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Supporting female athletes through ACL injuries: what needs to change?

Jess Lee
Female ACL injuries on the rise

Jess Lee

Female athletes face a persistent problem with ACL injuries, but why is this and what can be done to change it?

Over the last 18 months, 195 female ACL injuries have been confirmed in women’s sports. Whether a partial or full tear, the recovery process can last between six and nine months, sometimes longer.

Athletes need support during recovery to stay motivated and return to their sport. Whilst the number of reported ACL injuries in the media is vast, the recovery side is yet to be accurately represented.

What are ACL injuries?

The anterior cruciate ligament (ACL) connects the thigh bone to the shin bone, ensuring the knee can withstand daily activities.

It supports the knee during high-speed and precise movements such as jumping, pivoting, and landing, particularly in sports like basketball, football and volleyball where there are sudden changes in direction.

Consequently, if this ligament tears, it might require significant surgery to get back to doing regular activities.

Females are up to eight times more likely to endure an ACL injury than men.

Why these athletes are more prone to this is an ongoing discussion.

Sharing experiences…

Considering Stoke City Women’s player, Kayleigh McDonald, recently took to social media for surgery donations, I delved into recent recovery stories of athletes at varying levels of the women’s football pyramid.

McDonald’s Story

During a match against Burnley in the FA Women’s National League North, McDonald suffered a grade three ACL injury.

She was initially told she had ruptured her Lateral Collateral Ligament (LCL). However, two weeks later a medical professional diagnosed an added fractured knee, ruptured IT band and popliteus tendon.

McDonald was not entitled to help from the Professional Footballer’s Association as she had no experience in the Women’s Super League. Like many athletes, she joined the NHS waiting list, but it could have been as late as November to have the procedure. As a semi-pro footballer, it was not an option for McDonald to wait whilst her injury inadvertently ended her career.

With no support from Stoke City football club, McDonald was left to fund her £20,000 surgery herself. She set up a GoFundMe as a last resort, explaining her story. McDonald said: “Just when I thought the women’s game was finally getting somewhere, I received the worst news that I will have to join the NHS waiting list for surgery.

“I’m so gutted and mentally broken with my injury.”

After vowing to support the women’s team more after “failing to meet the standards” last season, the lack of funding from Stoke City continued.

It was not until receiving overwhelming amounts of support online (raising £11,700) that the club U-turned on their decision to pay for the surgery. Despite the club being valued at over eight billion pounds, it took significant backlash for Stoke to invest in one of their players.

The public donations will be refunded via a function on the GoFundMe website as the club takes on the financial control of the situation.

What example does this set for a younger generation?

Women’s football has surged in England recently, inspired by the women’s team winning the Euros in 2022. There are more female participants in football than ever before, especially starting from a younger age. This still begs the question, how can we continue to motivate future generations to play without concern over injury and lack of support?

Being a third-tier club in the English Women’s football pyramid, Stoke City still holds a reputation for influencing local youth teams.

Stoke City head coach, Marie Hourihan, commented: “These girls are role models. It’s not just obviously about here and now, inspiring the next generation of girls in the Stoke-on-Trent area to want to play for the Stoke Women’s team.

“It’s about being visual, it’s about being present, it’s about giving girls something to aspire to be.”

A precedent to protect all players in need of extensive treatment needs to be introduced.

From a grassroots perspective

Hannah Wood, a sixteen-year-old grassroots footballer, spoke about her injury experience. Surprisingly, it correlated closely with semi-professional McDonald, despite a difference in age and ability.

Wood had a partially torn Medial Collateral Ligament, with extreme tissue damage and fluid in the knee. Despite not needing surgery, support was still lacking in her recovery.

She was left for two weeks without an official diagnosis, with nothing but crutches, a knee brace and strong painkillers. She felt frustrated with the little guidance and immense pain she was in.

Wood was paired with a physio who she described as the “most important person in [her] recovery” after getting her results from an MRI scan. She added: “If I had anyone else, I don’t think I would have made it.”

Wood appreciated her physio so much that even after being discharged, she went out of her way to keep in contact. Despite this, she still felt she was not 100 percent supported in other aspects of recovery. Her mental health deteriorated, not because of the absence of sport, but because she was unable to complete simple tasks like walking upstairs.

Like McDonald, Wood just wanted to return to ‘normal life’. However, it appears impossible for extra support to be given with the lack of funding for this area in the NHS. It is understandable why patients are pushed out of hospital doors after being overexerted and understaffed.

Even after extensive rehabilitation, Wood said she still struggles with her injury most days. She has not returned to playing sports and admitted she probably won’t for a long time.

Preventing ACL injuries

From amateur players to professionals, the long-term effects these injuries leave on players are detrimental.

So, what can be done to help avoid these injuries in the first place?

Mary K. Mulcahey, MD explained: “Coaches and parents are on the front lines of prevention. They can encourage athletes to participate in injury prevention programs and ensure they are performing exercises correctly. By fostering an environment that prioritizes safety, proper technique, and strength training, coaches and parents can help female athletes build resilience against ACL injuries.”

Without changing the female anatomy, structuring a training programme around specific needs is essential to reduce the chances of injury. Conditioning, strength and neuromuscular are examples of training used in programs to teach the body to respond to the strain of sport.

Additionally, sports shoe companies have begun constructing ‘female football boots’ to keep the leg in alignment and give more stability whilst playing.

Nike have designed ‘The Phantom Luna’ with a lower cuff to accommodate the female ankle, and a higher collar to reduce rotational traction at the knee, reducing the risk of ACL injuries.

The takeaway

The recovery process in women’s football is something that needs to be shared alongside the awareness of the steep incline of ACL injuries. To all female athletes navigating the challenges of an ACL injury, you are not alone. Your strength, determination, and resilience inspires us to keep pushing forward.

Remember, your journey doesn’t end with an injury, it is just a blip in the road.

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Featured image courtesy of Esther Max via Flickr. No changes were made to this image. Image license found here.

Sports Journalism student at Solent University in Southampton.

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