Women’s football – why so many ACL injuries?!

Women's football ACL injuries
Image Credit: Deposit Photos, Editorial use only. Photography ID: 23692575, Copyright: Robi22.

The women’s football world cup is currently on and so it seems like a good time to look at the fact that female footballers are up to eight times (yes eight times!) more likely to suffer an ACL injury than their male counterparts? This is a big problem – as well as being a extremely painful injury, the recovery time can take up to 12 months, often involves surgery and can sometimes mean early retirement. There are also a large majority of athletes who will develop osteoarthritis within 15 to 20 years after an ACL injury, regardless of treatment.

So why is this and what can we do to reduce the number of ACL injuries in female football players?

Firstly, what is the ACL?

The ACL is the anterior cruciate ligament, which is one of the key ligaments that help stabilise your knee joint. The ACL connects your thighbone (femur) to your shinbone (tibia). See below.

Women's football. Anterior View of the Knee. ACL
Anterior View of the Knee (www.howardluksmd.com)

How can you injure or tear your ACL?

ACLs are most commonly torn during sports that involve sudden stops and changes in direction, pivoting accelerations and decelerations – sports like football.

Why are women more prone to ACL tears?

One main reason why women are more likely to suffer an ACL injury is because of physiological differences. Having wider hips than men means that the leg’s angle into the knee is increased. This angle is called the Q angle. Because the bone comes into the knee at a more acute angle there is more pressure on the knee and more chance for it to rotate inwards and cause the ACL to tear. This is called Valgus force.

Research suggests there could also be a few other reasons why women are more prone to ACL tears. One is under-developed muscles, which prevent the knee from turning in upon landing. A lot of female footballers have poor hamstrings and poor gluteus medius muscles (1), which are the muscles at the side of the hips that correct the knee and brings it back into alignment. The other reason is hormones, although there is still limited evidence to support this (2).

What can we do to help prevent ACL injuries?

You can’t change a women’s physiology but you can help to prevent ACL injuries in women by working on and improving core stability, balance, dynamic stabilisation and muscle strength in the lower body. Particular focus should be on strengthening the glutes and hamstrings, which as said above, are often weaker in women. It is worth having a look at our previous blog which focusing specifically on exercises to increase glute strength. It is also important to rehearse good landing mechanics. Landing with bad technique can place a great deal of stress throughout the kinetic chain and can end careers prematurely if this is not corrected. The goal is to land correctly with the right sequence and alignment and transfer the impact forces; first to the larger gluteus muscles, and then the hamstrings, quads, and calf muscles. Have a watch of Reid Hall’s video, which explains three exercises that will help to improve landing technique. https://www.youtube.com/watch?v=rqNJdtrNyqQ

If you need any help or advice on ACL injury prevention or recovery, or have any queries at all, please get in touch!

References:
(1) Elle Turner, Sports scientist, Manchester City Women’s team, https://www.bbc.co.uk/sport/football/29505871
(2) https://www.sports-health.com/blog/why-are-women-greater-risk-acl-injuries
https://www.aspetar.com/journal/viewarticle.aspx?id=82#.XRDr05NKjNx
https://bjsm.bmj.com/content/39/4/212;