Sports Rehabilitator, Jess Hilliard Shares Key Takeaways from the Injury Rehab Network Course about ACL injuries in female athletes.
Attending the Injury Rehab Network – Prehab and Rehab in Female Athlete Health course was an invaluable experience for me, both professionally and personally. As someone with a keen interest in women’s health and how it impacts athletic performance and recovery, this event was an opportunity to delve deeper into the subject of ACL injuries in female athletes. Something that has long been overlooked in sports science.
The day was packed with expert-led sessions covering everything from concussion risks in elite female athletes to how hormonal changes affect biomechanics. However, one topic that stood out – and was a real eye-opener – was the ACL epidemic in women’s football. ACL injuries in female athletes are happening at an alarming rate, yet the research and preventative strategies still lag behind. Here are my key takeaways from the event and why they’re so important for the future of women’s sport.
Why Are ACL Injuries More Common in Women?
The statistics around ACL injuries in women’s football are staggering. Studies show that female athletes are up to six times more likely to suffer an ACL injury compared to their male counterparts. This isn’t just a coincidence – it’s down to a combination of biomechanical, anatomical, and hormonal factors, as well as differences in training exposure.
One of the key discussions in the session was modifiable risk factors – things that can actually be addressed through training, rehabilitation, and education. Some of the biggest contributors to ACL injury risk include:
- Hip and knee biomechanics – Women tend to have a greater Q-angle (the angle between the hips and knees), which can place more stress on the knee joint and make it more prone to injury.
- Neuromuscular control – Differences in muscle activation patterns mean that women are more likely to rely on their quadriceps rather than their hamstrings when landing or changing direction, increasing stress on the ACL.
- Hormonal influences – Fluctuations in oestrogen levels can affect ligament laxity, making the ACL more vulnerable at certain times of the menstrual cycle.
- Training exposure – Many female footballers still don’t receive the same level of strength and conditioning training as male players, leaving them with weaker stabilising muscles around the knee.
Understanding these risk factors is the first step in addressing them, and it’s clear that more needs to be done to tailor training and rehab sports injury physiotherapy programmes specifically for female athletes.
How Can We Reduce the Risk?
A big focus of the course was on preventative strategies – what we can do to stop ACL injuries before they happen. One of the most promising approaches discussed was the implementation of structured injury prevention programmes. Studies have shown that targeted neuromuscular training can reduce ACL injury risk by up to 50% in female athletes. These programmes typically include:
- Strength training – Especially targeting the hamstrings, glutes, and core to improve knee stability.
- Jump mechanics – Teaching proper landing techniques to reduce impact forces on the knee.
- Agility drills – Encouraging controlled cutting and change-of-direction movements to improve neuromuscular control.
- Sprint Mechanics Assessment Score (S-MAS) – One of the sessions covered how this tool can be used to analyse and improve sprinting biomechanics, reducing excess strain on the lower limbs.
What struck me most was how simple but underutilised these techniques are in sports therapy with many women’s teams. While professional clubs may have access to these tools, grassroots and lower-league players often miss out. There’s a clear need for wider education and implementation at all levels of the game.
ACL Injuries in the Women’s Super League
The prevalence of anterior cruciate ligament (ACL) injuries in women’s football, particularly in the Women’s Super League (WSL), is a growing concern. Recent data indicates that during the 2022/23 season, the WSL experienced an ACL rupture approximately every 1,188 minutes of play, a stark contrast to the Premier League’s rate of one every 8,550 minutes.
High-profile players have been significantly affected. Arsenal and England forward Beth Mead suffered an ACL injury in November 2022, sidelining her for nearly a year and causing her to miss the Women’s World Cup. Similarly, her teammate Leah Williamson ruptured her ACL in April 2023, ruling her out of both the Champions League and the World Cup that year.
These statistics and cases underscore the urgent need for targeted research and tailored injury prevention programmes in women’s football to address this concerning trend.
Rehabilitation Challenges and the Gender Gap in Research
Another important discussion was around the rehabilitation process after an ACL injury – something that can be long, frustrating, and often not tailored enough to the female athlete. A case study of a female rugby player recovering from ACL, MCL, and meniscal surgery highlighted the unique challenges women face in recovery, from regaining confidence to dealing with changes in knee mechanics post-surgery.
One of the practical sessions gave us the chance to practice ACL diagnostic tests and functional drills aimed at improving return-to-play outcomes. A big takeaway for me was the importance of gastroc-soleus complex function in runners – something that is often overlooked but plays a crucial role in lower-limb stability.
A major barrier to improving rehabilitation strategies is the gender gap in sports science research. Women’s bodies are different – yet most sports medicine studies are still based on male athletes. The lack of female-specific data means rehab protocols are often generalised rather than personalised, which can have a huge impact on recovery time and long-term joint health.
The Bigger Picture: Changing the Landscape for Female Athletes
The course reinforced something I’ve felt strongly about for a while: women’s sport needs better representation in research, training, and injury prevention. The ACL crisis in women’s football is just one example of how female athletes are often left to navigate injury risks without the same level of support as their male counterparts.
Key changes that need to happen include:
- More female-specific research – We need better data to inform training and rehab strategies.
- Greater investment in women’s strength and conditioning programmes – Injury prevention starts long before an injury actually happens.
- Improved education at all levels – From coaches to players, everyone needs to be aware of the risk factors and how to mitigate them.
- A more personalised approach to rehab – Recognising that women’s recovery timelines and needs may differ from men’s.
Final Thoughts on Injuries in Female Athletes
Walking away from this event, I felt inspired but also aware of how much more needs to be done. The knowledge I gained will undoubtedly influence how I work on acl injuries in female athletes in my own practice in Lancaster, and I hope that conversations like these will continue to push for change across the industry.
For any physios, coaches, or athletes reading this – we all have a role to play in bridging the gap. Whether it’s implementing better warm-up routines, educating players on landing mechanics, or advocating for more research funding, every step towards change is a step towards a safer and more sustainable future for women’s sport. If you’d like to know more about how True Physio can help support local women’s teams and athletes, contact us today.