The ACL Injury Crisis of Women’s Football ⚽️ 🏟️

The ‘ACL crisis’ in women’s football refers to the vast number of professional and semi-professional women’s footballers tearing the Anterior Cruciate Ligament (a vital ligament in the knee). 

This is not an uncommon injury for male or female footballers, however the spotlight on this issue in women’s football has drawn the attention of many fans. 

37 footballers missed 2023’s Women’s World Cup in Australia due to the career-threatening injury, including England Lionesses’s star players Beth Mead and Leah Williamson who both spent an extended period out of football since tearing their ACLs at Arsenal. 

The crisis has not only affected football on the world stage: there is a devastating story of tier three footballer- Kayleigh Macdonald- who was forced onto the NHS waitlist after sustaining an ACL injury, despite playing at semi-professional level. 

After leaving the NHS and opting for private healthcare in hopes of a better timescale, she was forced to create a GoFundMe page to fund her surgery. Her story was spread so widely that her club (Stoke City) eventually agreed to fund her surgery and rehab. 

Arsenal women’s team alone gives us another insight into the extremity of the crisis after they suffered seven ACL injuries in just over a year. Beth Mead, Vivianne Miedema, Leah Williamson, Laura Wienroither, Kaylan Marckese, Teyah Goldie and Victoria Pelova. 

Unfortunately, since then, the crisis has not ceased, with world class players across numerous clubs, having to take months off for surgery and rehab. 

But the big question is: why do the injuries happen so often?

It is statistically proven that women are 6x more likely to tear the ACL than men. Scientists, physios, coaches, and pundits all voice their opinions as to why this is. 

Ideas vary including theories around boot styles, pitches, workload, the menstrual cycle, and women’s physiology. In reality, it’s most likely to be all these factors combined. 

Gary Lewin, Head of Medicine and Sport Science at Arsenal Women, said, ‘It isn’t as clear cut as we think it is. There are loads of factors involved.’ 

He described many factors, a key one being workload.

There are two elements to workload issues in women’s football: scheduling and match days. 

Top female footballers in England will sometimes play in all of the WSL (main league), the Champions League, the FA Cup, and the League Cup, plus their international fixtures. 

Women’s games are often shifted and moved subject to broadcasting rights and men’s games meaning players can end up with multiple match days too close together, increasing their chance of injury. 

FIFPRO have recently conducted a study on this and are hoping to take action in the future and make high workload more sustainable. 

In addition, Gary highlighted that the volume of work in a game has increased as the quality and intensity of women’s football has also increased. This means adaptations to prehab and rehab can be necessary however some clubs lack the infrastructure to do this. 

Gary also explained, ‘The sport is growing massively and very very quickly but has to think of ways it can support outside of the top tiers and get an infrastructure in play to support these young girls that want to play football.’ 

Essentially, there’s a struggle to maintain funding and infrastructure at a level which can cope with growth and increasing intensity, especially in lower tiers of women’s football. 

Gary outlined, ‘ACL rehab program and structure has changed dramatically,’ and ‘a lot of clubs have put preventative measures in.’ Although, programs and prevention techniques ‘can always be improved.’

Hopefully, there will be improvement soon, which should bring a decrease to the number of ACL injuries in women’s football. 

Players Beth Mead and Vivianne Miedema also spoke up about the topic after the two tore their ACLs in November and December of 2022, respectively. 

Working alongside Gary Lewin and other experts, they shared their rehab journey and discussed potential causes and solutions to the injury crisis through the ‘Step by Step’ documentary which Gary described as ‘an honest, open discussion with an insight into ACL injuries.’ 

Experts from a wide variety of fields came to the same conclusion that more data and research is needed to be able to provide evidence for what are currently potential contributing factors. 

Gary said, ‘the biggest progress since then is that people are talking about it.’ 

Spreading awareness appears to be the key for this epidemic as it will hopefully start the conversation in more clubs and large organisations. 

Hopefully, in the future, enough research and infrastructure will be provided for clubs (at all levels) to have methods which can cope with or even start to prevent the injuries that come with high intensity football, whilst also educating younger generations and facilitating for the rapid growth of the game.