Summary

This scoping review provides a summary of the currently available literature describing gendered aspects of women’s sport environments and shows how embedded stereotypes, gendered expectations of how women should behave and present themselves, and gendered inequities in opportunities and resources could plausibly affect women’s injury risk and experiences.

Abstract

Background

Attempts to explain the anterior cruciate ligament (ACL) injury rate disparity between women and men has met with limited success over the last 30 years. One reason may be the overwhelming historical focus on biological explanations for injury risk; however, societal gendered norms and expectations of women have been shown to greatly affect their experiences and opportunities in sport environments. To date, we lack information on how the sport environment may be contributing to the injury risk of women.

Objective

To determine what literature currently exists that describes the gendered environments of women’s sports which are higher risk for ACL injury, and whether the existing literature relates gendered aspects of the sport environment to injury.

Methods

Our scoping review searched the Medline, Embase, CINAHL, SPORTDiscus, SCOPUS, and Women's Studies International databases for English language publications from inception to March 2024. Studies were included if at least 50% of the study participants were adult women participating in organized sports with higher risk for ACL injury. Multiple team members screened the publications at every stage of the review (title/abstract, full text) and met regularly to discuss discrepancies and refine the research question and inclusion/exclusion criteria.

Results

The search identified 17,148 initial studies. Of the 854 references that underwent full text review, 73 were included in this scoping review. Only 19 of the 73 included studies specifically mentioned a relationship between gendered sport environments and injury. Most of these 19 studies contained minimal discussion on the topic, and any mention of injury was restricted to one or two direct quotes from an athlete. We identified three themes when summarizing the gendered sport environments that women athletes encounter. 1) Embedded stereotypes that devalue women and women’s sport. Fifty-five studies reported gender stereotypes that cast women as secondary to men, fragile, ‘dainty,’ unfit for sport, or unserious about sport. The sport environment taxes women athletes with expending affective labour because of their ‘nurturing qualities’, where their time could be better spent training or recovering. 2) Restricting femininities. Forty-five studies described ways that the sport environment reproduces restrictive gender norms for women, which can result in a form of invisible labour where women can feel compelled to manage how their gender and sexuality are ‘read’, both on and off the field of play. It can also hold women back as some women were hesitant to be too competitive to prevent being seen as too masculine. 3) Gendered inequities in opportunities and resources. Forty-six studies reported ways that gendered inequities were structurally embedded in women’s sport environments, including inadequate remuneration and gendered wage inequality, and provision of subpar training facilities, support staff, and medical care.

Conclusions

Existing literature describes a range of gendered inequities that exist for women in their sport environments; however, there has been no concerted effort to date to link those gendered environmental factors to ACL injury. Such research is needed if we are serious about eliminating the ACL injury rate disparity between women and men.