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. 2025 Jul 19;37(7):e70096. doi: 10.1002/ajhb.70096

Gender/Sex Entanglement, Structural Sexism, and Injury: The Case of Australian Rules Football

Madeleine Pape 1,✉
PMCID: PMC12275010  PMID: 40682458

ABSTRACT

This article considers how to approach sporting injury from the perspective of gender/sex entanglement. Taking the case of anterior cruciate ligament (ACL) injuries, I explore how the gender differences and inequalities that fundamentally shape many sporting environments may contribute to injury in women athletes. I look to Australian Rules football (Aussie Rules)—a male‐dominated, high‐contact, highly skilled running game and Australia's largest commercial sport—where, following the launch of a women's professional league in 2017, a marked gender disparity in ACL injury has been reported. Rather than attribute this reported disparity to essential biological differences between women and men, I consider how gendered practices and disparities may accumulate across the life course of athletes with consequences for the embodied experiences of women and girls. Building on the concept of structural sexism as a key determinant of health, I document gender‐related differences and inequalities at the early childhood, youth, and elite levels of Aussie Rules football. Via this case, I contribute to calls for a dynamic, developmental, and fundamentally gendered approach to studies of injury both in and beyond sport.

Keywords: anterior cruciate ligament, embodiment, environment, football, sport

1. Introduction

“The last weekend in September” is a phrase that defines the annual rhythm of the city of Melbourne, Australia. It denotes the Saturday afternoon when, late in the Southern Hemisphere winter, the Grand Final of the Australian Football League (AFL) is played before 100 000 spectators on the hallowed turf of the Melbourne Cricket Ground. October is a month of relative emptiness, during which the residents of Melbourne adapt to life without the hopes and thrills of a season of “Aussie rules” football until its return in March. Horse‐racing (the Melbourne Cup), Cricket (the Boxing Day test), and tennis (the Australian Open) provide welcome relief for those Melbourne residents seeking to immerse themselves in alternative storylines of professional sport. Boys, too, adapt their play habits, exchanging their kangaroo‐emblazoned leather Sherrins, Saturday morning Auskick, and local “footy” leagues for Kookaburra‐crested willow cricket bats. Cricket reigns as the summer sport of choice for boys, played on dry local ovals as well as the nation's abundant surf beaches.

At least, such was the rhythm of Melbourne when I was a child. Today, the sport of Aussie Rules is experiencing a kind of gender revolution, paralleling various other previously male‐dominated sports in Australia. 1 Since the AFL launched its professional women's league in 2017, known as the AFLW, the number of women and girls playing Aussie Rules in Australia has expanded exponentially. In the state of Victoria alone, from 2010 to 2019 the number of women's and girls' teams grew from 58 to 1092—a nearly 20‐fold increase (Black 2019). 2 At least 80% of these teams are for girls under the age of 18—a stark change from my own childhood, when I knew of no girls who played Aussie Rules. 3

This evolution has not been without controversy, with concerns in particular about rates of anterior cruciate ligament (ACL) injury in professional women players. In the early years of the AFLW, it was reported that women footballers were injuring their ACLs up to nine times as frequently as players in the AFL (Burt 2021). This mirrors broader concerns about women's susceptibility to ACL injury, with researchers in sport and exercise medicine suggesting an ACL injury rate in women that is anywhere from 1.5 to 8 times higher than for men (see, e.g., Montalvo et al. 2019). 4 The increasingly visible women's football codes of Aussie Rules and soccer have attracted particular attention, with media coverage referring to a “tsunami” of ACL injuries, an “injury epidemic,” a “crisis” that “haunts women's football,” an “ACL scourge,” a “curse stalking women's football,” an “injury plague,” and an “AC‐Hell.” In the case of Aussie Rules, this has led some to question “whether the game needs to be modified for female safety” (Burt 2021); that is, whether women and girls should even play the sport in the same form as it exists for men and boys.

In the context of wider calls to expand research on health, injury, and performance in women athletes (see, e.g., Moore et al. 2023), researchers have often turned to biological explanations of ACL injury disparities, with theories ranging from women's hip angle and joint geometry (Conley et al. 2007; Schneider et al. 2018), ligament and joint laxity (Myer et al. 2008), to hormonal fluctuations across the menstrual cycle (Herzberg et al. 2017). Put simply, the choice appears to be between “[h]ips or hormones” (Burt 2021). 5 Such theories are challenged by evidence that gender disparities in ACL injury—and even biomechanical differences—can disappear in sports where women and men have the same opportunities to develop and perform (Orishimo et al. 2009). Yet the role of gender disparities in developmental opportunities and training/playing conditions has been given short thrift in existing research on ACL injury (Danielsen et al. 2025; Fox et al. 2020; Parsons et al. 2021).

