Basketball is now the leading cause of sports-related injuries in the U.S., due in large part to a surge in knee injuries among female athletes, according to an Illinois sports medicine specialist.

Because of anatomical differences between the sexes, women are at greater risk of serious knee injury than men, according to Dr. Pietro Tonino of Loyola University Chicago Stritch School of Medicine in Maywood.

Fortunately, the risk of knee injuries can be reduced by teaching female athletes to change how they move on the court, Tonino told Reuters Health in an interview. “Some of this stuff can be prevented,” said the assistant professor of orthopedic surgery.

According to the U.S. Consumer Product Safety Commission, basketball topped the list of sports-related injuries, followed by cycling, football and soccer.

“The most surprising factor was how much basketball has risen to the forefront of injuries,” Tonino said. “This can’t be just from ankle sprains.”

Instead, Tonino places the blame on injuries to the anterior cruciate ligament (ACL), which is the major stabilizer of the knee. Cruciate ligaments cross each other in the knee, and the ACL is located toward the front part of the knee.

The ACL can be injured when an athlete pivots or changes direction rapidly, lands from a jump or slows down from running. Females are two to eight times more likely to experience an ACL injury, according to Tonino.

Because of anatomical differences, particularly in the shape of the pelvis, females tend to land differently than male athletes do, he explained. While male athletes most often land with their knees in a bent position protecting the knees from injury female athletes tend to land in a “knock-kneed” position, according to Tonino.

Most ACL injuries occur when the knee is overextended, so female athletes whose knees are not bent when they land are more likely to blow out a knee, Tonino said. “We have to figure out how to attack this problem.”

Fortunately for the growing number of female hoopsters, the anatomical differences can be easily overcome, according to Tonino. He noted that several programs have been developed to teach female athletes how to land properly after a jump so they are less likely to hurt their knees.

Female athletes can also be taught to improve their ability to sense the position of their body while they are moving, which may reduce the risk of knee injury. “This is something that the body learns only by practicing jumping,” Tonino said.

Strengthening some of the muscles that protect the knee may also help, according to the orthopedic surgeon. While strengthening exercises to protect the knee often focus on the quadriceps in the front of the thighs, Tonino said that strengthening the muscles on the back of the thigh may be more helpful for protecting the knee during jumping and landing.