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Sex Differences in Achilles Tendon Loading in Healthy Recreational Runners: A Cross-Sectional Study
Alex W Olver1,2, Amanda M Thiers1,2, Haley A Reierson1,2
1Department of Health Professions, Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, WI, USA.
Journal of Sport Rehabilitation
|February 3, 2026
Summary
Male runners experience higher Achilles tendon forces due to larger tendon size, but similar stress levels compared to females. These sex differences in Achilles tendon loading may influence injury risk.
Area of Science:
- Biomechanics
- Sports Medicine
- Orthopedics
Background:
- Running-related Achilles tendon injuries are more prevalent in males.
- Males have larger Achilles tendons and potentially higher loading during running.
- Sex differences in Achilles tendon mechanics require further characterization.
Purpose of the Study:
- To investigate sex differences in Achilles tendon cross-sectional area.
- To examine sex differences in Achilles tendon loading variables during running.
- To compare Achilles tendon kinetics and kinematics between male and female runners.
Main Methods:
- A cross-sectional study involving 26 female and 23 male recreational runners.
- Participants ran at a consistent speed (3.35 m/s) on an instrumented treadmill.
- Data collected via 3D motion capture, musculoskeletal modeling, and diagnostic ultrasound.
Main Results:
- Males exhibited greater peak Achilles tendon force (0.94 BW) and gastrocnemius force (0.52 BW).
- Males had a larger Achilles tendon cross-sectional area (0.1 cm2).
- No significant sex differences were found in peak Achilles tendon stress, strain, soleus force, foot strike angle, or peak vertical ground reaction force.
Conclusions:
- Male runners generate higher peak Achilles tendon forces at the same running speed.
- Despite higher forces, peak Achilles tendon stress is comparable between sexes.
- Differences in Achilles tendon size and force generation may contribute to sex-based injury risks.
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