In this paper, I approach Aussie Rules as an ideal case study for considering how gendered environments and their associated inequalities quite literally “get under the skin” during the developmental trajectory of children and young people, with implications for how those bodies move through the world in later life (Fausto‐Sterling 2005). Building on calls to situate sporting injuries in their gendered developmental environment (Danielsen et al. 2025; Fox et al. 2020; Parsons et al. 2021), I chart the structural differences and inequalities that accumulate across the life course of players in the sport of Aussie Rules with potential implications for how athletes acquire sport‐specific motor and movement skills (Fausto‐Sterling et al. 2012b). I conclude by offering recommendations for future research both in and beyond sport, so that models of injury and injury prevention might render visible how gender, rather than simply biology, becomes destiny.

2. Gender/Sex as a Determinant of Health and Injury

It is common for biomedical researchers and social scientists to endorse an analytical distinction between the concepts of sex and gender, with the aim of clearly differentiating research on biological factors from that related to social context (see, e.g., Clayton 2016). Myriad definitions of sex and gender flow from this distinction, with sex arguably best understood as a system of classification: a set of categories often assigned based on a cursory examination of genitalia and taken as a proxy for numerous associated traits, such as chromosomes and hormones (Karkazis 2008; Pape et al. 2024; Richardson 2022). While definitions of gender in biomedical research often emphasize identity (see, e.g., McCarthy 2015), feminist social scientists and scholars more broadly understand gender as a system of difference and inequality that is both relational and structural: it is reproduced through social interactions, underpins organizational hierarchies and practices, and is enforced through overarching social institutions (Acker 1990; Butler 1990; Connell 1987; West and Zimmerman 1987).

Like biomedical researchers, some feminist social scientists have endorsed the distinction of sex from gender, seeing this as a means to challenge inequalities between women and men as natural and inevitable and paving the way for gender as a powerful form of social, organizational, and institutional critique (see, e.g., Oakley 1972). An unintended consequence, however, has been for much biological research on sex‐related variation to proceed as though gender‐related factors are irrelevant (Fausto‐Sterling 2000). Feminist science and technology studies have bridged this divide by applying the tools of gender analysis to challenge scientific claims about sex as a form of essential, biological difference (Bleier 1986; Fujimura 2006; Hubbard 1990; Jordan‐Young and Karkazis 2019; Keller 1995; Richardson 2013). Building on such critiques, feminist researchers at the intersection of gender studies and the biological sciences have forged compelling accounts of how gender and sex, like nature and culture, are irreducibly entangled (Fausto‐Sterling et al. 2012a; Haraway 2008; Hyde et al. 2019; Keller 2010; van Anders 2012). According to this dynamic gender/sex approach, gender differences accumulate in sexed bodies over the life course and particularly during key stages of development (Fausto‐Sterling 2000, 2005).

As a case in point, Fausto‐Sterling (Fausto‐Sterling et al. 2012b) has shown how infants start to develop gendered habits during their first year of life in response to interactions with their parents, with implications for the development of their musculature and motor skills: infant boys, for example, may learn to sit independently sooner than girls, or to play with a soft football. In another relevant example, gender/sex differences in the mineral density of bones changes across historical periods, geographic regions, social classes, and occupations, in response to factors such as the amount of time spent in physical activity (Fausto‐Sterling 2005). Rather than debate whether such phenomena are gender or sex, the concept of gender/sex entanglement allows for an approach to embodied difference that neither denies biological realities nor divorces sexed bodies from their social and developmental environment.

2.1. Structural Sexism, Health, and Sport

In the context of health research, bodies are understood as entangled not only with social practices but also with social inequalities, as captured by epidemiologist Nancy Krieger's concept of ecosocial theory (Krieger 2001, 2014). At the core of the ecosocial model of health is the notion that patterned social inequalities shape trajectories of health and illness: when oppressive social relations shape living and working conditions, including access to civil, political, social, economic, and cultural rights, these are reflected in health outcomes. The health consequences of social inequalities have been clearly demonstrated in the case of race. For example, Black Americans tend to have more exposure to air pollution than non‐Black Americans, with effects on mortality exacerbated by higher rates of poverty, preexisting medical conditions, hazardous jobs, and poorer quality housing and healthcare (Geldsetzer et al. 2024). Macrolevel political shifts can also shape health: the passage of voting rights for Black Americans in 1965 led to pronounced reductions in Black infant deaths in Southern states subject to Jim Crow laws (Rushovich et al. 2024).

Feminist sociologist Patricia Homan (Homan 2019) has extended these insights to gender inequality by exploring how population health is shaped by structural sexism: the degree of systemic gender inequality in power and resources, or put differently, the extent to which the institutional arrangements in a society privilege men and subordinate women. Homan's (2019) original formulation focused on health outcomes across US states, where she found that the health of both women and men is poorer in states where measures of structural sexism (e.g., ratios of men's to women's earnings and the proportion of state legislature seats occupied by men) are higher. Importantly, structural sexism theorizes not only the role of gender differences but also the role of gendered power in shaping health and illness in all people.

