Analysed: The ACL injury phenomenon in women’s football
Vivianne Miedema, the Women’s Super League’s all-time top goalscorer, will leave Arsenal this summer for pastures anew, with Manchester City being speculated as her most likely destination.
The Dutchwoman brings down the curtain on a seven-season run with the Gunners – a largely memorable epoch, even though the final eighteen months were punctuated by injuries to her anterior cruciate ligament (ACL) and knee.
Vivianne Miedema in action for Arsenal Women (Image source: Wikimedia Commons)
But the 27-year-old has not been the lone victim of ACL injuries, with Leah Williamson, Beth Mead, Sam Kerr and Alexia Putellas also making the journey to the treatment table because of rupturing their ACL in the last two years.
And owing to an apparent rise in such incidents, a three-year research project was launched this April that focuses on environmental factors that impact ACL injuries in female footballers.
FIFPro, Nike, Leeds Beckett University, and the Professional Footballers’ Association (PFA) have joined hands to fund this project.
Previous research has mostly been focused on physiological factors like body position, football boots and menstrual cycles.
As the new project delves into the finer details of the ACL injury menace in women’s football, let us try and understand why the ACL injury crisis is so prominent in the women’s game in the first place, and what is the way forward to deal with it.
No research linking menstrual cycles to ACL injuries
First and foremost, it is important to address the relation, or lack thereof, between the female menstrual cycle and the occurrence of ACL injuries.
There is currently no research out there that has concluded that ACL injuries are directly linked to the menstrual cycle. Dr. Katrine Okholm Kryger, Associate Professor in Sports Rehabilitation at St Mary’s University, Twickenham, confirms as much.
“It would be very weird if it was only the ACL that was affected by the hormonal cycle and not the full body,” she remarks.
In popular consciousness, Chelsea Women have been cited as the world’s first football club to use tailored training programmes, designed as per their players’ menstrual cycles, to prevent ACL and other types of injuries.
Dr. Kryger though begs to differ in this regard. She says, “It is basically impossible to have a tailored programme for around 24 players.”
Chelsea’s Sam Kerr will miss the Paris Olympics due to rupturing her ACL earlier this year (Image source: Getty Images)
“Chelsea have as many injuries as anyone else,” she adds, to clarify that the London club does not necessarily have an edge over its fellow WSL teams.
On the other hand, what can be said with absolute surety is that the manufacturing of women’s football boots needs an urgent rethink to combat the frequency of ACL injuries.
Should current women’s football boots be given the boot?
A European Club Association-led study’s report last year, which surveyed more than 300 female footballers, disclosed that more than 80% of respondents felt uncomfortable when wearing women’s football boots.
Dr. Kryger lambasted sporting companies which claim to sell women-specific football boots, even though their marketing campaign features famous names from the men’s game.
For instance, just before the Women’s World Cup last year, American sportswear company Nike released their ‘women-focused’ football boot – the Phantom Luna – which featured a household name from the Premier League in its initial marketing campaign.
“The main person who wore the football boot in the marketing campaign was Kevin De Bruyne,” said Dr. Kryger.
“Initially on the (Nike) website it said with an asterisk, which they have removed now, that this football boot can also be worn by men,” she added.
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Furthermore, she remarked that none of the women’s football boots that are on market shelves right now are specifically designed for female footballers.
Women-specific football boots are incredibly important for football (Image source: Getty Images)
“It’s not a women’s football boot. It’s just a small men’s football boot that’s become pink. I don’t believe that the big manufacturers have a football boot on the market that’s truly designed for a woman”.
And football boots not specifically designed for women are somewhere or the other linked to ACL injuries – as the movement of a player’s feet is affected by the shape and size of their boots.
“The rotation that would normally happen around the ankle doesn’t happen there, but happens in the knee. That rotation stresses the tissue in the knee and especially the ACL,” explains Dr. Kryger.
The way forward to address the ACL injuries menace
Research results released by FIFPro in December last year point to the rising burden of games affecting the occurrence of ACL injuries.
The FIFPro study assessed players competing in the top-flight of England, France, Germany and Spain during the 2021-22 and 2022-23 seasons.
Research results say that the most frequent injury locations were the knee (32%), and the thigh (29%), followed by the hamstring (23%) and the ACL (14%).
The study also concluded that players who injured their ACL, made more appearances, had more instances of less than five days between matches, and got less time for rest in the four weeks before they ruptured their ACL, when compared to uninjured players.
In addition, players who sustained ACL injuries travelled longer, further and crossed more time zones than players who remained unscathed.
The main takeaway from these research results, on the face of it, is that the growing professionalisation of women’s football has started to take its toll on the players.
And it looks like the sole way forward is to carry out detailed, extensive research that will ultimately inform innovations in training regimes and football boot designs.
Another important thing is to positively deal with the challenges that the growing nature of the women’s game brings with it.
As Dr. Kryger puts it, “It’s a fine balance of growing the game and not growing it too fast.”
