Want to reduce the number of ACL injuries in women? Start when they’re children

With the World Cup imminent, Cotswolds knee specialist Alex Dodds looks at why injury prevention is essential to creating the Lionesses of the future.

Father & 2 Daughters Playing Football*photo courtesy of Kzenon via shutterstock

Millie Bright. Lucy Bronze. Fran Kirby. Beth Mead. Leah Williamson. Aside from them being roughly half a team’s worth of Lionesses, what connects them? Astonishingly, the answer is knee injuries. All of them are currently injured. Most have ligament damage. All but Millie Bright look set to miss the World Cup.

It’s a terrible stroke of bad luck to have quite so many stars out at the same time. But there’s nothing luck-related about the fact that female athletes are more prone to ACL injury. Anatomical and physiological factors play a significant part. Poor pitches, schedule congestion and the fact that most football boots are designed for men may also be contributory factors, as This Week notes.

This is a problem that is long in the making. Paediatric ACL injury is a growing burden. A paper from the Oxford Group using Hospital Episode Statistics data found a 29-fold increase in 20 years.

There’s lots we can do to reduce the prevalence of ACL injuries in women. But if we really want to address the problem, we need to start when those women are children, because the physical, psychological and other effects of ACL injury can be as devastating for young people as they are numerous.

There is, of course, the immediate effect on a young person’s sporting development. Damage to the meniscus or articular cartilage at the time of injury can lead to the later development of osteoarthritis. The cost of investigation and treatment now and in later life is considerable. Surgical reconstruction in the young can be ineffective with a higher re-rupture rate than for adults. Then there’s the notable risk of reaching major tournaments with half your national team out of action.

The need for injury prevention
70% of injuries in young people are non-contact related, which means they occur when pivoting, jumping or rapidly accelerating/decelerating. The case for getting better at injury prevention, therefore, is clear and it’s an area in which I have been involved (via BASK) for some years.

One of the simplest yet most effective ways to reduce the incidence of injury in the young is with a PEP (Prevent Injury, Enhance Performance) warm-up. It’s a warm-up that strengthen important muscles, reinforces strong body positions and improves stability.

As Oxford charity Skipp notes, making PEP a regular part of warm-ups for young people could help prevent 50% of ACL injuries. In Australia, where such warm-ups have been commonplace for some time, the evidence has been encouraging. Effectively, for every 49 high-risk participants switching to a PEP warm up, you prevent one ACL rupture. That’s not only good news for young athletes; it’s cost effective too.

Of course, the Lionesses aren’t getting injuries because there’s something wrong with their warm-up routine. These are elite athletes putting their knee joints and ligaments under extreme pressure and their warm-ups will be tailored and personalised.

But if improvements in warm-up technique can help more young people avoid injury, we’ll be saving lots of young athletes from the distress of ACL rupture and ensuring more of them have the chance to become the Lionesses of the future.

If you are concerned about your child’s knee injury, book an appointment at my Cheltenham knee clinic now or call 01242 246549.