Female soccer players run a much higher risk of suffering a cruciate ligament tear than their male counterparts. There are anatomical reasons for this – but not only.
Ana-Maria Crnogorcevic (r.) comforts Iman Beney, who tore her cruciate ligament shortly before the World Cup.
Daniela Porcelli / Imago
Nobody who has suffered a torn cruciate ligament forgets the noise, says Svenja Fölmli: “Like a little stick breaking.” When the 21-year-old international player heard the crack in her left knee during training last November, she knew what to expect: surgery and several months of rehabilitation. She had already torn her anterior cruciate ligament a year earlier, in her right knee. The injury cost her participation in the World Cup.
In addition to Fölmli, the national team is missing Eseosa Aigbogun, who was injured almost two weeks ago, and Iman Beney, who was out shortly before the World Cup, due to a torn cruciate ligament. Stars such as the English Beth Mead and Leah Williamson, the Dutch Vivianne Miedema, the German Giulia Gwinn and the French Marie-Antoinette Katoto shared their fate. A total of 37 players were unable to take part in the World Cup. And two weeks ago it hit Sam Kerr, one of the best in the world. It’s like there’s a bad flu going around.
Chelsea Football Club can confirm striker Sam Kerr has sustained an anterior cruciate ligament (ACL) injury during our warm weather training camp in Morocco.
— Chelsea FC Women (@ChelseaFCW) January 7, 2024
We now know that cruciate ligament tears affect female soccer players three to six times more often than male soccer players. In most cases, duels are not responsible; the majority of these injuries occur without physical contact. But why is that so? And what can be done about it?
Women’s feet in men’s shoes
What makes the injury so complicated is that it is multifactorial. On the one hand, anatomical aspects are responsible: the wider pelvic position of women can lead to slight knock-knees, which influences the force on the knee. Women have a narrower cruciate ligament cavity, which also increases the risk. And women land more unfavorably for their knees after jumps than men, namely slightly backwards and less bent. The good news is that you are not completely helpless under the circumstances. Tanja Hetling, sports doctor and team doctor for the Swiss women’s team, says: “With the right stabilization and strengthening programs, the risk of a cruciate ligament tear can be reduced by 30 to 70 percent.”
Hormone balance plays another important role: studies suggest that the risk of a cruciate ligament tear is higher in certain phases of the cycle. Hetling has been intensively involved with women’s sports and the effects of the cycle for almost ten years. Based on their findings, the national team trains in a cycle-oriented manner; the players are provided with tips when they return to their clubs.
It is undisputed that there is a lot of catching up to do in women’s sports. Training theory, anatomical peculiarities, the different development during puberty – many things are still being researched. Since the turn of the millennium, medicine and science have begun to no longer treat women like little men, even in sports. “But we are only at the beginning,” says Hetling, there is a lot of room for improvement – even if there are more and more studies that can be worked with.
And yet there are still factors that have rarely been studied. Katrine Okholm Kryger, professor of sports rehabilitation at the University of St Mary’s in London, complains in an article by Sky News that the safety and performance of female players have been impaired for too long by the fact that soccer shoes are largely designed for a male physique. In a survey of 350 female players in Europe, 82 percent said they found wearing the shoes uncomfortable. Kryger is now working on a project using 3-D scans to capture the differences between a female and a male foot.
Paradoxically, the flood of cruciate ligament tears also has to do with a success story: the sport has grown rapidly in recent years. But the working conditions for the athletes are not growing at the same pace. Although the clubs are becoming increasingly professional, in most clubs women struggle with worse places, less well-trained staff and less recovery time than their male colleagues because many work or do training alongside football.
In addition, the calendar for the top players is becoming increasingly crowded: championships, cups, international competitions, major tournaments and now the Nations League. Concentration, which has long been criticized by men, is now also expected of women. Two top players warned about the development in the English media this week. Leah Williamson, England’s captain, who has been out since April with a torn cruciate ligament, also attributes the increased number of injuries to the lack of time away from the game. She says in the “Telegraph”: “We are destroying ourselves, a solution to the game plan must be found soon, it is unsustainable.”
A total of 37 players missed last summer’s Women’s World Cup because of ACL injuries alone
✍️ @TomJGarry#TelegraphWomensSport
— Telegraph Women’s Sport (@WomensSport) January 18, 2024
The Norwegian Ada Hegerberg, world footballer in 2018, victim of a torn cruciate ligament and a stress fracture, says in the Guardian that she was shocked when she saw the match calendar for 2024. FIFA has planned a window for international matches in the middle of July. There is rightly a lot of talk about research, writes Hegerberg, but not enough about how this research is actually implemented. She welcomes the initiative of UEFA, which set up a cruciate ligament expert commission at the beginning of the year. “But what use is that if you have to play international matches in the middle of the summer?” she asks. The stress that the players are subjected to physically and mentally makes no sense.
Anyone who travels a lot carries a higher risk
A study by the football organization Fifpro supports the players’ criticism. Data from the last two seasons of 139 players from top leagues were examined. 58 injured themselves during this period, most (32 percent) of the knee. The analysis shows that the players who injured their cruciate ligament played more games, often had less than 5 days of rest between games and had less rest in the 28 days before the injury than their counterparts. They traveled further, longer and across more time zones.
Svenja Fölmli doesn’t want to worry too much about why she suffered the injury for the second time. A lot is being done in your club to prevent all possible injuries. She assumes that genetics also play a role and: “It is partly an occupational risk.” As devastating as the diagnosis was, giving up was never an option. “You can do two,” says the striker.
An article from “NZZ am Sonntag”