Biology or Sociology? Rethinking the Narrative in Women’s Football Research
This post explores the potential impact of sociological factors on injury rates in women's sports.
Alongside the rapid growth in women’s football, we are seeing much-needed increased attention on research seeking to address the Gender Data Gap: the substantial disparity between research conducted in men and women.
When it comes to comparisons between sexes and potential disparities in injury epidemiology, biological explanations have most loudly been explored. Hormones, anatomy, biomechanics and neuromuscular characteristics have all received considerable attention, particularly when attempting to understand why certain injuries appear to occur more frequently in female athletes.
However, an important debate has since emerged. Are we over-attributing differences in performance and injury risk to biology, while underestimating the role of sociology?
Sex, Gender, Biology and Sociology
Before going any further, it is worth distinguishing between sex and gender:
Sex refers to a complex combination of biological and physiological characteristics, including genes, hormones and anatomy,
Gender relates to socially constructed identities, roles, behaviours and structures.
Research investigating female athletes may focus on biological characteristics associated with sex, while differences in access, opportunity, expectations and resources are more closely related to gender.
However, as Parsons and colleagues (2021) highlight, sex and gender are ‘entangled’. The social environment can influence characteristics that we might otherwise interpret as intrinsic biological differences.
That interaction is really at the heart of this post.
The Historical Framing: Biology as Explanation
Much of the early literature comparing male and female athletes focused on biological sex differences, such as hormonal profiles, anatomical structure and neuromuscular control.
ACL injury provides an obvious example. Anatomical characteristics such as differences in pelvic morphology, Q-angle, intercondylar notch width, and posterior tibial slope have all been investigated as potential contributors to ACL injury risk.
Reviews have similarly explored structural factors, sex differences in strength expression, and endocrine influences as potential contributors to the higher ACL injury rates observed in female athletes.
None of this work is inherently problematic. Biology matters and sex-based physiological differences exist. There are important questions to answer around anatomy, hormones, physiology and how these may influence health, injury and performance in female athletes.
However, when injury rates are higher, the reflex response has often been: what is different about female anatomy or hormones?
The alternative question has been asked less frequently: what is different about the environment?
The Sociological Lens: Access, Exposure and Opportunity
Recent discussions in the literature have argued that disparities in injury and performance outcomes cannot be fully understood without also considering sociological factors. These might include:
Historical underinvestment in women’s sport
Reduced access to strength and conditioning provision
Fewer medical and performance resources
Limited exposure to structured resistance training during development
Compressed competitive calendars during rapid professionalisation
Lower-quality playing surfaces
Reduced access to sports science technology and support
I’ll be honest, this was not previously something I’d given much consideration to. Biological differences were my default explanation. Yet reading the BJSM review Anterior cruciate ligament injury: towards a gendered environmental approach by Joanne Parsons and colleagues opened my eyes to a whole new perspective.
If we consider ACL injury risk in women’s football, for example, it is insufficient to focus solely on anatomy or hormonal fluctuations. Differences in training age, access to high-quality strength training, load management systems and medical infrastructure may also meaningfully contribute to observed injury patterns.
This is particularly pertinent in this moment, during the rapid professionalisation of women’s football. Playing and training demands have increased considerably, yet the infrastructure surrounding players has not necessarily developed at the same rate.
More matches, greater training exposure and increasing physical demands without equivalent historical access to S&C, medical provision, facilities and recovery support creates a very different developmental environment to that experienced in established men’s professional programmes. Of course, these are now improving but we still cannot go back in time to address historical disparity.
Differences in training age, access to high-quality strength training, load management systems and medical infrastructure may also meaningfully contribute to observed injury patterns.
Evidence collated by Professor Sophia Nimphius and Dr Stacey Emmonds, based on an original article by McQuilliam and colleagues in 2022, illustrates one aspect of this particularly nicely. Data from a survey of 170 strength and conditioning (S&C) coaches highlighted potential disparities in cumulative S&C training exposure between genders in academy and first-team players.
