By: 4 January 2012

After a brief introduction by the event’s organiser, Professor Nicola Maffulli, Centre Lead and Professor of Sports and Exercise Medicine at Barts and the London School of Medicine and Dentistry, Dr Pippa Bennett, Chief Medical Officer to the England’s Women’s football teams, set the scene by kicking off with an opening presentation entitled “The Future of Football is Feminine”. Dr Bennett showed figures stating that 151,000 women participate in football at least once a week, with almost half of particpants being under 20. These numbers are increasing, and there are specific issues with women as the game gets faster and stronger. Dr Bennett’s second presentation discussed specific risks to the anterior cruciate ligament. Some of these risk factors included anthropometric, biomechanical, hormonal, neuromuscular and genetic influences. For example, the female knee has an increased valgus angle during cutting, and this combined with decrease hamstring firing, particularly at high speeds, may put the ACL at risk. Also, normal hormonal changes have a contributory factor.

Delegates from the morning session (from left to right): Ms Naomi Datson, Ms Tracy Lewis, Dr Pippa Bennett, Mr Paul Jones, Mr Rhidian Thomas, Professor Nicola Maffulli, Dr Nina Feddermann, Mr Andrew Williams.

Dr Nina Feddermann, Associate at the FIFA Medical Assessment and Research Centre (F-MARC), addressed the epidemiology of injuries in women’s football, and included a description of the injury surveillance system that has been used to record events since 1999. In 14 FIFA competitions there were 912 injuries, which is equivalent to 2.3 per game. Ankle injuries were the most common at 24%, followed by head injuries at 16%. Dr Feddermann described the injury prevention programme, 11+, and concluded that prevention programmes reduced the risk factors and injury occurrence in prospective randomised studies. Mr Paul Jones, Lecturer in Biomechanics and Strength and Conditioning at the University of Salford, continued the theme of prevention, more specifically ACL injury prevention. He discussed neuromuscular training strategies that have been shown to alter abnormal knee joint motions related to ACL injury risk. These strategies have also been shown to lower ACL injury rates in female athletes. He also posed the question as to whether it is possible to use field-based screening to identify at risk athletes.

Mr Andrew Williams, Consultant Orthopaedic Surgeon at Chelsea and Westminster, presented several very interesting and informative case studies discussing the rationale behind ACL reconstruction in female athletes. Mr Williams gave an insight into the “when, how and why” upon presentation of an ACL injury. The next presentation by Mr Rhidian Thomas, Consultant Orthopaedic Surgeon at Charing Cross, discussed ACL outcome in the female athlete. Mr Thomas explained that the surgeon can influence the outcome by attention to graft choice, graft placement, fixation techniques and rehabilitation. He ended the presentation with a personal observation that loss of full extension in the rehabilitation phase leads to loss of thigh circumference.

Before half time, and the final session of the morning, the topic of Performance Profiling, was co-presented by Ms Tracy Lewis, Head of Physiotherapy, and Ms Naomi Datson, Head of Exercise Science, both at the Women’s FA. Tracking the player during training sessions and games has been enhanced significantly by the introduction of GPS technology. All 32 matches in the 2011 Women’s World Cup were captured, with the statistics showing that midfielders covered the most distance, whilst forwards covered more distance at high speed and sprinting. The philosophy of performance profiling aims to match the demands of the game, with the physical ability of the player, and ultimately influencing selection and training. Individual player’s are screened using various tests, and are given feedback sheets to develop custom training programmes.

Attendees from the afternoon session (from left to right): Professor Neil Armstrong, Dr Sandra Wolfson, Dr Sangeeta Agnihotri, Professor Nicola Maffulli, Professor Ali Jawad.

The second half on Women’s Sport was opened by Professor Neil Armstrong, Professor of Paediatric Physiology, and Director of the Children’s Health and Exercise Research Centre, discussing the topic of Puberty and Exercise. Professor Armstrong said “The highest rate at which a child or adolescent can consume oxygen during exercise is the best single indicator of aerobic fitness. In several sports the ability to engage in rapid changes of pace is vital, and it is the transient kinetics of VO2 that is the key”. Elite young athletes have around 50% higher peak VO2 than untrained athletes. Several recommendations for increasing VO2 were presented, assessing frequency, intensity and duration of training. Professor Armstrong concluded that youth sport should be fun, and the focus should be on the role of sport in promoting the health and well being of the child.

Miss Sangeeta Agnihotri, Consultant in Gynaecology, Obstetrics and Maternal Medicine at Whipp’s Cross Hospital, outlined the sexual stages of the sportswoman, from pre-pubertal to menopausal, and the influencing factors of sexuality, sexual health and sexual behaviour. The discussion covered aspects of hormone changes, and a number of female specific conditions that may present. Reference was made to the “female athlete triad”, which is a syndrome of three interrelated conditions, specifically, disordered eating, menstrual dysfunction and osteoporosis/osteopenia. Professor Ali Jawad, Consultant Rheumatologist at Chase Farm Hospital, stated that “Exercise has beneficial effects on bone mineral density in premenopausal and postmenopausal women”. