The Women’s World Cup, as it does in the men’s game, represents the pinnacle of football.
But some of the finest players on the planet won’t be able to strut their stuff on the big stage in Australia and New Zealand after suffering from what is becoming all too familiar in the women’s game: ACL injuries.
England captain Leah Williamson suffered an ACL injury in April that meant heartbreak: she will miss the Women’s World Cup, as will her Arsenal teammate Beth Mead (also ACL) and Fran Kirby (knee).
Meanwhile, Vivianne Miedema – one of the most prolific goalscorers in women’s football – will also miss the flagship tournament with an ACL injury, while in May another Arsenal star, Laura Wienroither, damaged her anterior cruciate knee ligament. Alexia Putellas, the Ballon d’Or winner, missed Euro 2020 after, you guessed it, rupturing her ACL.
This type of injury is not completely uncommon in men’s football – Virgil van Dijk is just one player that has come back from such a serious ailment, but there is an alarming regularity with which female stars are damaging their knee ligaments….and unsurprisingly many in the game want answers.
What is the ACL?
First, a quick biology lesson.
The importance of the anterior cruciate ligament (ACL) cannot be underestimated – this connects your thigh bone to the top of the shin, and is one of the four major ligaments in the knee that includes the posterior, medial and lateral ligament. Together, these ensure the knee functions properly.
A torn or ruptured ACL, usually caused by quick changes in direction or speed, is a catastrophic injury for any sportsperson as it is this ligament which provides vital structure and solidity in the knee joint.
Sufferers can experience a partial or complete tear, and ultimately surgery may be required to fix the problem.
Because of the nature of the injury, it’s not uncommon for players to spend months on the sidelines as they nurse their knee back to full health – those with a Grade 3 complete tear can expect to be out of action for six months or more.
Why are Women More Susceptible to ACL Injuries?
According to the stats, female footballers are around six times more likely to suffer an ACL injury than their male counterparts.
The answer, right now, is that nobody knows. There hasn’t been enough scientific research to confirm a reason as to why, although theories range from women having shorter ligaments (meaning less surface area to bear the load of quick changes of direction etc) right through to menstrual cycles.
Dr Emma Ross has revealed that a woman’s menstruation can change the physiological and biomechanical make-up of the body, which may explain why the knee joint of top female athletes faces such stress and overload.
“When oestrogen is elevated in the menstrual cycle, and that happens in about the second week, it can affect the stability of joints,” Ross said.
“It can interfere with the collagen in our joints and it can create looser, more lax joints. A loose joint is therefore less stable and more inclined to injury.”
It’s an area that needs to be researched in more detail – if menstruation does make players more prone to injury, it could impact upon their performances on the pitch and even the scheduling and nature of their training.
Other theories abound. Women generally have wider hips than men, which therefore gives them a different shape in their legs – some have theorised that women are more prone to ACL injuries upon landing, after jumping for a header for example, due to underdeveloped muscles in the knee.
Another school of thought is that the quality of pitches can be a problem, particularly in the WSL where clubs are often playing at venues where the pitch is used as a training base by a men’s team. If the surface is not pristine, it’s more likely that a player’s studs will get caught in the turf – a common cause of muscle and ligament tears.
Fit for Purpose
Another potential cause that is being explored is the humble football boot.
Many women’s players are forced to wear boots designed for men, however that can have implications as the shape of the female foot is very different to that of the male.
By not wearing appropriate boots, women footballers are at danger of exposing themselves to injuries that might otherwise be prevented if they were to wear correctly-fitted boots instead.
A number of the key boot manufacturers, including Nike and Adidas, are listening, and so to mark the World Cup in 2023 they will release their first pairs of female-specific boots – the hope is that this will help to minimise the number of ACL injuries being experienced at all levels of women’s football.
But that might only be one solution to a multi-faceted problem that has so far been woefully under-researched.