The gender-specific knee – Women are no strangers to knee pain.

The female knee seems to be at a greater risk of damage or injury than the male knee. This is often due to hormonal and structural differences of the female knee.

Knees are one of the most frequently injured joints in the body, especially for females who play a lot of sport.

Active women are twice as likely to sustain a knee injury than men.

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The knee is a weight-bearing joint and injury can affect any of the cartilage, meniscus, bones, ligaments, bursae or tendons of the knee joint.

Arthritis can also affect people’s knees as they age. Women tend to get more kneecap (patella) pain, anterior cruciate ligament (ACL) injuries and degeneration of the cartilage under their kneecap (chondromalacia patellae) than men.

The female ACL tear rate is twice that of men in basketball and four times that of men in soccer.

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Females between the ages of 15 and 25 carry the highest rate of ACL injuries. Women tend to have looser kneecaps after the first incident of a subluxation or dislocation. Initially this type of injury occurs at the same rate in men and women, but women have a harder time getting that kneecap to stay in position post injury, and will tend to have many re-injuries over the years compared to men.

So why women?

We all have the same general anatomy; however, women tend to have wider hips than men as they are required to carry and give birth to children.

This will cause a greater inward rotation of the thigh bones from the hip to the knee (femur).

These anatomical differences may predispose women to certain forms of knee pain. Both men and women produce the hormone oestrogen; however, women produce it in greater quantities.

Women are more likely to have a knee injury when their oestrogen levels are highest, which is during ovulation.

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These increased oestrogen levels help to regulate a woman’s reproductive functions. Higher oestrogen levels are associated with changes in the formation of fibroblasts (the cells that produce collagen within connective tissue).

Oestrogen can affect water retention in the soft tissue within the knee. All together these effects of oestrogen can weaken the ligaments and make them more prone to stretching or tearing. Women tend to land flat-footed instead of on their toes, and this may lead to increased injury. By landing with a flat foot, more force is exerted through the foot and up into the knees. Female athletes tend to use their quadriceps muscles more relative to their hamstrings.

When performing the same actions, such as kicking a ball, men and women recruit their major muscle groups differently. It was found that men activate their hip flexors of the kicking leg and hip abductors (the outer muscles) of the supporting leg more than females.

There is also a difference in how much the glutes are activated between men and women.

Together, these differences in muscle activation may make it more likely that women will suffer tears to the ACL. Different muscle recruitment may also cause women to develop chronic knee pain from certain activities.

Women tend to bend their knees less than men after a jump, which puts added strain on the knee joint. They tend to remain more upright in pivoting and cutting than men.

This also adds strain to the joint. Therefore, by crouching and flexing the knee in these manoeuvres, women can reduce their risk of ACL injuries and other injuries.

As well as having differences in muscular and skeletal structure, men and women also differ in the way they transmit nerve impulses to control muscle force. Men seem to control nerve impulses for explosive muscle use, like sprinting, whereas women’s impulses are better suited for endurance or distance events. This tends to lead to more cartilage injuries over time.

How can women prevent knee injuries?

• Warm up before exercise.

• Take it slow when starting a new exercise programme.

• Wear good-quality shoes that are designed for you, and your sport or exercise. Ensure shoes are not old or overused.

• Reduce stress on the knees by maintaining a healthy weight.

• Do sport-specific exercises to strengthen the lower limb.

• Practise good jumping and cutting techniques.

• Stretch and exercise in the off season as well.

• Balance work and stretching.

• Stretching and strengthening exercises for your hamstrings and quadriceps is especially important in reducing your risk of ACL injury. Pay special attention to hamstring strengthening.

A physiotherapist can help diagnose your knee problem.

• They will start by taking your medical history and asking about risk factors and any obvious mechanisms of injury.

• They will do a physical examination consisting of knee movements as well as specific sport-related movements.

• A referral may be made to an orthopaedic doctor for further examinations and investigations (X-ray, CT scan or MRI).

Contact Groenewald Cox Physiotherapy and Associates on 011 974 9005.

Information compiled by Groenewald Cox Physiotherapy and Associates (Nadia Groenewald, Jose Cox, Nicole Smith, Charne Cox).

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