Women’s football as we know, is a competitive and strenuous sport which requires strength and agility. Players go through intense training and play for a whopping 90 minutes in each game (excluding extra times), thus exerting so much strain and stress to their bodies.

It’s no surprise that many footballers (male or female) come down with different injuries. However, what is disturbing is the higher rates of ACL injuries among female footballers when compared to male footballers. Just last year, 5 players in the international women’s soccer team sustained ACL injuries. A study demonstrated that female footballers were 2 to 8 times more likely to come down with an ACL injury than male footballers.

In this article, we’ll be discussing reasons why injuries to the anterior cruciate ligament (ACL) is so common in women’s football.

ACL Injuries simply means injuries to the anterior cruciate ligament of the knee joint.

For a better understanding of this ligament, we’ll be delving briefly into the basic anatomy of the knee joint.

The knee joint is made of 3 bones which includes; the femur (also called thigh bone), patella (also called knee cap) and tibia (also called shin bone).

A ligament is a strip of fibrous tissue that holds bones in place. The knee joint is held in place by 2 groups of ligaments and they include;

This group is divided into the anterior cruciate and the posterior cruciate ligament. They are located in the knee joint, and cross each other to form an ‘X’ shape. The anterior cruciate, as its name implies lies in front of the posterior cruciate.

This group of ligaments are vital for the front and back movement of the knee as in running, walking, sitting, squatting etc. The anterior cruciate ligament is much more vulnerable to injury than the posterior cruciate ligament.

This group of ligaments is made up of the medial collateral and lateral collateral ligament.

They are vital in stabilising the side to side movement of the knee joint, and preventing abnormal movement of the joint.

During movement, the anterior cruciate ligament which is a strip of strong connective tissue, holds the knee joint in place.

This ligament is very vital in preventing abnormal movement of the tibia (shin bone) which may compromise the knee joint.

Injuries to ligaments are also called sprains, and are common in people who participate in activities that demand high performance and mobility like athletes.

Injuries or sprains to the anterior cruciate ligament may be classified based on its severity into:

Grade 1 injury or sprain:

Here, the ligament is excessively stretched with mild damage. However, it still retains its ability to stabilise the knee joint.

Grade 2 injury or sprain:

Here, the stretch exerted on the ligament is to the point where the ligament loosens up. There is also a partial tear in the ligament. At this point, the ligament isn’t able to effectively stabilise the knee joint. This grade is not so commonly seen.

Grade 3 injury or sprain:

Here, there is a complete tear in the ligament. The ACL is either torn into two or completely detached from a bone it was connected to. This grade of ACL injury renders the knee joint unstable. This type of injury or sprain is very common among athletes.

ACL Injuries present with the following symptoms:

Pain

This is a constant feature seen in every case of ACL injury. Once the injury happens, the individual may hear a popping sound and feel unable to stand properly, like their knee is not able to carry their weight. The pain comes immediately and may persist for some days, after which, it subsides. Note that the disappearance of the pain does not indicate that the person is fit to continue activities as before.

Swelling

The joint may appear swollen within 24 hours of the injury. Like the pain, the swelling also subsides after a few days.

Reduced mobility in the knee joint

Due to the pain and swelling, the individual may be unable to carry out movements as before.

Tender knee joint

The joint, owing to the pin and swelling will become painful to touch.

As earlier established, injury to the anterior cruciate ligament is common in people who participate in high performance activities like sports.

These injuries are very commonly seen in women’s football and this is because of the nature of the sport. The intensity of their training sessions and the football game itself exerts continuous stress and strain on the anterior cruciate ligament, which itself is prone to injury. However, the reason for the discrepancies in the occurrence of this injury between the male and female gender has led to increasing research and studies to determine why it happens.

Many schools of thought have come to several conclusions as to why ACL injuries are more common in female footballers than male footballers. Some of the reasons suggested include:

The Menstrual cycle

Some have suggested that the menstrual cycle plays a role in the increased rate of ACL injuries in women. They further backed this claim with the statement that the first 2 weeks of the menstrual cycle causes a high level of oestrogen which leads to laxity of the joints and ligaments.

There however, isn’t enough evidence to back this claim.

Some schools of thought suggested that the wider hips in females contribute to the higher rate of ACL injuries among female football players when compared to male players.

Also, some have suggested that women walk and run differently from men, but despite this, their boots are designed the same as those for men. This may have an effect on their ability to move effectively leading to higher rates of ACL injuries. There however, isn’t sufficient evidence to back these claims.

Increased Workload

It isn’t news that female football has been long overlooked and undervalued. Some schools of thought suggested that the gaps in physical therapy, medical staff and facilities directed towards female football is an important reason for the increased occurrence of ACL injuries in female footballers.

Generally identifiable causes of anterior cruciate ligament injury or sprain among all football players include:

Trauma

Can be from direct collision as seen in football tackles and falls in the course of the game

Making sudden stops

Due to the technicalities and calculations involved in making a great play in football, players may need to stop suddenly after running for a while to either dribble or pass a ball. This sudden pause may exert tension to the ligament and lead to injury.

In football, players very often jump to either head a ball, block a ball or may fall accidentally. How these players land from these jumps matter a lot as incorrect landing may lead to an inappropriate amount of force exerted onto the knee joint, further causing damage to the anterior cruciate ligament.

Sudden changes in direction

This is a very common tactic among football players where they dribble or try to score a goal. This sudden change in direction may lead to increased tension on the anterior cruciate ligament, which then proceeds to injure the ligament.

With ACL injuries, prevention is always better than cure. For most players, having an ACL injury may cost a chunk of their football career, and it is best prevented.

Practical steps to help prevent ACL injuries include:

Targeted Strengthening Exercises

Weak ligaments and muscle are key elements that make one more prone to ACL injuries. Exercises like jumping plyometrics, hamstring and quadriceps strengthening exercises are recommended to keep the muscles and ligaments strong and less prone to injury.

Stretches and Warm-ups before Games

It is very important to stretch your joints and warm up before beginning any intense activity like football training or games. This helps to loosen the ligaments and prevent injuries, or reduce the severity of injuries.

It is very important to work on balance as a player. This helps prevent unnecessary falls which may predispose to ACL injuries.

This can never be overemphasised. Clothes or shoes that are too tight or too loose may impede mobility during games and predispose the player to ACL injuries.

Players are advised to utilise safe and less-impact prone techniques. Playing too roughly can increase a player’s chances of coming down with ACL injury.

Undergo Physical Examinations

Having routine physical examinations can help identify any weakness in the muscle or ligaments, which would have gone unnoticed. It is important to regularly undergo physical examinations to assess your level of physical fitness.

Treatment of ACL injuries or sprain is via two modalities;

Depending on the grade and severity of the injury, knee braces and physiotherapy can be sufficient for treatment.

ACL knee braces are recommended for the following; non-surgical therapy of ACL, before ACL surgery or while recovering from an ACL surgery. They provide support to the knee joint to stabilise it and prevent further damage while repair

Physiotherapy is also very important to strengthen the ligament and muscles and facilitate the healing process. For less severe injuries, recovery time may range from 6-8 weeks or more.

ACL reconstructive surgery is reserved for more severe ACL injuries. It involves grafting and reconstruction of the anterior cruciate ligament. Based on how severe the injury is, or how traumatic the surgery was, recovery time may range from 6 months to 1 year or more.

Anterior cruciate ligament (ACL) injuries have become alarmingly high in women’s football. The rates have far surpassed that of men’s football.

No definite reason has been given for this difference, however, research is currently ongoing to determine why female footballers have higher rates of ACL injuries than male footballers.