Why are female soccer players facing an ‘epidemic’ of cruciate ligament injuries? | British News


The term “keyhole surgery” may be misleading: despite the technology, expertise, and extreme finesse, it’s also extremely physical.

Sky News watches as surgeon Luke Jones performs an anterior cruciate ligament reconstruction in an operating room at King Edward VII’s Hospital in central London.

Mr. Jones (male surgeons are referred to as Mr instead of Dr) doesn’t just remove a hamstring muscle: He pulls it out by force.

Drills drill through bone. Meat smokes when cauterized. There’s a lot of hammering going on: “Mallet, please,” Mr Jones asks his assistant.

The ACL is a small band of tissue that runs through the middle of the knee and keeps it stable.

But by looking at the operation, it’s easy to understand why tearing it up is so devastating. Although the patient only has three tiny scars, his knee has taken a few beatings.

“I’m in the theater for 90 minutes,” Mr Jones tells Sky News, adding: “And after that there’s a year of rehabilitation with your physiotherapist.”

This is why cruciate ligament injuries are so feared, especially among one group of athletes: female soccer players.

“Far too many” players with cruciate ligament injuries

Between 25 and 30 players – enough for a whole extra squad – will miss the upcoming World Cup due to cruciate ligament injuries. England stars Beth Mead and Leah Williamson have been left out. Data from the ACL Women’s Football Club suggests 195 elite players sustained the injury in the last year.

It has been described as an “epidemic”. And it’s an epidemic that affects women much more than men: they are 2.5 to 3.5 times more likely to rupture cruciate ligaments than male athletes. And we don’t really know why. Even though women’s football is booming, research is lagging behind.

One player going to the World Cup is England defender Jess Carter. Ahead of her departure from St George’s Park, England’s national football centre, she told Sky News: “There have been far too many players who have suffered cruciate ligament injuries and not enough research has been done.”

“Why are there so many injuries? How can we prevent this? Why are they happening? A question I sometimes ask myself is, if that were to happen with top-level men’s players, would more work be put into improving it?”

England's Leah Williamson.  Image: AP
England’s Leah Williamson. Image: AP

Nature versus care

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 was able to find,” says Kat Okholm Kryger, sports rehabilitation researcher at St Mary’s University Twickenham and medical researcher for FIFA.

“And I think we can break it down into two main categories. And I like to call them nature and care.”

“So nature is like biology: the genes, the way the body is formed, the muscle mass, etc… But also the care of the environment in which women find themselves. So the way young female players are managed in comparison to male players, the facilities, the professionalism around the sport, the quality of the staff that is at their disposal.

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

“Danger? No. But in general, this is true for all research in football and sports medicine. The man was the norm,” she adds.

The research will ultimately benefit men’s football as well

Take a topic from the nursing field that Kat is studying: soccer shoes. The male foot was the norm. Boots specifically for women have only become available in recent years. And even then, we don’t really understand the differences, which is why Kats did 3D scans of hundreds of meters to map them.

This research will ultimately benefit men’s football as well, as Kat also charts the differences between ethnicities. Because the standard foot isn’t just that of a man, it’s that of a white man.

The man is also the norm for other environmental factors, such as booking a parking space.

Gravesham Girls and Women’s Football Club, founded in 1999, practices in Kent on a Thursday evening ahead of the start of the season. About 20 players, dressed in yellow, practice target practice and balls fly. A Sky News cameraman catches you in the stomach but bravely carries on.

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Toni Allen and Keylie Oliver have both suffered cruciate ligament ruptures in the past. “I just screamed – everyone thought it was a fox,” says Allen. Both were out for a year.

“It’s quite disheartening, especially when you consider that it can’t just have an impact on football,” says Oliver.

“We have a life outside of football and that affects that too… At the width, the women always have a two o’clock kick-off. And that’s because in our world, men’s football takes precedence over women’s football. We always have.” I have to play after that – so the pitch is always ruined.

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Women’s Soccer: The ACL Epidemic

The importance of the factors may change

Another difficulty is not only that many factors play a role, but also 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 affect injuries. Research seems to suggest that some hormones can cause ligaments to loosen, increasing the risk of rupture.

Therefore, over the course of the season, Prof. Elliott-Sale measures the laxity of players’ knees, compares this to their hormones, and compares it to other factors such as: B. an overload during the games.

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

“But once we have all the pieces, we don’t necessarily know which factor will play a bigger role on any given day. So it’s not like all parts are the same size. Some days a certain factor might be that.” The influence of this type of injury might be amplified while on another day it might be dismissed.

Biology remains a big part of the answer

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

Because in some sports, the discrepancy disappears when the cruciate ligament is injured.

“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, fracture rates actually level out,” said surgeon Mr. Jones. says.

“And a very good example of that is elite dancers. So, elite dance athletes, where men and women start training at the same age, do the same twisting, jumping, twisting moves, and the same training intensity, have the same conditions. If you compare their fracture rates, they are indeed balanced.”

“And that suggests that the effects of your training and your conditioning are really important and avoiding this injury.”

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

“We have an attitude, women do yoga, Pilates and men lift heavy things at the gym,” says Ms. Kryger.

“But the reality is that everyone needs to lift heavy things once in a while to prevent injury and have a healthy body.”

England's Beth Mead is also out due to injury.  Image: AP
England’s Beth Mead is also out due to injury. Image: AP

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

Matt Whalan is a sports scientist who works with Australia’s men’s and women’s football teams – the Matildas – who will be taking part in the World Cup. He spoke to me from the U-23 men’s camp there.

Football Australia introduced a program called ‘Perform+’ which can be incorporated into warm-up exercises and has reduced injuries, including cruciate ligament tears, by 40%.

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

“This is designed so that parent educators can just go online and watch the program. It has all the videos there and information on how to teach it to your athletes, from under seven to 55 years old.” ’95 year olds, you can do these exercises if you want to,’ says Mr Whalan .

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

That stays in the future. When the World Cup starts next week, it won’t be star-studded.

England striker Chloe Kelly told Sky News: “Having suffered a cruciate ligament injury myself it’s so sad to see so many players suffering this injury. Hopefully we’ll get the insights we need to prevent these injuries from happening so frequently.”

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