While a small but growing literature has linked structural sexism to various health outcomes (Homan 2024), the concept has yet to be applied in the realm of sport. This is despite the long list of gendered practices and inequalities in sport, from pervasive sex segregation to male dominance of leadership and coaching roles (Kane 1995; McDonagh and Pappano 2008; Travers 2008). Girls continue to drop out of sport at higher rates than boys during adolescence, including in Australia (Clearinghouse for Sport 2025). Professional women athletes are often lower paid and in more precarious contracts, less often covered by the media, and face up to twice as much harassment and abuse as their male counterparts (Cooky et al. 2015; Fink 2015; Lang et al. 2023; UNESCO and UN Women 2023). The “extremely gendered” institution of sport (Bryan et al. 2021) has thus provided rich terrain for feminist theorizing about the impact of gendered practices on the development of gendered bodies. For example, philosopher Iris Marion Young's seminal essay, “Throwing like a girl” (Young 1980), challenges the notion of biologically driven differences in the throwing techniques of girls and boys by describing how girls are taught to move their bodies and occupy space in ways fundamentally different to boys, with lifelong consequences for their motor skills.

The recent attention to ACL injury disparities in football codes has surfaced clues of a potential role for gendered developmental disparities. For example, in one news article on “sexism” as the “risk factor” for ACL injury in women, a physical trainer for a women's professional soccer team traced injury disparities to the habits of school‐aged children: “If you look at kids in the school yard at break time, how many of the girls … play football there?” (Burgen 2024). 6 A UK government report on sporting injury in women and girls has similarly suggested that “issues of sexism” are likely to be among the “multifaceted” causes of ACL injury in women, noting, for example, that “women are often put on secondary playing surfaces,” have lower quality coaching, and are less likely to have accessed “strength and conditioning coaches and nutritionists from a very young age” (Women and Equalities Committee 2024, 19).

Aussie Rules is ripe for documenting the accumulation of gendered inequalities across the developmental trajectory of athletes. According to Fox et al. (2020), “[t]he combination of reduced sport‐specific motor skill development acquired through deliberate practice [over the lifecourse], along with very short preseason training periods for the AFLW, could create a ‘perfect storm’ of athletes with higher risk of ACL injury in a ‘new’ sport encompassing high‐risk tasks” (Fox et al. 2020, 2). Fox et al. effectively develop a theory of structural sexism as a health determinant in sport, noting the gaping resource and salary disparities between the women's and men's leagues, including “reduced access to facilities, training opportunities and medical/athletic development staff” (2), and their impacts on embodied development. In what follows, I further develop this structural sexism lens, using the case of Aussie Rules as an opportunity to consider how, concretely, the gender unequal organization of sport may come to have material consequences for injury risk.

3. Case Study: Gender/Sex and Aussie Rules Football

3.1. Overview of Aussie Rules

Aussie Rules is played primarily in Australia, 7 with the sport believed to have developed from an indigenous game known as marngrook (National Museum Australia 2023). Not to be confused with rugby, which is primarily played in north‐eastern Australia, men's Aussie Rules is the preeminent professional sport in Australia as measured by revenue. The game evolved in Melbourne in the mid‐1800s, and while the (men's) AFL officially came into existence in only 1990, the state league that it expanded—the Victorian Football League—has existed since 1897. 8 The game centers on a leather ball that is rounder than an American football and smaller than a rugby ball. Alternating with cricket in making use of Australia's natural grass ovals during the winter months, there is no standard sized playing surface for Aussie Rules, which is considerably larger than a soccer, rugby, or American Football pitch (Figure 1). This vast terrain allows for many more players on the field compared to other football codes (18 per side).

FIGURE 1.

FIGURE 1

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Dimensions of an Aussie Rules oval and starting positions with 18 players per side.

Aussie Rules is a high scoring, field‐based team invasion sport characterized by fast‐paced running and frequent collisions. 9 Players primarily move the ball by kicking it through the air, which can project the ball as far as 75 m (Ball 2008). 10 The player in possession of the ball can run in any direction to avoid their opponents but must dispose of or bounce the ball every 15 m—a demanding skill given the oval shape of the ball and natural grass surface. Four posts at each end of the ground mark the goal zone: a goal, when the ball is kicked through the two center posts, is worth six points; a “behind,” when the ball passes through the outer posts or is touched by hand, is worth one point. During a typical match, players may accumulate up to 12 km of running (Wing et al. 2021), depending on their role and position, including a high number of sprints, accelerations, and changes of direction (Johnston et al. 2018; Saw et al. 2018).