Such differences in training history have important implications for the development of strength and musculoskeletal robustness. If a male player has accumulated considerably greater exposure to structured strength and conditioning throughout adolescence before entering the first team, should we be surprised if we subsequently measure differences in strength characteristics between him and a female player of the same age?
That mismatch isn't biological. It is structural. Yet importantly, that structural difference may subsequently manifest itself as a biological or physiological difference when we test the athletes.
We’ve previously looked at Meeuwisse’s dynamic model of injury aetiology on the blog. Parsons and colleagues illustrate how incorporating gender as a pervasive developmental environment expands this model, with gendered processes operating throughout the athlete’s journey from pre-sport experiences through training, competition, injury and treatment.
This perspective doesn't mean that the biological risk factors previously identified suddenly disappear. Instead, it asks us to consider how the environment may have contributed to their development in the first place.
Biology and Sociology Are Not Opposites
The S&C example above illustrates why separating biology and sociology isn't straightforward. This is not an argument against biological research in women’s sport. It is an argument against biological reductionism.
Biology and sociology interact. The environment influences training exposure, training exposure drives adaptation, and those adaptations subsequently influence the physiological characteristics we measure.
This is acknowledged within the strength literature itself. In Nuzzo and colleagues’ Sports Medicine review (2023), the authors postulate that differences between men and women in eccentric: concentric strength ratios may, at least partly, be explained by men participating in muscle-strengthening activities more regularly than women.
Similarly, in his 2023 JSCR narrative review of sex differences in muscle strength, James Nuzzo discusses how sociological factors may influence the strength-training experiences of men and women alongside the biological mechanisms underlying sex differences in strength.
In other words, something we measure as a physiological sex difference today may partly reflect differences in the environments and opportunities athletes have experienced over many years. This doesn't mean biological differences don't exist, but it should make us cautious about automatically attributing every observed difference to biology.
The same thinking applies to injury. Injury is not simply the result of ligament morphology or hormone concentrations, but emerges from interacting biological, mechanical and contextual factors. As Parsons and colleagues state in their review: “we cannot simply tell girls/women to ‘get stronger’ to reduce injury risk if society and the environment do not support those types of activities for everyone”.
Why This Debate Matters for Women's Football Practitioners
For practitioners, widening the lens potentially changes where we focus some of our attention. Research into female physiology, menstrual health, hormonal fluctuations, neuromuscular characteristics and injury mechanisms remains incredibly important, particularly given the historical underrepresentation of women within sports science research. But these factors represent only part of the picture.
Long-term physical development, strategic load management, pitch quality, and investment in medical and sports science provision - to name only a few - all become important parts of the conversation too. Athlete education and empowerment matter, as do the opportunities girls receive much earlier in their sporting development.
Arguably, many of these factors are also more within our control than anatomy or hormonal fluctuations. We cannot change an athlete's skeletal morphology, but we can influence the quality of her training environment, the physical preparation she receives and the resources available to support her.
I've recently had the opportunity to join the new NWSL Health Advisory Council, bringing together expertise from medicine, research and elite sport to advance player health and wellbeing. One of the things I'm particularly excited about is the opportunity to consider women's health holistically rather than through any single lens, as well as working with such inspiring leaders in sport and research!
This type of approach feels particularly important as women’s football continues to professionalise. Rather than replacing the biological narrative with a sociological one, we need to better understand how the two interact and which factors we can actually influence. Some of the disparities we currently observe may be modifiable through changes to the environments in which girls and women develop, train and compete.
Final Thoughts
Women’s football is not simply a biological variation of men’s football. It exists within a distinct historical, cultural and structural context. The growing attention on women-specific research is long overdue, and there remains enormous value in understanding female physiology, menstrual health and the biological factors that may influence injury and performance.
But in our enthusiasm to better understand female biology, we should be careful not to assume that biology explains every difference we observe. Understanding performance and injury requires us to consider both the physiology of the athlete and the environment in which she has developed, trains and competes. Some of what we currently describe as biological differences may, at least in part, be the product of very different opportunities, exposures and experiences.
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