‘A lot of this is preventable’: Inequity, anatomy reasons for why women face increased risk of ACL tears

Canada’s women’s team has high hopes for success in the FIFA World Cup tournament, coming off an Olympic gold medal at the Tokyo Games in 2021.

Among the challenges faced by female athletes like these, in addition to their opponents, is a risk of one particular type of injury, at a level which is higher than for their male counterparts.

And it’s a risk Team Canada, a mix of veterans and new players, knows well, as a knee tear knocked out one of its players before the tournament in Australia even started.

In March, 28-year-old forward Janine Beckie was playing for the Portland Thornes when she tore her anterior cruciate ligament (ACL), which connects the femur to the tibia. This injury, which involves a long-term recovery, left her unable to continue the season and caused her to miss the World Cup.

Beckie is not the only female player who’d been headed to the tournament and was sidelined by this type of injury.

Many women hoping to play in the World Cup have put their dreams on hold, including England’s captain, Leah Williamson, Vivianne Meidema from the Netherlands, and America’s Cat Macario, CNN reported.

Experts say not only does their sport of choice increase the likelihood of an ACL injury, but that women and girls face a higher risk than men and boys, due to body composition and inequity in resources.

ABOUT ACL INJURIES

Due to the lateral movements, quick stops and jumps, soccer is one of the sports where tears in ACLs are high-risk. 

The ACL is an important part of how someone stabilizes themselves while walking and holds a crucial aspect in how soccer players in particular can move on the field. 

If the ligament is torn, surgery may be needed to fix the issue followed by months of physio and regaining strength, with a full recovery taking about a year, Dr. Darrell Menard said in an interview with CTVNews.ca.

“But on the same side of the coin, there are other athletes where that injury is the end of their career, they just can’t get back from it,” said Menard, a sports medicine physician and a board of directors member for the Canadian Academy of Sport and Exercise Medicine.

WOMEN 2.8 TIMES MORE LIKELY TO FACE ACL INJURY

Exactly why women are at a higher risk than men is complicated, Menard said.

“The vulnerability to have an anterior cruciate ligament tear is multifactorial, so it’s not just one thing,” he said.

Women are 2.8 times more likely to face an ACL tear playing soccer than for males, a study published in the National Library of Medicine suggests. Another study published in the same journal found that when women play on artificial grass (turf), the increased traction compared to natural grass also increases the risk of injury.  

In addition to their activities, one of the ways to understand if a person is more at risk for this injury is based on their anatomy. 

“For women, there’s a little intercondylar notch in the femur, and for whatever reason, it’s a little narrower than it is with guys,” Menard said. 

The ACL can get “caught” on the notch and tear.

The pelvic bone also plays into the risk of ACL tears. Those who have a wider pelvis have hips that push outward, which can cause them to have “knocked-knees.” This is when the knees move inward while the feet stay out.

There are also studies that point to ACLs being vulnerable to the fluctuations in a women’s menstrual cycle, Menard said.

A journal article published in the National Library of Medicine says during a woman’s period the ACL can experience increased laxity, or looseness, due to hormones, in turn increasing the risk of injury.

WAYS TO REDUCE THE RISK

These anatomical reasons are uncontrollable, but there are ways for women to lower their risk of ACL tears.

Sometimes when people jump — for example, going in for a header, a technique involving using a player’s head to hit the ball — they will land with their legs straighter, Menard said. This adds pressure on joints that take the force of the movement.

Menard says a person should be bending their knees when they land to engage their muscles. 

Another way to decrease the risk of injury is by working on neuromuscular control. This is spatial awareness of joints and muscles, which can be taught through practice and specific exercises. 

Menard said the easiest way to lower a female’s risk of an ACL tear is to encourage them to be active when they are younger.

“There is still a tendency (that) little girls that are not encouraged to be as physically active as boys,” he said.

“If you don’t give young ladies a chance to learn to jump, run and to physically protect themselves when they’re moving…It’s harder to learn those skills when they get a little older… A lot of this is preventable.”

INEQUITY IN SPORTS

There has been some improvement in the last decade when it comes to equality for women and girls in sports, but many fall out by the time they reach early adulthood. 

A lack of access to sports and not being able to see a career path are among the reasons, a report from the Canadian Women & Sport organization found.  

As women age, inequities do not disappear, as seen with Canada’s women’s soccer team and its dispute with Canada Soccer over treatment and pay. 

The national soccer federation came under fire earlier this year when women from the team alleged they were not compensated for games in 2022 and were not being paid the same as the men’s team.

The women have also scaled back training camp days and the number of players and staff invited to the camps.  

An interim funding agreement was reached between Canada Soccer and the women’s national team in March, but negotiations for a permanent solution are ongoing. 

“You’ve changed the schedule to mimic the men yet you’re not giving the female players the same level of resources,” Beckie told Reuters in April, post-knee surgery. “If you’re going ask an elite athlete to play 50 games a season, you’ve got to provide them the top-of-the-line care.”