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Preventing ACL injuries in Female Soccer Players

June 30, 2006 |  By Shelagh McNally for Knee1 Injuries in sports are to be expected. But why do women have a tendency to tear their Anterior Cruciate Ligament (ACL) more often than men, particularly while playing soccer? Female athletes between 15 and 25, whether playing at the high school or collegiate level, are 2 to 8 times more likely to sustain ACL tears.

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Tips for Women to Stay in the Game Learn and practice proper soccer technique. Take time in the weight room to develop your hamstrings. Stretch both your hamstrings and quads before, during and after games and practices. If you pinch or twist your knee, take enough time to recover rather than playing through the pain. Pay attention to your body’s signals – if you are having pain there is a problem.

Last year more than 3,000 female athletes suffered from serious knee injuries and those numbers are growing as more women compete at a professional level. FIFA (Fédération Internationale de Football Association) estimates that the number of girls and women playing soccer will equal the number of men by 2010. To date there are 40 million girls and women playing this sport around the world.

For more than a decade, researchers have been studying the problem and believe the main causes are due to differences in anatomy and knee alignment, along with muscle strength and training. In June 1999, the American Academy of Orthopaedic Surgeons held a consensus meeting and came up with several important factors to explain the increase in ACL injuries and provide suggestions for prevention.

The ACL is one hard working ligament. Connecting the upper leg (femur) to the lower leg (tibia), it prevents the lower leg from sliding overtop the upper leg and keeps the knee from being stretched, straightened or bent beyond its normal limits. When the ACL can’t do its job, the lower leg moves forward and since the knee isn’t built for this kind of movement, it buckles suddenly.

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Anatomy of an ACL injury Twisting or sudden stops can cause small or medium tears in the ligament A separation of the ligament from the femur or tibia is a avulsion tear Complete separation of the ACL ligament from the bone is a avulsion fracture Avulsion injuries can cause the blood vessels to tear and blood fills the knee joint causing swelling. After an ACL injury, the knee can be unstable and the lower leg can move too forward on the upper leg causing the knee to buckle.

The actions used in sports like soccer – twisting, cutting, jumping and sudden stops – can put sudden stress on the ACL. But why are men more likely to simply twist their knee while women will completely rupture the ACL? Blame it on the Q angle. When the femur meets the tibia it creates the Q angle (quadriceps angle) and the size of the angle is determined by the width of the pelvis. Women have a wider pelvis than men and the resulting larger angle puts a greater force on the ACL. So while a man can twist his knee and just stretch his ACL, a woman will often blow hers. To further aggravate the problem, this Q angle can also cause flat feet, which puts even more stress on the knee.

Even though women are more flexible than men, they do have a more limited ACL movement due to a smaller intercondylar notch, the depressed area at the end of the femur where the ACL ligament lies. Since space is limited in this femur notch but the hips are flexible giving the thighbone more motion, it can easily pinch the ACL which again leads to a rupture.

Researchers also found that female athletes tend to use their quadriceps muscles more and need to be trained to use their hamstrings more often instead. Women also turn and pivot in a more erect position, which also strains the ACL. Training at an earlier age may also prevent injuries. Often male athletes start participating in soccer at a young age and received training like footwork drills and proper landing techniques which help them to develop proper muscle reflexes and coordination. Thus the muscles that hold the knee in place become stronger and more stable. Most female athletes take to the sport at a later age so often their muscle strength, coordination and reflexes may not be as fully developed. Earlier strengthening and conditioning of the muscles, along with learning to crouch and bend at the knees and hips will reduce the strain on the ACL.

The Women’s World Cup is coming in 2007. We want our players to be ready!

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