The plague that is ACL injuries in women’s football

With an increase in games played, ACL injuries have been on a rapid increase lately in both men’s and women’s football. However, the situation in the women’s game is of high concern.

On the 27th of January, Manchester City announced that Jill Roord – Manchester City women’s record signing – is out for the rest of the season after rupturing her ACL.

This news came a day after Eintracht Frankfurt announced that Tanja Pawollek had torn her ACL during their UEFA Women’s Champions League game against FC Barcelona Femení. And just three weeks ago, Chelsea had confirmed that Sam Kerr had torn her ACL during their warm weather training camp in Morocco.

Roord is the latest edition to this ever-growing list. But why is it that ACL injuries are more common in women’s football? Before we get to that, let’s start by understanding ACL injuries.

What is an ACL injury?

An ACL injury occurs when the anterior cruciate ligament (ACL), one of the key ligaments in the knee joint, is damaged or torn. This ligament is essential for providing stability to the knee, especially during activities that involve sudden stops, changes in direction, or pivoting movements.

These injuries frequently happen in sports like (American) football, basketball, and skiing, where there is a risk of sudden stops or changes in direction. ACL injuries can result from various mechanisms including contact and non-contact injuries.

ACL injuries can range from mild sprains to complete tears. The severity of the injury depends on factors such as the force of the impact: the angle of the stress on the knee, and individual factors like muscle strength and flexibility.

In cases of complete tears or significant instability, surgical intervention, typically involving ACL reconstruction, may be recommended to restore knee stability and function.

Rehabilitation and post-surgery recovery are critical components of managing ACL injuries, aiming to have the players return to regular activities, including sports while minimizing the risk of future injuries.

What exactly is happening in the women’s game?

The surge in ACL injuries has struck women’s football with alarming frequency. Big players like Chelsea’s Sam Kerr and City’s Jill Roord are one of the 12 Women’s Super League athletes now on the road to recovery.

The recent blow to Chelsea’s prolific striker, Sam Kerr, shows the severity of ACL injuries. Kerr’s unfortunate injury, sustained during a training camp in Morocco, has ruled her out of the Women’s Super League season, the UEFA Women’s Champions League campaign, and the Matildas’ Olympic qualifying playoffs.

The timeline for her recovery remains uncertain, with the upcoming Paris tournament merely seven months away, making a timely return challenging. She may never play under Emma Hayes again.

ACL recovery is a process demanding a minimum of six months. Previous cases, including Australia and Lyon’s Ellie Carpenter’s nine-month journey, prove the complexities of rehabilitation. Rushing a return heightens the risk of re-injury, creating a delicate balance between short-term convenience and long-term well-being.

How bad are the numbers?

Football-focused research, which remains scarce, indicates that women footballers are six times more likely to experience ACL injuries compared to their male counterparts, and they are 25% less likely to achieve full recovery.

The incidence of ACL injuries per 1000 match playing hours varies between 0.6 and 2.2. In the past 18 months, there has been an addition of more than 195 elite players to the list.

Findings from the UEFA Women’s Elite Club Injury Study, a comprehensive report covering 1,527 injuries across four consecutive seasons from 2018 to 2022, unveiled that 64% of ACL injuries were sustained without direct contact.

On the domestic front, WSL clubs, particularly Arsenal, suffered the most from ACL injuries last season. Arsenal, based in North London, had a total of four players sidelined due to ACL tears. Key players for Arsenal, namely Beth Mead, Vivianne Miedema, and England captain Leah Williamson, have only recently returned from ACL recovery.

But it is starting to look like as soon as one recovers, another falls victim.

Presently, 12 WSL players, including Sam Kerr, are in the process of recovery. Ironically, Mia Fishel, brought in by Chelsea in the summer from Lyon as Kerr’s understudy, is undergoing her own recovery journey from an ACL tear sustained in June 2022.

The ACL injury crisis is so severe that it affected football’s biggest event. Between 25 and 30 players, equivalent to a full squad, missed the Women’s World Cup last summer due to ACL tears. Among the notable absentees were Leah Williamson, Beth Mead (England), Janine Beckie (Canada), Delphine Cascarino, Marie-Antoinette Katoto (France), Vivianne Miedema (Netherlands), Christen Press, and Catarina Macario (United States).

What is the reason for the high numbers?

As the “plague” of ACL injuries continues to unfold, it raises critical questions about the unique challenges female footballers face.

Contrary to what many may think, women footballers are just as skilled and athletic, so it does not come down to that. The key lies in the support provided by those in influential positions within the sport, ensuring that these dedicated female athletes, who just like any other athletes give their all, get the backing they need.

The problem appears to be that there is this big need to make the women’s game very similar to the men’s game. Matching schedules, and a matching number of competitions, however, resources in the women’s game are still very limited. There is no balance unlike in the men’s game where intensity and resource allocation are given equal attention.

For a long time, football has been considered a ‘man’s game.’ So even when it comes to football-related research, the focus has mainly always been on men. But as we have seen in this article, research has been done and continues to be done. The problem is not nearly enough resources and time have been put into the women’s game to implement solutions to the findings.

In the men’s game, high levels of training are implemented from the start of the player’s career. Young boys in football academies are raised and brought up in a tailored manner that will ensure they will be ready to play at an elite level as professionals in the future. That is not the same for young girls.

In the words of England and Chelsea forward Fran Kirby to Sky Sports:

“It’s important to get the basic fundamentals really young – there is a difference when it comes to how we [boys and girls] are brought up playing.

The boys are doing gym work and learning basic running mechanics at the age of six. When I was coaching at Reading the grassroots girls couldn’t even access a gym. The most important thing is teaching young girls the basic mechanics of being a footballer and being a sportsperson.”

There is limited funding for the women’s game, and naturally, that affects the quality of development and rehabilitation methods.

With most football research being tailored to the biology of men, it creates a unique problem in women’s football. Women and men have different bodies, so naturally, prevention, treatment and rehabilitation methods may vary.

Speaking to Inside the WSL last season, female health specialist Dr Emma Ross had this to say:

“We published a paper over a year ago which showed that, in sport and exercise science research, only six per cent of studies are done exclusively on females. There are a lot of myths out there about menstrual cycle and injury.”

Football has been designed ‘for men, by men.’ Football boots, for example, are designed for men to wear. It was only last year that Nike launched its new Phantom Luna boot, which they described as the “most innovative and researched women’s led boot” in the company’s history. They were released just in time for the 2023 World Cup.

More needs to be done

Various factors contribute to the alarming rate of ACL injuries among female footballers. Muscle imbalances, inadequate access to top-quality pitches and training equipment, ill-fitting boots, and less engagement with injury prevention training are among the reasons.

It is very important to note that a lot of this is due to the lack of resources, gender bias, and a historical disregard for women’s specific needs in football.

Amid the crisis, voices within the women’s game, including former players, sports medicine specialists, and researchers, are demanding urgent action. Proposals for improved medical provision, tailored research units, and the development of female-specific equipment – all matching up to the match schedules – will help to address the root causes and reduce the risk of ACL injuries.

The issue of ACL injuries in women’s football demands a comprehensive and coordinated response from those who call the big shots. Just as it is a priority to protect male footballers, it is time for the well-being of female footballers to be prioritized. This will ensure the sport’s long-term success.

The growth of the women’s game has been amazing, but unless more is allocated to ensuring the well-being of these players, the sport risks compromising its athletes’ health and potential, casting a shadow over the remarkable progress of women’s football, and undermining the long-term success of women’s football.

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