Given the high running load, the chaotic nature of player and ball movement across the ground and through the air, and frequent player‐to‐player collisions when tackling or contesting the ball, there are many different circumstances under which injuries can occur (Saw et al. 2018). The three most common injuries in the elite men's game are hamstring strains, groin strains/osteitis pubis/hip injuries, and ACL injuries (Verrall et al. 2014). Aussie Rules rates particularly poorly among sports for ACL injury risk, with only skiing having a higher incidence per participant (Janssen et al. 2012). Up to 56% of ACL injuries occur through noncontact mechanisms (Saw et al. 2018), with contributing risk factors including change of direction (sidestepping), deceleration, the angle of landing, and studded footwear increasing friction with the playing surface (Cochrane et al. 2007; Saw et al. 2018).

ACL injury rates in Aussie Rules are not static: in men's AFL, injury data shows an important change over the period 1999–2012, when the incidence of ACL injury decreased from an average of 1.2 to 0.76 new injuries per club per season (Orchard et al. 2013; Verrall et al. 2014). This reduction is believed to reflect changes in strength and conditioning practices (Finch et al. 2016) as well as improvements in the playing surface (Orchard and Seward 2002), pointing to a dynamic relationship between athletes' bodies and their playing environment—an understanding of injury that has not necessarily been extended to the emerging women's game.

3.2. Women's Aussie Rules

Women have long been loyal fans of Aussie Rules football, with historical accounts describing women gracing the stands with their presence as early as the 1870s: “Women too were regular attendees, parading in their finery around the playing area” (National Museum Australia 2023). More than spectators, women were also early players, participating in women‐only tournaments and exhibition matches from the early 20th century (Saulty 2018). In Victoria, an official women's league was created in 1981 with four participating clubs; national championships were established in 1992, organized by Women's Football Australia (WFA). In 1995, a pioneer of women's Aussie Rules—Sal Rees—made news headlines by nominating herself for the men's AFL draft, prompting the AFL to implement a rule change to prevent such an occurrence in the future (Hanlon 2016). In 2010, the AFL took over the operations of WFA and commissioned a review into women's football, leading to the establishment of a professional league for women in 2017 (the AFLW).

The AFLW has expanded rapidly from eight teams and a 7‐week “home‐and‐away” 11 season in 2017 to 18 teams and 11 weeks in 2024. In what follows, I consider how, despite this rapid growth—which has been mirrored at the grassroots level—women experience vastly different playing conditions, pointing to key social structural factors that should be considered in injury studies. As an alternative to theories of women's inherent physical vulnerability, I apply the concepts of gender/sex and structural sexism through a focus on childhood sport participation rates, gender‐adapted rules, and structural inequalities in current playing conditions.

4. Gender/Sex and Structural Sexism in Aussie Rules Football

4.1. Gendered Patterns in Childhood Sports Participation

A large body of research has documented the acquired nature of sporting skills and capacities and the consequences of early life exposure to different sports for health and injury outcomes later in life (see, e.g., Goodway and Branta 2003; Proudfoot et al. 2019; Vandorpe et al. 2012). Early exposure to sport is considered critical to acquiring a comprehensive repertoire of fundamental motor skills (FMS), including running, jumping, and the control of objects. According to Vandorpe et al. (2012), “FMS do not naturally occur in children, but instead develop through the interaction of biological and environmental constraints” (221), with an important role for “the quality of the instructional environment and the provision of practice‐based opportunities” (O'Brien et al. 2023, 3278). There may also be a longer‐term injury prevention benefit: research suggests that ACL injury risk can be reduced when children practice sport‐specific movements and skills early in their development, particularly, between the ages of 6 and 10 years old (Heering et al. 2023). This is supported by research on ballet, which has shown no difference in ACL injury rates between women and men nor any meaningful difference in their landing mechanics, possibly due to the intensive training that both girls and boys receive from a young age (Orishimo et al. 2009).

In the case of Aussie Rules, childhood exposure starts with Auskick: a program for children aged between 5 and 12 that develops the basic skills of the sport, with competition in organized leagues beginning at 8 years old. Games are used to support children to acquire the ball handling and movement skills of the game, including movements that involve changes in direction such as “dodging,” “weaving,” and “evasion skills” (Auskick 2024) (Figure 2). The vast program of Auskick attracts over 100 000 participants every year, making it the nation's largest grassroots sporting association. Since 2016, approximately a quarter of participants have been girls. 12

FIGURE 2.

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In the activity called Foosball, taggers (center) practice moving back and forth along a lateral line; attackers (left) practice weaving and dodging to run to the other end (adapted from AFL Play 2025).

According to the AFL, “[u]nlike boys, girls are less likely to have progressed from AFL Auskick and junior football through to youth girls,” with women's leagues “still attracting new players who have never played the game before” (Australian Football League (AFL) 2020, 10). Even at the AFLW level, players typically did not grow up playing Aussie Rules, in “stark contrast to the typically lifelong developmental experience of men in the AFL” (Fox et al. 2020, 2). In 2024, the average AFLW player would have been born around 2000 with the opportunity to participate in Auskick from around 2005—a time when Aussie Rules was practiced by fewer than 1% of girls compared to 12.6% of boys aged 5–14 (Figure 3). By 2022, the sport had climbed to the ninth most practiced among Australian girls with a participation rate of 5.8%. 13 By contrast, Aussie Rules has consistently ranked among the top five sports nationally for boys, particularly in the state of Victoria, where in 2022 it was the second most popular sport practiced by nearly 31% of boys aged 5–14. 14 In practice, this means a deeper pool of adult men who have been accumulating exposure to the motor demands of Aussie Rules since early childhood.

