Whenever I see a player go down with a serious injury in the women’s game it is painful to watch because you know the road to recovery is a long one. It has a heavy impact on a career, forcing an individual to miss months of action and potentially life-changing moments.
Barcelona’s Alexia Putellas, Lyon’s Ellie Carpenter and Arsenal’s Leah Williamson are three of the many players at the top of the European club game to have sustained an anterior cruciate ligament injury over the past year. Putellas was forced out of the Euros as a result and Williamson will miss the World Cup in July and August because of the timeframe to recover from one of the most serious injuries in the professional game.
It raises the question of what needs to be done to potentially prevent others enduring the heartbreak of such injuries. From workload to making sure equipment is the best and most suitable it can be, there is plenty to look into.
Men also sustain ACL damage and it is high profile when they do, but the issue seems to be more prevalent in the women’s game. More investigation and study of female footballers is needed to find out why they get injured – not just ACLs but all physical matters.
It is a hot topic at the moment, and rightly so. I have had a lot of conversations with people who all have different thoughts, and we need to look more into it. People have mentioned reviewing the development of children in the academy system. Young boys start their training a lot earlier than girls, and they have better medical care, more expertise and knowledge that makes the transition to the professional game easier. At academy level, do we have the knowledge of how to look after a young female athlete? I was trained as a male athlete but I am a female and my body is very different and needs to be treated as such.
The menstrual cycle is a big part of that. There are different stages of the cycle. For elite athletes we have to understand how it affects our diet, sleep, recovery from exercise and hormone levels. Then we can use the data to help sportswomen through sleep strategies and know what type of training is suitable at the different phases of the cycle to make sure they are at their best. There is no definite clinical link between the menstrual cycle and ACL injuries but the more we know the better.
In recent years the workload for an elite female player has increased because of the growth of the game. A top player can play a maximum of 44 games. Three out of every four summers there is a major tournament, whether it is the Olympics, Euros or World Cup. The players can cope with the games but we need to allow them sufficient recovery time. For example, Manchester City’s England players won the Euros last summer and 18 days later were playing a Champions League qualifier.
If footballers are not permitted to rest and recuperate, playing is going to have a greater impact on their body and potentially make them more susceptible to injuries where tiredness will be a factor.
When I was playing I ruptured my ankle ligaments. I remember preparing for a training session by running around the pitch in the warm-up and I said to Fran Kirby that I was really tired. I was tired in my mind and thought that I had put my foot down on the ground but I had not – the ground was an inch lower – so when I landed I did some severe damage. It happened because I was fatigued and did not understand the loading and what I had been through that week, and it left me out for six months. Sometimes when a player twists something in the turf, we immediately look at the quality of the playing surface, which should be the best possible, but it can also be caused by tiredness.
There are different types of tiredness, both psychological and physical, that can affect performance and make someone more susceptible to injury. I look at players to see what stresses they are going through. I am probably more interested about the psychological stress, because I have a Master’s in psychology; at what their loading has been like, to see whether that is causing problems.
Another factor that can affect workload is a change of position. If someone, for example, moves to a role where they need to do more running, that can cause tiredness, which can result in injuries.
It has to be remembered that we are still in the early stages of professionalism in the women’s game. Medical care is constantly improving within clubs, a couple of whom have implemented a female-focused setup. At Chelsea you see the specific work they have done with Melanie Leupolz to help strengthen her pelvic floor after coming back from having her baby. It shows the efforts clubs are making to help get their players to their best levels physically.
I could continue to list things we need to know more about – and that is the point: we do not have a full understanding of various aspects of elite sportswomen, not just in football, and until we do, they will keep getting injuries that could be prevented.
