Q&A Topic: Non-Athlete Women and Knee Injuries

Evan H. Karas, MD, FAAOS

Q. Are non-athlete women more susceptible to knee injuries than men?

A. In general, women have a much higher incidence of knee problems than men. I see many women who wake up with joint pain in one or both knees from running after little ones, taking a weekly gym class, or carrying heavy grocery bags upstairs. Women – athletes and non-athletes -- tear their ACL (anterior cruciate ligament connecting the thigh bone to the shinbone) four times more often than do men. 

Q. What common knee problems in women result from everyday activities?

A. One is dysfunction of the kneecap mechanism (patellofemoral syndrome). This pain in front of the knee is typically caused by activities that overload the kneecap, such as kneeling, stair climbing, running up and down hills, or lunging exercises.

I see patellofemoral problems and tears in the ACL from certain hugely popular group exercise classes in which participants are encouraged to do as many exercises as they can, as quickly as they can. What can get lost is the proper position of your limbs. And that can alter your biomechanics and put intolerable stress on the knee cartilage.

Other overuse injuries are inflammation of the broad sheet of tissue that runs from the hip toward the knee (ITB); and patella tendonitis and hamstring tendonitis, both involving inflammation of tendons. Something as simple as giving piggyback rides can be the culprit.

Q.  Why are women’s knees more vulnerable?

A. It’s partly due to their knee anatomy. Women have a smaller intercondylar notch, the groove at the bottom of the thighbone where it meets the knee. The narrowness of the notch makes it more likely that twisting injuries will result in tears. Also, women’s wider pelvis affects the alignment of the knee and can put more stress on the knee’s cartilage when walking up hills or stairs.

Most women have weaker musculature than men and a greater strength imbalance between front and back thigh muscles. Weaker muscles don’t absorb shock as well, such as landing from a jump, carrying shopping bags, or lifting a toddler many times a day. Some evidence suggests women are more prone to knee injuries right before ovulation, as higher estrogen may relax the ACL, making it susceptible. 

Q. How can I help prevent knee injuries?

A. Stop smoking. Smoking damages cartilage metabolism, increasing your risk of developing osteoarthritis.  Strengthening is also key to avoiding injury. Focus on working the quadriceps (front of thigh), hamstring (back of thigh), plus hip and buttock muscles to stabilize the pelvis. 

The key to protecting your knees is not overloading your kneecap joints. Every time you generate the force to stand from a kneeling position, especially when holding extra weight, pressure on the cartilage behind the kneecap is multiplied by four times your body weight. So rather than kneeling to weed, sit on a stool. Limit how many times you go up and down stairs holding baby. And maintain a healthy weight. 

If you have chronic pain in your knee, don’t delay in seeing an orthopedic surgeon. That could increase pain unnecessarily. The vast majority of these problems are treated successfully without surgery.

Learn More About Dr. Karas
Co-Chief, Orthopedic Surgery
Co-Director, Orthopedic & Spine Institute
Northern Westchester Hospital

Northern Westchester Hospital is a proud member of Northwell Health.


Read Past Topics from Dr. Karas: 
Shoulder Pain and Advanced Shoulder Surgery
Boning Up On A Common Knee Injury
Managing Arthritis in the Knee 
Sports-Related Shoulder Injuries
A New Solution for Massive Rotator Cuff Tears — Superior Capsular Reconstruction 

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