Why are so Many Female Soccer Players Having ACL Injuries?
Last weekend, US soccer legend Christen Press scored her first goal for Angel City FC in the NWSL in over two years. The forward suffered an Anterior Cruciate Ligament (ACL) injury during a game in June 2022, which required four surgeries to repair. She did not return to playing until August 2024.
Christen Press recovering from her 2022 ACL injury (The Athletic)
Similarly, across the pond, the Women's Super League started three weeks ago, and there have already been three new ACL injuries. Everton's Aurora Galli, Inma Gabarro, and Liverpool's Sofie Lundgaard now join the other 18 players in the league who are out for the entire season with the same injury.
Injuries are always a risk for professional athletes, regardless of gender. However, nearly 30 female players missed the 2023 Women's World Cup due to ACL injuries. The women's game has reached a point where it seems almost inevitable for every female player to experience at least one ACL injury. These injuries typically occur when changing direction or pace puts strain on the knee joints and ligaments. Given the fast-paced nature of soccer, this type of movement happens constantly for all players.
So, why are female players experiencing ACL injuries at a significantly higher rate than their male counterparts?
USA Soccer federation signing equal pay agreements (Getty)
There is no singular cause but a combination of factors that disproportionately affect women in soccer, including training/recovery, facilities, equipment, schedule of fixtures, and physiology. However, the main takeaway from these elements is that the standard for women's games is not the same as that of men's games, and this has to change to achieve equality in the sport.
There are long-standing gendered discrepancies in training and recovery facilities. Women's teams have less access to training and facilities and typically participate in fewer strength conditioning and resistance training sessions. Additionally, injury prevention programs need to be as accessible to women as they are to men. This must start at a grassroots level within youth structures to have the most significant impact.
Physiology has often been cited as the reason behind higher injury rates in women's soccer, with many suggesting that female players should simply accept the increased risks. However, adopting a "nurture, not nature" approach is crucial. This perspective emphasizes addressing controllable factors, such as ensuring that facilities meet appropriate standards for women, rather than focusing solely on biological differences.
2023 World Cup Final
Facilities also include playing fields, and the 2023 Women's World Cup was the first tournament where all matches were held on natural grass. Many Women's Super League (WSL) teams still play on artificial turf or academy pitches, with only a few WSL and National Women's Soccer League (NWSL) teams sharing stadiums with their male counterparts in the Premier League and Major League Soccer (MLS). Improving the quality of pitches could reduce the likelihood of women re-tearing their ACLs, similar to American player Jordan Angeli, who experienced the injury three times during her college career at Santa Clara and continued to struggle with it throughout five years in her professional career. Although recovery rates have improved significantly, these injuries can still be life-altering, even if they aren't necessarily career-ending.
Manchester United Women’s new training facility (Manchester United)
Some teams have taken steps to improve training facilities for women's soccer. For example, Manchester United Women recently moved to a new £7 million training complex, while Manchester City Women plan to build a new £10 million facility. However, funding is essential, and it's no surprise that only the most prominent clubs with substantial financial resources can make these investments.
It will take time to see the results of these efforts, but governing bodies such as US Soccer, the FA, FIFA, and governments need to implement effective strategies. Soccer facilities should be equitable for women and men at all levels, not just for the top professional teams.
The schedules in most women's leagues and major tournaments have been changed to match the format of men's leagues, which is a positive step toward equality. However, this has resulted in increased demands on players' bodies, yet female athletes have not been given sufficient recovery time alongside these changes.
“You’ve changed the schedule to mimic the men, yet you’re not giving the female players the same level of resources. If you’re going to ask an elite athlete to play 50 games a season, you’ve got to provide them top-line care.”
One crucial factor is the equipment used, particularly the cleats worn during play. Like many products in our society, most cleats are specifically designed for men, leading to significant issues since men's and women's feet have different bone structures. A European study found that 82% of female soccer players experience discomfort when wearing their cleats. In response, footwear companies have taken action. For instance, Nike has developed the Phantom Luna Elite line to reduce the risk of major injuries for female soccer players.
It is evident from the facts that there is an ACL epidemic among female soccer players worldwide. Project ACL is a three-year study launched this year to investigate the reasons behind the problem. Hopefully, as more research is carried out, more measures will be taken by those with the power to make changes. Equality within the sport is the ultimate goal, and to achieve this, the women's game needs the same funding, research, facilities, and support as the men's game.