Excitement is in the air as the Women's World Cup is just over six weeks away, but many of the sport's biggest stars will be missing out due to ACL injuries, which have reached a crisis level in women's soccer.
More studies on female athletes are needed (in fact, that's one of the main problems in addressing the crisis) but it appears that women are up to six times as likely as men to suffer non-contact ACL injuries, with a variety of possible explanations having been proposed to explain the disparity.
ACL (Anterior Cruciate Ligament) injuries are some of the most severe common injuries in soccer, often requiring surgery and months or years of rehabilitation.
Among the biggest names expected to miss the World Cup due to partial or complete ACL tears are Canada's Janine Beckie, France's Marie-Antoinette Katoto, England's Beth Mead and Leah Williamson, New Zealand's Katie Rood, and the U.S.'s Catarina Macario.
Several more players are hoped to recover in time, including Savannah McCarthy for Ireland, who returned to play in April.
Many more names could be listed; the number is staggering. At least 57 ACL injuries were reported across the top 5 European leagues this year. The Netherlands' star forward Vivianne Miedema, who ruptured her ACL in December and will now miss the World Cup, noted that "More than 20 percent of last year's Ballon D'Or nominees are out with ACL injuries right now. It's ridiculous."
Miedema is among several players urging for more resources to be put into the issue.
"I think it's way too common in the women's game," said English star Beth Mead recently.
"I think that if it had happened in the men's game, a lot more would have been done sooner. It's important for us to drive the different factors and aspects around why it's happening so often."
Miedema has pointed out that women's schedules have expanded rapidly in recent years, so that they are now playing 50 or 60 game seasons along with their male counterparts, but resources off the field haven't increased to the same amount.
"We get put under the same physical stress as males, but we don't have the same facilities and circumstances around us. That's definitely something the clubs need to look at right now."
Canadian forward Janine Beckie concurred:
"You've changed the schedule to mimic the men, yet you're not giving female players the same level of resources. Premier League players are playing 40, 50+ games a season and are able to maintain fitness levels because they're treated like gold, which they should be. If you're going to ask an elite athlete to play 50 games a season, you've got to provide them top-of-the-line care."
Sufficient resources are surely needed, but given the extreme disparity between ACL injuries in men and women, a biological component is also likely, especially since the injuries themselves are appearing differently by sex: women are more likely to injure their nondominant knee, while men mostly injure their dominant knee.
Postulated factors include women's relatively more valgus (knock-kneed) positioning and the smaller size of the ACL in women, increased ligament laxity during some phases of women's menstrual cycles because of shifting hormone levels, and even the fact that most women's boots are just men's boots sized down, though women have differently shaped feet. (Progress appears to be coming on this score, at least: on June 8, Nike unveiled the much-hyped "Phantom Luna" boots, specifically designed for women's football). The women's game itself is also different than the men's, generally involving more attacking as a team and requiring more touch passes.
After losing four major players to ACL injuries, Arsenal is conducting its own study into causes, but continued research is crucial to determine the factors behind these injuries, especially if certain phases of menstrual cycles make women more vulnerable to them. Only then can prevention programs become as effective as possible.
