Dr. Clive CluttonThe studies below compare people by biological sex, because they look at factors such as anatomy, ligament laxity and hormones. That is why this article uses “women” and “men” in that sense.
1. Patellofemoral pain (kneecap pain)
A dull ache behind or around the kneecap, worse with stairs, squatting, kneeling or sitting for a long time. In a study of students at a US military academy, women developed it about 2.2 times as often as men.1
What the research supports: exercise therapy, with hip and knee exercises combined rather than knee exercises alone. International consensus statements recommend this combination, often leading with hip strengthening early on before progressing to more knee-focused work.2,3
2. Knee osteoarthritis
Joint pain, stiffness and sometimes swelling, often worse with activity and more common with age. A meta-analysis found men had a lower risk of knee osteoarthritis than women, and women tended to have more severe disease, especially after menopause.4
What the research supports: a Cochrane review of 44 trials found that land-based exercise reduced pain by about 12 points out of 100 and improved function by about 10 points, with benefits still measurable two to six months after treatment ended.5 Your family doctor can discuss other treatment options, including medication and, for advanced cases, a referral to an orthopaedic surgeon.
3. ACL injury
A sudden pop, swelling and a feeling of the knee giving way, usually from cutting, pivoting or landing awkwardly. In a meta-analysis, female athletes in sports such as soccer and basketball tore their ACL roughly three times as often as male athletes in the same sport.6
What the research supports: prevention. A 2025 meta-analysis in female team-sport athletes found that neuromuscular training, which combines strength, balance, plyometrics and landing technique, roughly halved ACL injuries, especially when done regularly through the season.7 If you think you have torn your ACL, see your family doctor or a sports medicine physician, who can arrange imaging and a referral to an orthopaedic surgeon if needed.
4. Iliotibial band syndrome
Sharp pain on the outside of the knee, typically starting a few minutes into a run. It is one of the most common knee injuries in runners. Runners with it have been found to have weaker hip abductors on the injured side.8
What the research supports: in one study, a six-week hip-strengthening programme returned 22 of 24 runners to pain-free running.8 A 2024 systematic review found that conservative treatments, most often including hip strengthening and sometimes combined with shockwave or manual therapy, reduced pain by 27 to 100 percent over two to eight weeks.9
The common thread: hip strength
| Problem | Risk in women | Core of conservative care |
|---|---|---|
| Kneecap pain | About 2.2 times higher | Hip and knee strengthening |
| Knee osteoarthritis | Higher risk and severity | Land-based exercise |
| ACL injury | Roughly 3 times higher in some sports | Neuromuscular training to prevent it |
| IT band syndrome | No reliable comparison | Hip abductor strengthening |
Hip strength comes up again and again across these conditions. It is not the only factor, but it is a practical place to start.
Take-home
- Persistent knee pain is worth having assessed, because the cause shapes the plan.
- Exercise, especially hip and knee strengthening, is a core part of care for most of these problems.
- If you play a cutting or jumping sport, a neuromuscular warm-up programme can lower ACL injury risk.
See a doctor promptly if your knee locks or gives way repeatedly, if it swells quickly after an injury, if you cannot bear weight, or if the knee is hot, red and swollen with a fever.
Sources
- Boling M, Padua D, Marshall S, et al. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports 2010;20(5):725-730. Prospective cohort study. Link
- Crossley KM, et al. 2016 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Br J Sports Med 2016;50(14):844-852. Consensus statement. Link
- Collins NJ, et al. 2018 consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain. Br J Sports Med 2018;52(18):1170-1178. Consensus statement. Link
- Srikanth VK, et al. A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthritis Cartilage 2005;13(9):769-781. Meta-analysis. Link
- Fransen M, et al. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med 2015;49(24):1554-1557. Cochrane systematic review. Link
- Prodromos CC, et al. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy 2007;23(12):1320-1325. Meta-analysis. Link
- Gu et al. Neuromuscular training for preventing knee injuries in female team athletes: a meta-analysis. Ann Med 2025;57:2581891. Meta-analysis. Link
- Fredericson M, et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med 2000;10(3):169-175. Case-control study with treatment follow-up. Link
- Sanchez-Alvarado A, Bokil C, Cassel M, Engel T. Effects of conservative treatment strategies for iliotibial band syndrome on pain and function in runners: a systematic review. Front Sports Act Living 2024;6:1386456. Systematic review. Link
This article is general education. It does not replace advice from a clinician who has examined you.