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SPORTS MEDICINE

WOMEN’S FOOTBALL: A RISING STAR OR A TICKING TIMEBOMB?

By Professor Graham N Smith, FCSP

Football is now the fastest growing and number one female sport in England, recently overtaking netball. Football Association fig- ures (1) now show that 1.4 million girls are taking part in some footballing activity on a regular basis and the number is growing. However the sport is developing a shadow which, if remained unchecked, could have serious implications for its participants.

THE PROBLEM IDENTIFIED Evidence from the USA, Scandinavia and now the UK has revealed that female players are between 2-6 times more likely to sustain an anterior cruciate ligament (ACL) injury than their male coun- terparts (2,3). With such high numbers participating in the sport this should raise concern among players, coaches and the football authorities.

PREMIER LEAGUE DATA In a recent study, a questionnaire was sent to therapists at each of the 34 clubs within the Women’s Premier League which profiled the incidence of ACL injuries across the 3 seasons from 1998-2001 (3). Half of the clubs who responded to the questionnaire report- ed at least one incidence of an ACL tear during this time. Significantly, 83% of the injuries resulted from no direct contact and over 80% occurred in matches as opposed to training. This suggests there is an unexpected element in the competitive match that cannot be trained for but that increases the risk of an injury.

LOW CENTRE OF GRAVITY HELPS MALE PLAYERS Jumping and landing with bent knees is much safer than with straight legs. Males tend to naturally play with a lower centre of gravity than females which gives them a wider base of support. However, there is also evidence to show that as female players get tired they adopt a more upright posture than their male counter- parts (4) which gives them a higher centre of gravity. Consequently, when landing with the knee almost straight, the ACL ligaments are tight and an explosive, dynamic, muscular adjustment may be need- ed to retain balance, thus putting the ACL at risk.

AGE PROFILE CHANGING Previous studies show the 15-18 age range as most vulnerable to this injury (5). Now results from the Stevenson and Smith study (3) show a new trend developing in 19 to 25 year old players with- in the UK. Fifty eight per cent of the ACL injuries reported in this survey occurred in the older age bracket.

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ENDURANCE AND PLYOMETRIC TRAINING While much more research is needed from a medical standpoint, clubs, players and coaches can start helping themselves. It is vital that players play on good surfaces and are wearing the right footwear. Equally, coaches have a significant role to play. Most of the injuries are occurring in games and not during training. Females who train for perhaps just two nights a week may spend most of their time on skills work. But potentially they need to be working on endurance and plyometrics to help them develop ade- quate levels of fitness to cope with the game.

INTERCONDYLAR NOTCH SIZE Intercondylar notch size has also been recently quoted as a major factor in ACL injuries (6). Research by Dr Donald Shelbourne in the USA has shown that a small notch width will be a major pre-dis- posing factor for potential ACL tears, regardless of gender. The fact that females have smaller intercondylar notch widths in general, could be a factor but should not be regarded as the main one.

Either way, this topic is still one that is likely to provoke discus- sion and concern especially for female footballers, coaches or parents.

THE AUTHOR Professor Graham Smith is a fellow of the Chartered Society of Physiotherapists and chairman of the Society of Sports Therapists. Professor Smith lectures all over the world in the subject of muscu- loskeletal medicine and will be discussing the above topic in con- junction with world-renowned ACL expert, Dr Shelbourne on the 15th May (see inside back cover for more information).

References 1.The Football Association www.thefa.com 2. Arendt E and Dick R. Knee injury patterns among men and women in col- legiate basketball and soccer. NCAA data and review of literature. American Journal of Sports Medicine 1995;25(2):187-190 3. Stevenson and Smith G. The Incidence of ACL injuries in Female Soccer within the UK. Presented at WCPT Conference Barcelona 2003 4. Ireland ML. The female ACL: why is it more prone to injury. Orthopaedic Clinics of North America 2002;33(4):637-51 5. Bjordal JM, Arnly F, Hannestad B and Strand T. Epidemiology of anteri- or cruitate ligament injuries in soccer. American Journal of Sports Medicine 1997;25(3):341-345. 6. Shelbourne KD, Davis TJ and Klootwyk TE. The relationship between intercondylar notch width of the femur and the incidence of anterior cru- ciate ligament tears. American Journal of Sports Medicine 1998;26 (3):402-408.

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