Neuromuscular differences between men and women

Anterior cruciate ligament (ACL) injury prevention strategies have not always been successful. The identification of modifiable risk factors for injury is an important step in the injury prevention process. The gender differences observed in ACL injury rates pose an additional layer of complexity within this process; specifically, what are the sex-specific, modifiable risk factors for noncontact ACL injury? The identification of sex-specific risk factors for noncontact ACL injury facilitates the development of precise interventions. The purpose of this chapter is to outline the dynamic joint stability paradigm and provide an overview of the neuromuscular differences between men and women. The authors' studies have demonstrated that female athletes have decreased proprioception, compensatory neuromuscular control patterns, enhanced static balance, and decreased lower extremity strength compared with male athletes. These differences have resulted in altered neuromuscular control as observed in the kinematic and kinetic characteristics of the knee during dynamic tasks. Injury prevention and performance optimization must account for these differences, with specificity of training included to reduce the incidence of these debilitating ACL injuries.