FIGURE 3.

FIGURE 3

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Participation rates in Aussie Rules football (%), girls and boys aged 5–14, 2000–2021 (Australian Bureau of Statistics 2008, 2012; Australian Sports Commission 2024).

The limited participation of girls in Aussie Rules is reflected in the unusually high number of AFLW players who come from other sports; indeed, all 10 AFLW clubs in 2019 were even required to recruit two “cross‐code rookies”—athletes from other sports who had not played organized Aussie Rules for at least the previous 3 years. The limited pool of players with a full developmental history in the sport may be part of the ACL injury story: during the 2022 AFLW season, at least three of seven athletes injured during a spate of ACL injuries grew up playing other sports (volleyball and soccer). 15 This points to an opportunity to test the gender/sex entanglement hypothesis: if years in a sport shape injury risk, then any gender disparity in ACL injury rates in Aussie Rules may shift over time as girls are increasingly supported to take up and stay in the sport from a younger age.

4.2. Embedding Gender Difference in the Field of Play

Tracking accumulated time in the sport may offer preliminary insights into how developmental opportunities may differ for women and men; a further question is whether there are qualitative differences in playing conditions, including in competition (Danielsen et al. 2025). Aussie Rules is segregated into gender‐specific competition, though girls may request to play with boys' teams until they are 14 years old. 16 Girl‐only competition begins with the under‐10 age category, with the AFL recommending that leagues provide single‐age group competition categories until under‐18 (AFL 2019); in practice, however, many girls' leagues need to combine age groups to field teams, particularly in rural areas. Furthermore, some rural clubs are required to merge with nearby towns to create teams, increasing travel demands for training and competition. Girls' leagues also tend to have more variation in the experience levels of players, meaning more skill mismatches and increasing the risk of injury (AFL 2019). Taken together, the result is a more disjointed developmental pathway and a greater likelihood of players giving up the sport (AFL 2019).

In the context of girls' highly varied development, a key question for the AFL has been whether and when to recommend adapted rules for girls' matches. Prior to 2024, girls were subject to a delayed introduction of advanced rules and conditions in comparison to boys. In the under 10 age group, for example, girls played on a smaller terrain and without the modified tackling allowed for boys of the same age (AFL 2020). Girls in the under‐12 age category were not permitted to tackle, bump, and barge like the boys in under‐11 and 12. Until under‐18, girls played with fewer players; in all age groups, they played shorter quarters. These adaptations were at times justified by the AFL with language that blurred the line between developmental disparities and inherent differences between girls and boys, such as one statement that “[m]ost young girls do not have the strength or power capacity to kick as far, run as fast or process the same level of match information as women or boys” (AFL 2020, 26). 17 The AFL updated these rules in 2024, removing all differences between the girls' and boys' game until the under 15 age group (Australian Football League (AFL) 2024). From here, however, girls and boys still diverge: girls play with a smaller football and with 16 rather than 18 players, with the aim of creating “a less‐congested and freer‐flowing match” (AFL 2019, 5).

These are just a small number of factors that could result in distinct developmental experiences for girls and boys in Aussie Rules. Quality of coaching, for example, has been identified by the AFL as a particular challenge for girls' football (AFL Working Group 2020). Importantly for a gender/sex entanglement approach, such differences in playing conditions hinder meaningful comparisons (Danielsen et al. 2025): young girls and boys have simply not been traveling along the same developmental pathway nor playing the same version of Aussie Rules. As I show in the following section, the same can be said about the AFLW's distinct playing conditions, with potential implications for injury disparities.

4.3. From Gender Difference to Structural Sexism in Elite Aussie Rules

The AFLW is the pinnacle of a new wave of women's Aussie Rules and, as at the junior level, is evolving rapidly, meaning the conditions for players can vary from one year to the next as the AFL adapts the scheduling of the AFLW season, match rules, and salaries as negotiated with the AFL Players Association (AFLPA). At the time of writing, however, the AFLW is far from offering its players the conditions enjoyed in the AFL. In addition to their highly varied developmental pathways, AFLW players experience different match conditions, a reduced volume of football and training over the course of a year, and salaries that reflect the often part‐time nature of their contracts.

