Female Athlete Hip Injuries: How Sex-Specific Differences in Structure & Function Affect Injury Patterns

The anatomy of the hip and pelvis varies considerably in females compared to males. Many of these differences exist in order to allow for pregnancy and childbirth in women, while others are likely related to multiple factors. Some of these differences include:

• Broader and shallower pelvis with circular inlet
• Smaller femoral head with decreased surface area
• Increased acetabular dysplasia (shallow sockets)
• Increased femoral and acetabular anteversion (rotation)
• Increased risk for low bone mineral density
• Hypermobility
• Other hormonal influences

Additionally, female athletes exhibit differences in biomechanics and sport-specific movements compared to male athletes, including:

• Increased dynamic malalignment (see image)
• Reduced core and gluteal strength
• Increased asymmetry in lower extremity strength and biomechanics
• Altered neuromuscular control

As a result of these differences, certain injuries to the hip joint and surrounding soft tissue structures are more common in female compared to male athletes, such as:

• Hip/acetabular labral tears
• Bone stress injuries/stress fractures in the hip and pelvis
• Hip flexor, gluteal tendon, and high hamstring tendon dysfunction & pain
• Quadriceps injury
• Various impingement syndromes & nerve entrapments

Bottom line:

• Unique differences in hip region anatomy and biomechanics result in a predisposition for specific injuries in female athletes
• Consideration of these factors is important—not only for injury diagnosis—but for optimizing treatment, injury prevention, and performance