist if they’re physically active. An expert who can separate food fiction from fact, a nutritionist can help you understand how many calories you need to eat each day—plus where those calories should come from—in order to support your overall well-being. (You can sign up for a free consultation with one of The Vitamin Shoppe’s nutritionists here.)