How To Reduce the Prevalence of Knee Injuries In Women’s Sport

by Ciara Dossett

In recent years, injuries involving damage to the anterior cruciate ligament, as well as other ligaments in the knee, have become more common in sport, particularly women’s. Ligaments attach bone to bone and generally help to stabilise and protect joints. 

The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments found in the human knee. Its function is to prevent the tibia from sliding out the front of the femur, as well as providing rotational stability to the knee. ACL tears are common in sports that involve a considerable amount of changing direction, such as hockey and football. There are two ways in which you can tear this ligament: landing from a jump with a straighter knee or cutting and turning with the knee falling inwards.

Unfortunately, women are between two and six times more susceptible to ACL injuries than men. This is because women’s pelvises tend to be wider, which affects the way the muscles pull on the knee joint and so can prevent the knee from turning. However, the reason that ACL injuries are more prevalent in female sport is not purely to do with biomechanics. Hormones play a role, as female hormones can loosen ligaments. Moreover, in recent years, many women’s sports have become professional, some have made the transition from part-time to full-time in a matter of months, creating fatigue. Elle Turner, Manchester City women’s strength and conditioning scientist, says “research has shown that when the fatigue is highest, that where are injuries rates are biggest”. Is it too much too soon? Sporting associations may be jeopardising the health of players by increasing the number of hours they play in such a short period of time. When asked if the FA consults medics about the schedule, Dr Pippa Bennett, England women’s chief medical officer, replied “not as far as I’m aware, certainly not in my 15 years at the FA, no”. This comment suggests how little thought sporting associations are putting into the health care of players, instead they appear to be more concerned with TV rights.

There is also speculation surrounding the use of artificial turf in games such as hockey and football. Artificial surface tends to be harder than grass and so is less forgiving on the knee. FIFA has come under scrutiny for choosing to play this years women’s world cup on artificial surface.  Although there is no explicit evidence confirming that artificial turf causes more knee injuries, there is undoubtedly a difference between the surfaces and it has been suggested that the adaptation from grass to artificial turf could cause players to be more susceptible to knee injuries.

It is obviously not just professional athletes who suffer from ACL injuries. In fact, there are increasing rates of school pupils suffering from ligament tears. Dr. Jordan D. Metzl has suggested that this could be due to  training sessions being too long and youth seasons lasting all year, not allowing young players to rest.

Although women are more likely to suffer from ACL injuries, there are ways in which we can lower the likelihood of tearing ligaments. Strength and conditioning is arguably the most important preventative method, as underdeveloped muscle prevent the knee from turning. Working on control and dynamic movement is salient too. Hopping on one foot and proprioception work can help with this. There are also some tips that can help prevent most injuries, not just ACL tears:

•     Wear the correct footwear for the surface you are playing on

•     Refuse to play on an unsafe surface, e.g. if icy or slippery

•     Ensure that you warm up properly before participating in sport

However, even if you were to do all these things there is still a possibility that you could tear your ACL; unfortunately, injury is often unavoidable. However, tearing your ACL does not mean the end of your sporting career nor does it mean that you could not become a successful sportsman. In 2011, the American women’s football team reached the final of the World Cup. Out of the 21 players in the squad, 6 players had torn their ACLs. This statistic not only shows how common these injuries are in women’s sport, particularly football, but also conveys the high rate of successful re-habilitation. 

In September 2013, I ruptured my ACL, whilst playing a hockey match. Before injuring myself, I didn’t even know what an ACL was. On the day I tore mine, I was tired, having been off school with a cold for most of the week. In hindsight, I should have refused to play but, unfortunately, I was unaware of the risks of injury under fatigue. It is important that players are aware of the injuries that could occur and also the methods which can help to prevent such injuries. However, it is equally important that if such an injury occurs to a young girl or boy that they are aware of the high rates of successful rehabilitation, which mean that they are more than likely to participate in sport again.