Knee pain and knee injuries can happen to anyone at any age, whether you’re physically active or not. In fact, according to the American Academy of Family Physicians (AAFP), approximately 25 percent of U.S. adults suffer from chronic knee pain as a result of injury, osteoarthritis, or other causes. “But, studies have shown that women have an increased risk of knee injuries when compared to men,” says Struan Coleman, MD, an orthopedic surgeon at the Hospital for Special Surgery (HSS), co-founder of Motive Health, and former team physician for the New York Mets. “Specifically, female athletes tear their ACLs at a much higher rate than men—as much as five times more often, especially when participating in sports like soccer and basketball.”

Why are women more prone to ACL injuries than men?

Dr. Coleman says that although there has yet to be conclusive evidence pointing to a specific reason, there are several factors that likely contribute to the disparity. “Men’s and women’s bodies have unique differences when it comes to muscles, ligaments, and bone structure,” he says. “Females tend to have wider hips than males, which affects the forces across the knee joint. In addition, studies have shown that women have more laxity in their knee ligaments, as well as other parts of the body, and changes in both hormone concentrations and menstruation can play a role in ligament laxity.”

Another key factor increasing the risk of ACL injuries in women vs. men has to do with differences in muscle activation patterns and relative strength around the knee when jumping and landing that may result in higher forces across the ACL for women, according to Dr. Coleman.

“A big factor leading to ACL injuries in female athletes is the weakness of the quadriceps muscles above the knee,” he shares. “Strengthening the quadriceps muscles in female athletes can help to protect the knee joint from injury.”

What activities and risk factors cause the most knee injuries in women?

There are certain activities or sports that can make women more prone to ACL injuries than others, primarily due to the movement patterns and the stresses placed on the knee joint. “Women who play sports that involve cutting and pivoting like soccer, basketball, skiing, and lacrosse are especially at risk for a knee injury as these movements generate large forces across the ligaments of the knee,” explains Dr. Coleman.

Furthermore: “Any repetitive activity that causes consistent impact to your knee puts you at risk for knee injuries and subsequent pain. This includes running, jumping, deep bending in the knee, or squatting.” That’s not to say that you shouldn’t do these activities. In fact, weight-bearing workouts like running and strength training are some of the best ways to protect your joints—you just want to make sure you’re working out with proper form and not overtraining.

Interestingly, Dr. Coleman says that there can also be external lifestyle factors that further increase the risk of knee injuries like ACL tears. He explains, “Fatigue and dehydration are also big risk factors for a knee injury as both can cause the muscles that support the knee to give out, which can lead to the injury of ligaments or cartilage in the knee joint.”

What can women do to keep their knees safe from injury?

Dr. Coleman is a big proponent of prevention as the first line of defense when dealing with knee injuries in women. Preventing knee pain and ACL tears begins by ensuring that you have adequate strength and flexibility (aka mobility) in your muscles and joints for the types of exercise and workouts you are doing.

“Many studies have demonstrated that strong and flexible quadriceps and hamstrings—especially in women—are the best way to prevent knee injuries, especially ACL tears,” advises Dr. Coleman. “It’s critical to incorporate strength training into any exercise routine, and in addition to strengthening the leg muscles like the quadriceps and the hamstrings, you should focus on the bigger muscles of the core.”

In terms of strengthening your core, which is ultimately crucial in stabilizing your body during any type of physical activity, Dr. Coleman recommends Pilates. “Additionally, a simple, proactive, at-home therapy like using a Motive Knee device that targets the knee specifically is a great pain management tool to add to your wellness routine,” he says. “It’s app-based and can be used at home to strengthen the quadriceps muscles above the knee joint [through electrical stimulation therapy]. Our clinical evidence shows that stronger quadriceps muscles reduce the forces across the knee joint, leading to less knee pain, better joint health, and increased mobility.”

Dr. Coleman says that Motive Kee is the only FDA-cleared stimulation device to treat knee pain and increase mobility by treating the root cause of the pain—a lack of quadriceps muscle strength—and it can be safely used by anyone.

Can I stay active if I have knee pain?

While a lot of people embody the mindset that if they have knee pain, they need to stop working out and/or take pain medication, the opposite is actually true, according to Dr. Coleman. “When knee pain is caused by muscle weakness, it is critical to strengthen the muscles around the knee, especially the quadriceps muscles. Additionally, medication can be helpful, but medication does not treat the underlying problem—the key is to keep the muscles around the knee as strong as possible in order to decrease knee pain and help to prevent injury.”

Ultimately, Dr. Coleman believes that knee pain can often serve as a crossroads for many people in their lives: “One path is to be proactive and to diagnose and treat the underlying cause of the knee pain,” he says. “The second path that people can take when they experience knee pain is to become less active and to cut out activities that, although enjoyable, cause the knee pain to increase. The latter path results in a vicious cycle where the person becomes less active, the muscles around the knee weaken, and the pain becomes more severe.”

This is all to say that sometimes the path of least resistance is resistance training.