The AFL describes AFLW matches as “short, sharp and action‐packed” (AFL 2025). Indeed, the total length of an AFLW match is about 65% that of the AFL, with shorter quarters, different rules for time on (added time for stoppages), and a shorter half‐time break (Figure 4). The AFLW also has fewer players on the ground (16 compared to 18 in the AFL), one additional player on the bench (5 as opposed to 4 in the AFL), and a higher proportion of permitted player interchanges given the length of the match (60, which is 80% of the 75 allowed in the AFL). Research on other sports has shown that reducing the number of players on the ground and reduced playing time can increase the intensity of play (see, e.g., Hammami et al. 2018)—a factor that may be exacerbated by a higher proportion of interchanges with rested players. How efforts to increase the intensity of play in the AFLW impact injury risk warrants examination; at the very least, they result in incomparable playing conditions for AFLW and AFL players, and a rather significant step‐up in match intensity for younger women players coming from the lower leagues.

FIGURE 4.

FIGURE 4

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Match length and accumulated minutes of match play and active time over the course of the year (2024 season).

AFLW players have a more compact season than their AFL counterparts. Whereas the AFL season encompasses 23 regular rounds plus finals, the 2024 AFLW season had only 11 regular rounds. Combined with the shorter playing time per match, AFLW players are exposed to only 30% of the match play opportunities available to AFL players across a season (Figure 4). They also spend less time in training: under the 2023–2027 collective bargaining agreement (CBA), AFLW clubs can impose a gradually increasing training load, from 20 h per week in 2023 to 25 h per week in 2026 (including time dedicated to matches during the season); by contrast, AFL players have a cap of 32 h of training per week during preseason and no specific cap during the season itself (AFL and AFLPA 2023). Whereas AFL players are entitled to 9 weeks of leave across the year, AFLW players are considered to be on leave for approximately half of the year (24–28 weeks), depending on whether their team participates in the finals. Taken together, a conservative estimate suggests that in 2024, AFLW players had at most 45% of the exposure to training and match‐related activities as AFL players (Figure 4), 18 significantly reducing the time spent accumulating sport‐specific conditioning with their club.

The list of further factors differentiating the conditions for AFL and AFLW players is long. One is the timing of the season: until 2023, the AFLW was held over the summer months to ensure no overlap with the AFL, meaning moister soil and winter grass for the AFL compared to drier conditions and summer grass for the AFLW. Harder, drier playing surfaces increase the risk of ACL injury, including in Aussie Rules (Orchard et al. 2013). Given the part‐time nature of their contracts, AFLW players may play other sports and/or hold additional employment, taking time away from recovery and sport‐specific conditioning. Forexample, Monique Conti, the AFLW's best player in 2023, continues to play in Australia's professional women's basketball league. Under the CBA, AFLW clubs cannot require training during working hours—a scheduling difference that has consequences for sleep quality and associated outcomes (e.g., mental health) (Mascaro et al. 2024). This is in part because when facilities are shared, the men's AFL clubs take priority, but also because nearly half of AFLW players continue to rely on some form of employment outside of their playing contracts. While AFLW salaries have risen rapidly, up to $60 000 in 2023 and negotiated to reach $82 000 by 2027, they lag considerably behind those of their male counterparts, who in 2023 earned an average of $441 464 per season.

At least five of the nine players who sustained an ACL injury in 2022 were employed outside of football. One such player, Isabel Huntington, described the issue as follows:

At the crux of the issue is the fact we're part‐time athletes. If we were full‐time and had the same amount of time to spend on our bodies and injury prevention [as the men] … then I think it would be a very different story… Often the women's teams are seen as a bit of a sideshow and aren't given equal access to the men's team and are often relegated to the back fields and the older change rooms… All those things are factors and probably build up to a higher level of risk, as well as a lot of these women are starting out and playing the game for the first time. Women's sport in terms of resourcing hasn't had as much time to catch up and have the access to the resources and facilities and staff to be able to really focus their efforts on prevention.

(cited in Ractliffe and Butt 2021)

That is, the still limited training and match play opportunities for AFLW players are part of a much larger, long‐term trend of structural arrangements and practices that combine to undermine women's development and conditioning, constituting a form of structural sexism with potential consequences for injury.

5. Discussion: Advancing Equity and Inclusion in Aussie Rules

This essay has sought to challenge the reflex to invoke “hips and hormones” as the seemingly logical explanation for differences in the injury experiences of women and men, in this case by looking at ACL injury in the physically demanding sport of Aussie Rules and documenting just some of the differences between women's and men's involvement at childhood, youth/adolescence, and elite levels. In doing so, I have sought to make a gender/sex entanglement approach plausible by showing how gender differences in exposure to the physical and skill demands of Aussie Rules are baked into the very organization of the sport. While the developmental pathway charted above is far from being complete—most notably, it is does not discuss the talent development programming that serves as a bridge between junior football and the professional game—it shows that researchers simply cannot assume that girls/women and boys/men have accumulated quantitatively and qualitatively comparable exposures to the sport (Fox et al. 2020; Parsons et al. 2021; Danielsen et al. 2025). This makes the sport of Aussie Rules a fitting case study for examining how research on health and injury can shift toward new hypotheses of gender/sex entanglement.

