Norwin senior basketball player Savannah Schneck didn't know much about ACL injuries when she first tore hers in February 2021.
Now, she knows more than she would probably like to. After surgery and rehabbing the first injury, she tore the same ACL only a few weeks after she was cleared to play.
"I fell and I heard it pop," she said. "I just screamed in pain, and I started to cry."
Schneck overcame her injuries just in time for her senior season. She is a major contributor for the Lady Knights, who are now playing in the PIAA tournament.
Still, nearly two full seasons on the bench and in recovery made her notice the injuries happening around her.
"Knee braces, the shoulder braces, the ankle braces, you see all of these different things, and the sport is just becoming more competitive."
She began to question why so many other female athletes in her circle seemed to be getting hurt, theorizing the menstrual cycle may play a role.
"A lot of the times when it hits that time of the month is when a lot of girls seem to tear their ACLs," she said. "You're going to be tired during that week. You're going to have strain on your body. Your hydration levels are actually a lot lower."
Dr. Moira Davenport, a sports medicine physician with Allegheny Health Network says there's something to that theory. Research shows female athletes do have an increased risk for injury.
According to Yale Medicine, female athletes are two to eight more times likely to suffer an ACL tear compared to males.
One potential explanation is heightened estrogen levels that occur during puberty and the menstrual cycle. It can make tendons and joints more flexible and more susceptible to tears.
"Women in general do have much more lax joints, especially looking at the shoulders and fingers, can be affected depending where you are in the menstrual cycle. Just the greater range of motion does allow somebody to put their limb at greater extremes. That makes that person that much more likely to get injured."
When it comes to ACL injuries in particular, Davenport says the width of a female's pelvis can play a role.
"Our hips tend to be a little bit wider than the male's. The angle that muscles and tendons and ligaments insert on their joints, especially muscles that start on the hip and start on the knee, those can be greater angles which makes them more susceptible to injury."
There are a number of other factors doctors and trainers consider a potential risk factor for injuries in female athletes. Females have a narrower space for the ACL to pass through the knee. They're also more likely to have a lower calcium and vitamin D intake.
Davenport said the topic has received more attention in recent years, as more female athletes appeared to suffer serious injury even in non-contact situations.
It has also led to a push for more female coaches and trainers in girls and womens sports, who may be more knowledgable and feel more comfortable speaking about the female anatomy.
"Women are much more willing to talk about things like hormonal cycle and how that may impact training and how you can use where a woman is in her cycle to time what kind of workouts she should be doing."
For injury prevention in girls and women, Davenport suggests eating a nutritious diet and using equipment designed for female athletes, not substituting with men's equipment. She also suggests female athletes keep close watch over their menstrual cycle and slowing their physical output during ovulation.