Is There an Epidemic in ACL Injuries in Women’s Soccer?

This year’s women’s world cup saw an epidemic of anterior cruciate injuries preventing athletes from competing on the world stage.  The list of star players is astounding including England’s duo of Leah Williamson and Beth Mead, Dutch star Vivianne Miedema,  France‘s Marie-Antoinette KatotoCanada‘s Janine Beckie, and the American pair of Christen Press and Catarina Macario. Australia‘s Ellie Carpenter and Spain‘s Ballon d’Or winner Alexia Putellas, made it back just in time for the tournament after suffering the same injury.  This is an extremely common injury in women’s soccer highlighted by the US Star Megan Rapinoe having had 3 ACL injuries throughout her career.  In fact in the USA soccer is more likely to cause an ACL tear than any other sport for women.  ACL injuries can take about a year to recover from and not every athlete with this condition returns to their same level of play.  Lastly, this is also important because many of these athletes end up with knee arthritis later on in life after suffering this injury.  

So why is soccer and why are women at such a high risk for this injury? 

Difference in ACL Injury Incidence between Women and Men:

Women are known to have a higher incidence of anterior cruciate ligament (ACL) injuries compared to men, especially in sports that involve cutting, pivoting, and jumping, like soccer, basketball, and volleyball. Several reasons contribute to this difference:

  1. Anatomical Differences: Women tend to have a wider pelvis, which can result in a greater angle of the thigh bone (known valgus or knock kneed) relative to the knee. This can place additional stress on the ACL.
  2. Hormonal Factors: Fluctuations in hormones during the menstrual cycle can affect ligament laxity and potentially influence the risk of ACL injury.
  3. Neuromuscular Control: Some studies have suggested that women might use their muscles differently than men during certain activities. For instance, women might have a tendency to land from a jump with a more extended and inwardly rotated knee, which can be a risk factor for ACL injuries.
  4. Biomechanical Differences: Women often show biomechanical differences such as increased knee valgus (knees collapsing inward) during dynamic tasks.
  5. Strength and Conditioning: Differences in muscle strength, especially hamstring-to-quadriceps strength ratios, can affect ACL injury risk. Typically, strong hamstrings can help in preventing the forward motion of the tibia on the femur, a movement resisted by the ACL.

Ways Women Can Decrease Their Risk of ACL Injury:

  1. Neuromuscular and Plyometric Training: These training programs focus on improving strength, coordination, reflexes, and landing techniques. They teach athletes to land with the knees bent and over the toes rather than allowing the knees to collapse inward.
  2. Strengthening Exercises: Building hamstring strength is vital, as these muscles play a role in stabilizing the knee joint. Core strength is also essential for overall stability.
  3. Flexibility: Maintaining good flexibility in the muscles around the knee, such as the quadriceps, hamstrings, and calf muscles, can help ensure that they function optimally.
  4. Proprioceptive Training: Balance and stability exercises, like using wobble boards, can help improve proprioception, which is the body’s ability to sense its position in space.
  5. Regular Assessment: Regular assessment from a sports physical therapist or athletic trainer to ensure that one’s movement patterns are optimized can be helpful.
  6. Education: Being aware of the risk factors and understanding the importance of prevention measures can be one of the most effective strategies.

At Total Orthopedics and Sports Medicine we use several tools to assess and decrease the risk for ACL injuries in our women athletes.  The main tools are assessment and education.  We employ Physimax, a computer motion detection device, to assess poor mechanics and to develop a conditioning program to improve an athlete’s mechanics there by decreasing their risk.  

It’s worth noting that while these strategies can significantly reduce the risk, no prevention program can eliminate the risk entirely. Participation in sports will always come with inherent risks, but appropriate training and preparation can minimize the chances of injury.

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