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ACL analysis in women’s football: In conversation with Sarah Shephard

What connects Sam Kerr training in Morocco’s warm weather in January 2024, Leah Williamson hitting the turf after an innocuous challenge at Leigh Sports Village last season, and Alexia Putellas attempting a shot in training on the eve of Spain’s first Euro 2022 game?

The answer: All three ended up injuring their anterior cruciate ligament and their participation in football, be it club or international competitions, was put on the back-burner for the foreseeable future.

After Williamson returned to Arsenal’s starting line-up against West Ham on February 4th, and as FIFPRO launches its own research into ACL injuries in women’s football this month, let’s take a deeper look at this phenomenon.


Overwhelming schedule causing ACL injuries

Last month, in an interview with The Telegraph, Williamson poured her heart out about her ACL injury and recovery, and one key issue she highlighted was the overwhelming playing schedule in women’s football.

New research from FIFPRO, which looks at female players in top-flight leagues in England, France, Germany and Spain during the 2021-22 and 2022-23 seasons, signals that injuries, including ACL injuries, are significantly affected by the game’s increased demands.

Players who sustained ACL injuries made more appearances, had more instances of less than five days between matches, and had less time for rest in the four weeks prior to injury when compared to players who were unscathed. Players with injured ACLs also travelled further, for longer, and crossed more time zones than players who were uninjured.

In numerical terms, football players who sustained ACL injuries made almost 30% more appearances, and travelled nearly 50% more than uninjured players during the 2021-22 and 2022-23 seasons, as per FIFPRO’s data.

The most frequent injury locations were the knee (32%), and the thigh (29%). Meanwhile, twelve injuries were to the ACL (14%) and nineteen were to the hamstring (23%).

FIFPRO Chief Medical Officer Prof Dr. Vincent Gouttebarge, speaking to the football players’ union, said: Our research shows that match congestion in women’s elite football is associated with a higher frequency of injuries, especially ACL injuries.”

Sarah Shephard, staff writer at The Athletic who covers football and boxing, wrote an article on the danger of ACL injuries in both women’s and men’s football, and spoke to the Sports Gazette to provide more insight.

She said: “I don’t know if there’s anything being done (to reduce match congestion). In terms of FIFA it’s only increasing.”

She also asked what NewCo, the organisation which will run the top two tiers of English women’s football from next season, will do to ease the burden on players from the 2024-25 season.


Understanding women’s bodies: A solution for ACL injuries

A solution to the ACL menace, hiding in plain sight, is what Emma Hayes has done at Chelsea Women – they are the first club in the world to tailor their training schedule as per the menstrual cycles of their players.

The results are ground-breaking to say the least – since 2018, Chelsea Women have only seen five ACL injuries, including the one suffered by Kerr last month in Morocco.

Emma Hayes ACL injuries

Emma Hayes has tailored Chelsea’s training schedule to suit her players’ menstrual cycles (Image source: Wikimedia Commons)

Shephard said that the method adopted by Hayes is something that is still being researched about, but advocated for coaching techniques focused on and aware of the uniqueness of biological functions of the female body.

“There are certain big rocks that need to be in place. Women’s football players should have access to female-specific coaching,” she said.

Shephard’s line of thought is echoed by two-time Ballon d’Or winner Putellas, who suffered an ACL injury in July 2022.

Putellas, while talking to FIFPRO, said: “ There has hardly been time to carry out these types of studies (FIFPRO’s research) and learn a little more about the body of women’s footballers or women’s athletes, because it is clear that it’s a different body to a man’s.”

She added: “The conclusion that I’ve drawn from this injury, from the experience that I’ve had, is that it’s a multi-factorial injury. That’s why it’s so important to improve the conditions for women’s players: rest, travel, the surfaces on which we play and, of course, all those studies.”


Governing bodies must take stand against ACL injuries

One of the things to consider when it comes to ACL injuries in the women’s game is the psychological blow that one gets dealt with when they sustain this injury. 

Dr. Katrine Okholm Kryger, Associate Professor in Sports Rehabilitation at St Mary’s University, Twickenham, shines a light on the mental impact of this injury.

“You lose your identity for almost a year. Your body is not what it used to be and you have to cope with getting it back to where it was,” she said.

In this context, Shephard said: “There probably is something of a psychological barrier that players have to overcome when suffering an ACL injury. 

Embed from Getty Images

A fan holds a placard wishing Sam Kerr a speedy recovery (Image source: Getty Images)

“It’s notorious for being difficult to come back from, but, seeing so many others return can offer players hope that it doesn’t have to be the ‘bogeyman’ of injuries it once was.”

One of the solutions suggested by FIFPRO is providing both in-season and off-season breaks to players, along with easing their match and training workload. Another suggestion is to facilitate additional recovery for players who are exposed to travel fatigue and jet lag.

But while conducting research and providing recommendations is the remit of organisations like FIFPRO, it is ultimately up to governing bodies like the FA, UEFA, and FIFA to actually take an active interest in implementing them.

If evidence is anything to go by, the women’s game needs a monumental change to its overwhelming schedule, coaching methods and playing conditions – and the time to start with this reset is now.


  • Chaitanya Kohli

    Sports journalist with a keen interest in covering stories about European club football and the history of the beautiful game. Passionate Barcelona and Messi supporter. Perennially interested in bringing out inspiring stories about Indian football on the global stage.