The current focus on women's biology in ACL injury debates assumes the culprit to be intrinsic, individual‐level factors, which are often divorced from the gendered social and developmental context of many sports. This has opened the door for sporting equipment companies to market products such as “boots specifically designed for women's bodies” as an alleged preventative measure for ACL injury (Ingle 2024). A less marketable approach, and one that would require considerably more reckoning on the part of male‐dominated sports organizations and cultures, is to seriously interrogate the role of gendered practices and inequalities in shaping developmental opportunities for women and girls.

A gender/sex entanglement approach asks researchers to incorporate a new range of variables in studies of injury disparity, such as number of years in the sport, participation in (which) other sports, time spent in training and match play (historical and current), and time spent in outside employment. Following Homan's (2019) index of structural sexism, injury studies at the AFL and AFLW level could also incorporate concrete measures such as player salaries, coach salaries, strength and conditioning budgets, and medical support, in addition to the gender balance of coaching and administrative staff. Gender differences in caregiving obligations may also undermine recovery and contribute to different loads for the bodies of women and men (Parsons et al. 2021). Differences in the quality of coaching and training techniques are also important to document. According to one sports scientist who works with women's and girls' Aussie Rules teams: “[F]rom the workshops we have run this year, we know that some coaches and players are tentative to practise contact skills at training, despite the game demanding a level of contact” (Ractliffe and Butt 2021). Such qualitative differences challenge the notion that women's neuromechanical strategies are the product of hormonal changes during puberty (Hewett et al. 2004), pointing instead to gendered gaps in development and conditioning as well as how coaching practices may be shaped by underlying assumptions about women's and girls' capabilities (Parsons et al. 2021).

A structural sexism approach could also consider how to measure exposure to misogynistic abuse and its impact on player health. In 2019, AFLW star Tayla Harris became the target of unprecedented online abuse after a photo was published of her kicking the ball in full flight. As Harris later reflected:

The nasty and sexist online abuse I copped that sexualised my body and belittled my athleticism, not only had profound consequences for me and my loved ones, but it also sent a message to girls and young women that they're not welcome on the field. It is a message that continues to box women and girls out of playing traditionally male dominated sports and stops them from speaking out, participating and becoming leaders.

(Harris 2021)

A similar culture of misogynistic abuse and harassment has been documented in women's soccer (see, e.g., FIFA Social Media Protection Service 2023). Misogynist harassment—aimed, it would seem, at discouraging the presence of women and girls in previously male‐only spaces—could compound existing gaps in the playing and development trajectories of women and girls.

Decentering notions of essential biological differences between women and men may also lend support to the AFL's approach to providing transgender athletes, and particularly transgender women, with reasonable avenues to inclusion. Currently, the AFL welcomes transgender and gender diverse players without restriction at the community level (AFL 2020). At the elite level, transgender women are subject to eligibility criteria that assess their performance capabilities case‐by‐case, informed by the current performance standards of the AFLW (AFL 2020). 19 These standards will presumably change over time, reflecting a game in flux and the rapid development curve of women's Aussie Rules. This dynamic approach to performance in all athletes is consistent with a gender/sex entanglement approach to athlete development and injury risk, since it focuses on concrete measures and resists static narratives of female–male difference.

More than a story of an obscure Australian sport undergoing a belated (and unfinished) gendered transformation, Aussie Rules can be a generative case for reflecting on how gendered practices create divergent developmental pathways for women and men, beginning in childhood and extending across the life course (Fausto‐Sterling et al. 2012b). These structural contingencies are too easily rendered invisible and their effects on embodied development naturalized as “biology,” cutting short the production of more complex and situated empirical accounts of bodies and their environment (Richardson 2022). By beginning from a conceptual model of gender/sex entanglement, researchers can open up avenues of inquiry that ultimately improve understanding of health and injury mechanisms in all populations, both within and beyond sport.

Ethics Statement

The author has nothing to report.

Conflicts of Interest

The author declares no conflicts of interest.

Acknowledgments

I am indebted to the Harvard GenderSci Lab for their close reading of this manuscript and particularly the insightful and challenging comments of Sarah Richardson, Patricia Homan, Annika Gompers, Katharine Lee, and Lauren Rothenberg Aalami. Sincere thanks also to Ryan Lobigs for his generous and expert feedback. This article is dedicated to Peter Pape and the Eastern Football League Umpires Association, who encouraged me to pursue my own path in Aussie Rules football. Open access publishing facilitated by Universite de Lausanne, as part of the Wiley ‐ Universite de Lausanne agreement via the Consortium Of Swiss Academic Libraries.

Pape, M. 2025. “Gender/Sex Entanglement, Structural Sexism, and Injury: The Case of Australian Rules Football.” American Journal of Human Biology 37, no. 7: e70096. 10.1002/ajhb.70096.

