While an ACL injury can occur due to a simple and innocuous twist, this rise seems to be, first and foremost, a result of an increased number of women taking part in high-intensity sports – activities such as football, basketball, and skiing, all of which involve sudden stops, changes in direction, or jumping, are where ACL injuries occur most often.
As well as increased participation in sports, research suggests that ACL injuries are 2 to 8 times more likely in female footballers than in males. The exact reasons for this remain unclear, but there are some theories, which, when pulled together, build a compelling picture.
Lack of diversity in training
‘Many specialists are seeing that ACL injuries are common in those who are committed to playing or are only involved in a single sport, ’ says Mr Deepu Sethi, one of Welbeck’s leading consultant orthopaedic surgeons. ‘The thinking is that due to repetitive and unvaried training drills and exercises, the muscles and ligaments around the knee lack diversity in movement, which can leave the ACL more susceptible to damage.’
Mr Deepu Sethi has noticed a significant increase in female patients he sees with ACL injuries, both in recreational and professional athletes. This appears to correlate with an increase in the popularity of women's football.
Flexibility and hypermobility
Another theory is that women are generally more flexible than men and are also more likely to exhibit hypermobility. This is where the joints have an unusually large range of movement, so are more flexible than average. Hypermobility is known to cause an increased risk of injury, including ACL tears.
Biomechanics and female anatomy
Body shape may also play a role. Mr Sethi explains, ‘women generally have wider hips than men, which results in a larger angle from the leg into the knee, this results in increased load on the ACL in activities such as jumping’.
Hormones
Last, but certainly not least, we turn to hormones. ‘There are points in the menstrual cycle where women may be more prone to injury. Some football clubs are actively managing when players are training to help them avoid injury,’ says Mr Sethi. ‘As consultants, we’d like to see more clubs introducing injury prevention programmes, which could involve specific warm-up drills, to help reduce the risk of injury.’
Only recently, a Fifa-funded year-long study began at Kingston University London to research the possible connection between hormonal fluctuations during menstrual cycles and the rise in anterior cruciate ligament (ACL) injuries in women's football.
The hope is that the results of this study will provide information that can help clubs put plans in place to mitigate the risk of ACL injuries.
