How the Women’s World Cup Raised the ACL Discussion Again.

During the Women’s Soccer World Cup currently being held in Australia and New Zealand, the world’s media revisited a topic that many of us physical therapists specialized in this area have become exhausted with.  How to reduce ACL injuries with the female athlete. The reason why this topic has reached world media outlets is because the equivalent of an entire squad of players will missed this year’s tournament due to ACL injury. 

 This seems an unusually high number, but a high incidence of ACL injuries among female athletes can be found at all levels of the game.
Many female athletes have spoken out about the need for more funding into this area, and while this would help avoid the majority of studies being conducted on men and the results being incorporated into female sport. There is a great deal of information we know about preventing ACL injury that is currently being ignored. 
What We Already Know…………….

The reality is that females are as much as 3.5 times more likely to sustain an ACL injury than male athletes (Arden et al. 1999, Voskcanian et al. 2013). The reasons are many and both modifiable and non-modifiable.

The non-modifiable risk factors are factors such as the menstrual cycle and the effect of hormones on ligament stiffness, less muscle mass, anatomical factors such as the female Q-angle (The wider angle of the femur from pelvis to knee) and subtle differences in knee joint anatomy from interarticular notch width to tibia angle. 

Studies into the modifiable factors have considered many elements such as gender roles where females are less likely to be multi-sport athletes or engage in ‘athletic play’ as adolescents, therefore theorized to have less body awareness. The main thrust of research shows that we should be focusing on understanding and training the female athlete appropriately. We should be incorporating specific gym and field-based training strategies specific to the female athlete’s needs.  

What do we do About it?

My personal experience on this topic is that we have an audience that is willing to listen but not ready for change. 
 I see an ACL injury (particularly in adolescent sport) as a welfare issue. An ACL injury causes significant pain and disability with a return to sport taking 12 months in most cases. Not to mention the mental side of injury with removal of an individual from their hobby and social group. The long-term health of the knee after an ACL injury is also the topic of much research and discussion among experts.The extra bit of detail is that of the athletes who return to multi-directional sport, 20-28% will go on to sustain a second ACL injury (Bodkin et al. 2021.)In short…..the impact is significant and the relative attention to prevention is small.

There are a magnitude of protocols that can easily be incorporated into a team’s training that have been shown to significantly decrease the risk of an ACL injury. An accumulation of data across numerous studies shows a potential 70% reduction in risk. (Sugimoto D et al. 2012). The issue is that compliance with these protocols is very limited. I am sure coaches have numerous initiatives they would like to introduce themselves and feel limited by time. We must also accept that few athletes and parents are asking for prevention programs over quality coaching sessions and results on the field. Physical therapists are not innocent either, I have seen many instances where PTs dip their toe in the injury prevention world and prescribe sessions that are time consuming or inadequate to decrease risk of injury.

The Future is Bright.

We are better off than we were 10 years ago. The female athlete is being taken seriously with improved financial, research and team support. Injury prevention programs will eventually become the norm as it makes sense, as a good prevention program also has the same elements as a performance program.

 Athlete testing is currently seeing an evolution with high tech devices that were previously unattainable to any party except at elite sport, are now becoming more affordable and field assessable. There is no longer an excuse for professionals to claim to offer injury prevention or injury rehab and not have access to this level of detail with testing.

If you want to do your part, please feel free to forward this email to an athlete or coach, it may make a huge difference.If you know someone who has sustained an ACL injury please put them in touch, I am offering to test the first few athletes who contact me a free force plate testing session to highlight any vulnerabilities as unfortunately you never graduate from ACL rehabilitation, you manage the risk factors for life.

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