Funding: This work was supported by the Flax Foundation and Swiss National Science Foundation (PZ00P1208890).

Endnotes

1

In the Australian context, the male‐dominated professional sport of cricket is also experiencing a gender revolution.

2

At least 80% of these 1092 teams are for girls under the age of 18.

3

My own forays into Aussie Rules were limited to one match as the only girl on my primary school team, one match for my high school, and 6 years as a field and boundary umpire for the Eastern Football League (Victoria).

4

Danielsen et al. (2025) have contested the size of this alleged injury disparity, noting that the use of athlete exposure—a common denominator measure of exposure time used in calculations of injury rate—may be biased toward overestimating ACL injury rate in women.

5

One newspaper stated that “[b]iomechanically, women have a wider pelvis, increasing the ‘Q‐angle’” (Burt 2021), ignoring research showing that Q‐angle correlates with height rather than with sex category assigned at birth (Grelsamer et al. 2005; Khasawneh et al. 2019). Another news article suggested that “ACL injuries are more common in women due to differences in anatomy, muscle strength and hormonal fluctuations” (Stearn 2023) despite research showing no consistent link between menstrual cycle phase and injury risk (Dos'Santos et al. 2023).

6

Indeed, research on children's movement in the school yard has shown that certain groups of boys tend to dominate use of shared recreational space (Balandra 2024).

7

So‐called expat leagues exist in 29 other countries.

8

This is why there is a predominance of Victorian clubs in the AFL (10 of 18 clubs).

9

In 2022, AFL teams scored an average of 83 points per game.

10

The ball cannot be thrown but can be moved over a shorter distance using a “handball” or “handpass,” whereby the ball is held with one hand and punched with the clenched fist of the other.

11

The “home‐and‐away” season refers to the regular rounds played before the finals.

13

Sports participation in Australia is characterized by gender segregation: while swimming was the most popular sport for all children in 2022, and soccer increased in popularity among girls, girls were otherwise concentrated in gymnastics, netball, and dancing, compared to soccer, Aussie Rules, and basketball for boys (Australian Sports Commission 2024).

14

Nationally, 19.5% of boys aged 5–14 participated in Aussie Rules in 2022, making it the third most practiced sport behind swimming and soccer.

15

Only seven of nine injured players could be identified from public records.

16

This is only permitted if “the girl is skilled, confident, physically capable and has the consent of her coach and parents” (AFL 2019).

17

This phrase also diminishes adult women's capacities by equating them to those of boys.

18

Calculated based on a 32‐hour week for the AFL and a 22‐hour week for the AFLW per requirements for the 2024–2025 season.

19

Beyond meeting a testosterone threshold (5 nmol/L), transgender women are compared to cisgender women players on a range of endurance, power, and anthropometric measures, using lab‐based performance testing (e.g., VO2 max) as well as GPS match data.

Data Availability Statement

The data that support the findings of this study are available in Ausplay data portal at https://app.powerbi.com/view?r=eyJrIjoiZGU1YWFhZDgtMmRhZi00YTgyLThhMzItYjc2ODk5NTg0MTg1IiwidCI6IjhkMmUwZjRjLTU1ZjItNGNiMS04ZWU3LWRhNWRkM2ZmMzYwMCJ9. These data were derived from the following resources available in the public domain: ‐ Ausplay data portal, https://app.powerbi.com/view?r=eyJrIjoiZGU1YWFhZDgtMmRhZi00YTgyLThhMzItYjc2ODk5NTg0MTg1IiwidCI6IjhkMmUwZjRjLTU1ZjItNGNiMS04ZWU3LWRhNWRkM2ZmMzYwMCJ9‐; AFL Match Policy, https://resources.afl.com.au/afl/document/2020/01/21/0947b624‐5457‐4983‐8ed8‐a862ccfefca1/Australian‐Football‐Match‐Policy.pdf.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available in Ausplay data portal at https://app.powerbi.com/view?r=eyJrIjoiZGU1YWFhZDgtMmRhZi00YTgyLThhMzItYjc2ODk5NTg0MTg1IiwidCI6IjhkMmUwZjRjLTU1ZjItNGNiMS04ZWU3LWRhNWRkM2ZmMzYwMCJ9. These data were derived from the following resources available in the public domain: ‐ Ausplay data portal, https://app.powerbi.com/view?r=eyJrIjoiZGU1YWFhZDgtMmRhZi00YTgyLThhMzItYjc2ODk5NTg0MTg1IiwidCI6IjhkMmUwZjRjLTU1ZjItNGNiMS04ZWU3LWRhNWRkM2ZmMzYwMCJ9‐; AFL Match Policy, https://resources.afl.com.au/afl/document/2020/01/21/0947b624‐5457‐4983‐8ed8‐a862ccfefca1/Australian‐Football‐Match‐Policy.pdf.

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