Knee injuries in women's football explained – why the ACL is far more common
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Women's football is facing something of a crisis at the moment, with a spate of ruptured ACLs affecting some of the game's best stars.
England and Arsenal duo Leah Williamson and Beth Mead are among the more prominent players to have suffered the knee injury – which requires surgery and a long period of rehabilitation – in recent months.
Arsenal's Vivianne Miedema also went down with an ACL injury in November, the same month as Mead.
An explanation has since been sought as to why the injury is more common among female players than males.
"We know female athletes are up to six times more likely to have a non-contact ACL injury than their male counterparts," Doctor Emma Ross told Sky Sports.
She also believes there's a lack of research around the subject.
"We published a paper about a year ago which showed that, in sport and exercise science research, only about six per cent of the studies are done exclusively on females – meaning they study things that are happening to the female body – so we don't have a lot of research on female athletes.
"But what we do know about the menstrual cycle and injury is that the changing hormones across the cycle can impact the physiology and biomechanics of the body.
"For example, when oestrogen is elevated in the menstrual cycle, and that happens in about the second week, it can affect the stability of joints. It can interfere with the collagen in our joints and it can create looser, more lax joints. A loose joint is therefore less stable and more inclined to injury.
"So we do have some information about loose joints, but what we don't have is the end step of whether that really does increase the risk for injury in female athletes."
Report author Dr Katrine Okholm Kryger made the point that women's feet differ naturally from men's in terms of shape and volume, and that boots that don't fit properly could cause injuries.
There's been a call for all major football boot manufacturers to make women's only boots as standard practice.
Kryger says she wants to "kindly nudge manufacturers and research towards to the need to pay more attention is this area".