The Relationship Between Core Stability and Knee Injury Risk in Female Athletes

The Relationship Between Core Stability and Knee Injury Risk in Female Athletes Blog

Athletic injuries seem to be occupying news headlines with increasing frequency of late, as concern rises about the dangers of various sports. This concern has also prompted a great deal of research in an attempt to identify underlying problems that may predispose some athletes to injury. From that research, significant findings have emerged about the characteristics that differentiate female athletic injuries from those of their male counterparts.

Of the numerous types of athletic injuries, one of the most frequently occurring and severe is a rupture of the anterior cruciate ligament (ACL) of the knee. Not only is an ACL rupture painful and debilitating, but it can be career-ending for any athlete. Female athletes in particular are at significantly greater risk of ACL rupture than their male counterparts in the same high-risk sports.

Factors Affecting Knee Injury

There are many factors that come into play leading up to an ACL rupture. The individual anatomy of an athlete, their training status and experience, and other factors may predispose certain athletes to injury. ACL injuries are more likely to occur in sports that require rapid changes in trunk position during cutting, stopping, and landing movements.

The ability of an athlete to control their trunk, or core, can have a profound effect on the dynamic stability of their lower extremities. Poor trunk control can lead to increased abduction torque at the knee, increasing strain on the knee ligaments. Because females have a broader pelvis than males, the angle from hip to knee is more pronounced, placing the lower extremities at greater risk for valgus collapse leading to injury.

Core stability is considered to be foundational to dynamic trunk control, allowing the  production, transfer, and control of force and motion to the lower extremities. A stable core plays a critical role in the body’s ability to maintain and resume equilibrium in trunk position after it has been disrupted, meaning it overrides the forces of gravity and momentum. When trunk equilibrium is lost, those forces then impact the lower extremities, particularly the knee.

A Study of ACL Injuries in Male and Female Athletes

A recent study by Zazulak et al. (2007) of 140 female and 137 male collegiate athletes (N=277) tested participants for trunk displacement after force release to identify predictors of knee injury risk.

Findings of the study revealed:

  • Trunk displacement was greater in athletes with knee, ligament, and ACL injuries than in uninjured athletes
  • Lateral trunk displacement was the strongest predictor of ligament injury
  • Trunk displacement was a stronger indicator of knee injury risk in female athletes than in males
  • History of low back pain was a significant predictor of knee ligament injury risk in male athletes but not in females

The take-away message from this study and others like it is that factors predisposing athletes to knee injury can be identified in individual athletes, and measures can be taken to correct movement deficiencies to prevent or reduce the risk of future injury. Interventions that incorporate core stability training, proprioception exercise, and disruption and correction of body sway can potentially reduce knee ACL injury risk in both male and female athletes.

Athletic Retraining at NYDNRehab

Measures of trunk displacement and other movement deficiencies require specialized equipment to detect and quantify anomalies. At NYDNRehab in NYC, our expert team of sports medicine professionals uses cutting edge technology to detect and correct movement deficits, including CAREN (Computer Assisted Rehabilitation Environment), a virtual realty tool that maps an athlete’s body movements by taking force measurements during specific activities. The same technology can then be used to correct dysfunctional movement by retraining movement patterns.

Do not wait until you are injured to correct motor deficiencies in your sport. Contact NYDNRehab today for a complete analysis and corrective training that can keep you in the game, injury-free, for years to come.


Zazulak, B. T., Hewett, T. E., Reeves, N. P., Goldberg, B., & Cholewicki, J. (2007). Deficits in neuromuscular control of the trunk predict knee injury risk. The American Journal of Sports Medicine, 35(7), 1123-1130.

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