Soccer: Why women suffer more often from cruciate ligament tears – Sport

She stretches for the ball, lands unhappily on her knee and falls to the ground, her face contorted in pain. First-half stoppage time is on when Vivianne Miedema has to be treated and then tearfully substituted. Her teammate Beth Mead, who also injured her knee in November, accompanies her to the dressing room on crutches. A few days later the diagnosis follows: cruciate ligament tear. Miedema can no longer help her team this season.

She is another name on the long list of players to have torn cruciate ligaments this season. And the problem is by no means limited to the English Women’s Super League: Catarina Macário has been absent from Olympique Lyon since June for the same reason. One day before the start of the Women’s European Championship in the summer, “World Footballer of the Year” Alexia Putellas was also injured, followed by French striker Marie-Antoinette Katoto. This means that five of the 20 best players at the last Ballon d’Or ceremony are currently suffering from a cruciate ligament tear.

The majority of sports and movement science research is still concerned with male bodies

One could think of this as a random accumulation. Soccer With its quick changes of direction and many jumps, it is one of the sports that are known to cause cruciate ligament tears. However, research has shown that women are at an increased risk of sustaining this injury. Female soccer players are three to four times more prone to cruciate ligament tears than their male colleagues, says Ingo Tusk, a specialist in orthopedics, the SZ. So where do the many cruciate ligament tears in women come from? And what can be done to avoid the number of serious knee injuries?

Fifa has just launched a new competition in the Club World Cup women soccer announced. The Nations League decided by Uefa will also start in autumn 2023. And the players hardly have any breaks anyway: World and European championships or the Olympic Games are on the program every year until 2025. The full game plan and the resulting shortened regeneration times favor serious injuries. The problems, however, go deeper than the increased burden.

The majority of sports and movement science research is still concerned with male bodies. There are various factors in which women differ from men – and therefore also have a different risk of injury. The thigh muscles, knees and ankles are most commonly affected in football. While women have to deal with muscle injuries as often as men, they are more susceptible to cruciate ligament injuries, explains Ingo Tusk from the Frankfurt Red Cross Clinics, who also worked for a long time as the team doctor for the women’s national soccer team.

The wider pelvis of women and the knock-kneed position associated with it is assumed to be a possible reason. This puts a different strain on the knee and is more likely to buckle inwards. A cruciate ligament rupture occurs when the center of gravity of the body is behind the knees and the legs are loaded unevenly. Observations when jumping have also shown that female soccer players land differently than their male colleagues. While men are more likely to squat, women are more likely to backbend, and this increases the likelihood of a cruciate ligament rupture.

More and more clubs are supporting their players in tracking their cycle

Differences in the skeleton can also cause a greater susceptibility to injury. The notch, i.e. the tunnel in which the anterior and posterior cruciate ligaments run, is anatomically narrower in women. As a result, there is less space in the female knee, the cruciate ligaments are narrower – and that also increases the risk of injury, explains Tusk. It is also suspected that a greater inclination between the upper and lower leg bones puts more stress on the knee joint and can therefore lead to increased stress on the anterior cruciate ligament.

Hormones and the female cycle also seem to play a role. One Study published in 2021 has shown that the risk of muscle and tendon injuries is almost twice as high in the follicular phase than in the luteal phase. Shortly before ovulation, women are significantly more susceptible to cruciate ligament tears than in the phase before menstruation. More and more clubs are therefore supporting their players in tracking their cycle. By evaluating this data, the training intensity, nutrition and sleep plans can be adapted to individual needs – and thus also help to prevent cruciate ligament injuries.

In addition to the sum of all these anatomical and biological factors, there is another reason for the increased risk of injury: many structures in women’s football are still underfunded and not every player enjoys professional training conditions. So has one Study published in early 2022 demonstrated that there are significant differences in strength and conditioning training between men’s and women’s soccer teams. The fact that female soccer players have fewer weekly sessions than their male counterparts during the season can therefore have a negative impact on physical development and the risk of injury.

Therefore, Manchester United player Aoife Mannion urges to focus first on the areas that are known to make a difference. “We should get good, experienced sports and movement scientists into the clubs,” she said recently The Athletic: “We have to make sure that we have the necessary resources and good physiotherapists. From there we can then start to look at all the different factors that can influence the cruciate ligament.”

For professionals, the cruciate ligaments need nine to twelve months to heal completely

But what specifically can be done to protect women from knee injuries? “You cannot avoid a cruciate ligament rupture by improving your muscles alone, because the injury occurs much faster than the muscles have time to protect the cruciate ligament,” explains Tusk. Instead, proprioceptive training as well as coordination and jumping training are recommended. In addition, so-called drop jumps can be used to determine whether a player tends to knock knees and is therefore particularly at risk. To do this, she jumps off a box, lands and jumps up with maximum strength. If the knees are bent inwards when landing, you should work specifically to change this movement pattern.

And even if it hurts to have to sit in the stands: players should definitely avoid returning too early. According to Tusk, under-20-year-olds have a 20 percent risk of tearing their cruciate ligament again in the first year after the injury. “Therefore, young girls in particular who have injured their cruciate ligament should be explained from a medical point of view that it makes sense to be completely stable in the knee before they return to the field.” In professionals, the cruciate ligaments need nine to twelve months to heal completely – for the Dutch national player Vivianne Miedema, the dream of the World Cup in Australia and New Zealand (July 20 to August 20, 2023) has burst.