Every fan of women’s football shudders when a player goes down. It’s a moment of collective dread, as everyone waits to hear those three dreaded letters: ‘ACL’.
With an epidemic of Anterior Cruciate Ligament injuries plaguing the women’s game in recent seasons, the question isn’t just ‘What’s happening?’ but ‘Why has this been allowed to happen?’ How is it possible that elite athletes are still being failed by outdated systems and a glaring lack of female-specific research? The future of women’s football demands an immediate, decisive response. Too many stars are spending crucial months sidelined by agonising injuries and drawn-out recovery periods, and it’s time for serious changes to protect their careers. Why are women more vulnerable to ACL injuries? And more importantly, what can we do to stop this spiral of preventable devastation?
There have been over 500 Anterior Cruciate Ligament injuries amongst elite footballers since 2022, and at least 37 players missed the 2023 World Cup due to this injury alone, including big names like Vivianne Miedema (Netherlands), Marie-Antoinette Katoto (France) and England Lionesses captain Leah Williamson. An ACL injury is a season-ender taking players out of the game for 8-12 months, if not longer, and for too many it leads to early retirement.
These injuries weaken entire squads. Arsenal, for example, had to navigate much of last season without five key players, which derailed their ambitions. Other players had to rotate through unfamiliar positions, rapidly adapting to new tactical layouts to compensate for missing stars.
How do ACL Injuries Happen?
ACL injuries typically occur during high-intensity actions that involve sudden movements or awkward landings. Non-contact injuries are the most common, with the ligament tearing when the knee is put under stress. Often, when the injury happens it doesn’t look as serious as it is, but the pain afterwards is unmistakable as players realise the journey that lies ahead.
Why are female footballers so vulnerable to ACL tears?
Research has pointed to several factors, the most prominent being anatomical and biomechanical differences between men and women. Women’s wider hips contribute to a higher ‘Q-angle’, (angle between the quad muscles and the patella tendon), which places extra strain on the knees during high-intensity movements which are very common in football. This increased angle, combined with differences in muscle strength and movement patterns, makes women six to eight times more likely to suffer a non-contact ACL injury than men.
Female athletes move differently to men, particularly when jumping, landing and changing direction. Women often land with their knees more extended, increasing strain on the ACL. An upright torso position also reduces the body’s ability to absorb shock and impact.
Additionally, hormonal fluctuations play a role. Studies show that oestrogen can weaken ligaments, especially during certain phases of the menstrual cycle, leaving players more susceptible to injury.
The disparity in training and recovery facilities between men’s and women’s football has also been cited as a contributing factor. While male players are conditioned in state-of-the-art facilities from an early age, many elite female players only recently gained access to professional-grade resources, if at all. This gap in conditioning and care leaves their bodies less prepared for the physical demands of professional football, increasing their risk of injury.
There are many other reasons that women are so prone to this injury, a lack of female-specific football boots, the stress associated with the rapid-growing women’s game and the poor-quality surfaces that many women play on. But what can be done to combat these issues and protect the careers of players going forward?
What needs to change?
Personalised Injury Prevention Programs:
Women’s football needs specific training programs that focus on reducing ACL injury risks. Exercises that target knee strength, balance, agility and jump-landing techniques could help. Many experts suggest that neuromuscular training, like the FIFA 11+ program, should be adopted more widely, focusing on better body control during high-impact movements.
Monitoring of Hormonal Cycles:
Teams should consider working with sports scientists to monitor players’ hormonal fluctuations and menstrual cycles. Research has suggested that using data-driven methods to adjust training load during high-risk periods of the cycle could be beneficial.
Improved Footwear and Playing Surfaces:
Poor-quality playing surfaces and the use of male football boots can exacerbate the risk of injury. Developing boots tailored for women’s feet could reduce non-contact injuries, while advocating for better playing surfaces across leagues might further mitigate risks.
Load Management and Recovery:
Players are experiencing more condensed schedules due to the rising popularity and commercialisation of the women’s game. To reduce the toll on players’ bodies, clubs need to implement better load management strategies to ensure adequate recovery time which is crucial in injury prevention.
Cultural and Institutional Change:
Beyond the physical aspects, there needs to be a broader cultural shift towards better player care. This includes investing in physiotherapy, ensuring expert medical staff are present and improving research on the specific needs of female athletes. Clubs and governing bodies need to allocate more resources towards safeguarding player health, especially given the alarming increase in ACL injuries.
The women’s game is growing, but without urgent action, ACL injuries will continue to steal the futures of too many players. The solutions are clear—it’s time to prioritise the health and safety of female athletes to avoid seeing more players go through this devastating injury.
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