‘An epidemic’ of ACL injuries affecting female footballers – but why is it happening? | UK News

Keyhole surgery is perhaps a misleading term: despite the technology, expertise and extreme finesse involved, it is also extremely physical.

Sky News watches surgeon Luke Jones perform anterior cruciate ligament reconstruction in an operating theater at King Edward VII Hospital in central London.

Mr Jones (male surgeons are called Mr rather than Dr) doesn’t just remove a hamstring: he forcefully removes it.

The drills go through the bone. The flesh smokes when cauterized. There’s quite a bit of hammering: “Mallet, please,” Mr Jones asks his assistant.

The ACL is a small strip of tissue running across the middle of the knee that keeps it stable.

But watching the operation, it’s easy to see why tearing it apart is so devastating. Even though the patient will only have three small scars, his knee suffered blows.

“There’s 90 minutes of theater with me,” Mr Jones told Sky News, adding: “And then there’s a year of rehabilitation with your physiotherapist afterwards.”

This is why ACL injuries are so dreaded, especially by one type of athlete: female soccer players.

“Too many” players with ACL injuries

Between 25 and 30 players – enough for a whole extra squad – will miss the next World Cup due to ACL injuries. England stars Beth Mead and Leah Williamson have been ruled out. Data from the ACL Women Football Club suggests that 195 elite players have suffered the injury in the past year.

It has been described as an “epidemic”. And it’s an epidemic that affects women much more than men: they have 2.5 to 3.5 times more risk of ACL rupture than a male athlete. And we don’t really know why. Even though women’s football has exploded, research has lagged.

One player going to the World Cup is England defender Jess Carter. Speaking ahead of the start at St George’s Park, England’s national football centre, she told Sky News: “There have been far too many players who have suffered ACL injuries and not enough research has been done. do about it.

“Why are there so many injuries? How can we prevent them? Why do they happen? A question I sometimes ask is: if this happened to top male players, would there be more work to try to make things better?

England's Leah Williamson.  Photo: AP
Leah Williamson of England. Photo: AP

Nature versus culture

The problem is that there isn’t just one answer.

“I made a list the other day, and I think there are 30 reasons that have been discussed in the literature that I could find,” says Kat Okholm Kryger, a sports rehabilitation researcher at the University. St Mary’s of Twickenham and medical researcher for FIFA.

“And I think we can divide it into two main categories. And I like to call them nature and nurture.

“So nature is like biology: genes, body shape and muscle mass, etc. But also the environment that women are in. So the way young players are managed in relation to the male players, the facilities, the professionalism around the sport, the quality of the staff they have.”

I ask if injury research in women’s football has received as much attention as men’s.

“Warning? No. But generally, it’s in all football and sports medicine research. The male has been the norm,” she adds.

The research will also end up benefiting men’s football

Take a question from the area of ​​”food” that Kat studies: football boots. The male foot was the norm. It’s only been a few years since boots designed specifically for women became available. And even then, we don’t properly understand the differences, which is why Kat made 3D scans of hundreds of feet, to map them out.

This research will also end up benefiting the men’s game, as Kat also traces the differences between ethnicities. Because the default foot isn’t just a male’s, it’s a white male’s.

The male is also the norm when it comes to other environmental factors, such as booking a site.

On a Thursday night in Kent, the Gravesham Girls and Women’s Football Club, founded in 1999, train before the start of the season. About twenty players, dressed in yellow, practice shooting and the balloons fly. A Sky News camera operator takes one in the stomach but bravely continues.

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Both Toni Allen and Keylie Oliver have ruptured their ACLs in the past. “I just screamed – everyone thought it was a fox,” Allen says. Both were away for a year.

“It’s quite daunting, and especially when you realize it’s not just football that it can have an impact,” Oliver said.

“We have lives outside of football and that also has an impact… At grassroots level, the ladies always have a two o’clock kick-off. And that’s because in our world, men’s football has the priority on women. We always have to play after – so the pitch is always ruined.”

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Women’s football: The ACL epidemic

The importance of factors can change

Another difficulty is not only that there are many factors involved, it is that the importance of the factors can change.

Professor Kirsty Elliott-Sale is Professor of Female Endocrinology and Exercise Physiology at the Manchester Met Institute of Sport.

She works closely with clubs, including Arsenal, to study how the menstrual cycle, or taking the pill, can influence injuries. Research seems to suggest that certain hormones can loosen ligaments, increasing the risk of rupture.

Thus, during the season, Professor Elliott-Sale measures the laxity of the knees of the players, compares it to their hormones and crosses it with other factors like the congestion of the games.

“It’s definitely a puzzle,” she says. “And it’s kind of about putting all the pieces together.

“But once we have all the pieces, we don’t necessarily know which factor will play the biggest role on any given day. So it’s not like all the pieces are the same size. On some days, a particular factor that could influence this type of injury could be amplified, while another day it could be denied.”

Biology remains a big part of the answer

But even then, the difference between female and male body types – which in the past has led some women to dismiss women as too “fragile” to play traditionally male sports – may not be a factor. as important as previously thought.

Because in some sports, the ACL injury gap disappears.

“If you compare sports, where men and women start at the same age, train at the same intensity throughout their sporting lives, and perform the same movements during that sport, then in fact the breakup rates s ‘even,’ said Mr Jones, the surgeon, said.

“And a really good example for that is elite dancers. So elite dance athletes, where males and females start training at the same age, they do the same movements of pivoting, jumping, torsion, and they have the same training intensity and conditions. If you compare their break rates, they’re actually evenly matched.”

“And what that suggests is that the impact of your training and conditioning is really key and avoiding that injury.”

Every expert I spoke to emphasized the role of strength and conditioning in injury prevention. Here, education influences nature.

“We have this attitude, you know, women do yoga and pilates and men lift heavy things in the gym,” Ms Kryger says.

“But the reality is that everyone needs to lift heavy things from time to time to avoid injuries and have a healthy body.”

England's Beth Mead was also ruled out due to injury.  Photo: AP
England’s Beth Mead was also ruled out due to injury. Photo: AP

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The good news is that quantifiable progress is being made here.

Matt Whalan is a sports scientist who works with Australia’s men’s and women’s soccer teams – the Matildas who will compete in the World Cup. He told me about the men under 23 camp there.

Football Australia has introduced a program called ‘Perform+’, which can be incorporated into warm-ups, which has reduced injuries, including ACL, by 40%.

And most importantly, it’s not just for elite players.

“This is designed so mom and dad coaches can just go online, pull the program off, all the videos are there, there’s information on how you can deliver it with your athletes, and under sevens 55 years old, 95 years old, if you want, you can do these exercises,” Whalan says.

“The advantage for us at the top level, working with the national teams, is that if we have players who have been doing this, since they were 12, 13, 14, it makes life a lot easier for us.”

It remains in the future. When the World Cup kicks off next week, it will do so without a host of stars.

As England striker Chloe Kelly told Sky News: “Having suffered an ACL injury myself, it’s so sad to see so many players suffering from this injury. Hopefully we get the research we have needed to prevent these injuries from happening so often.”

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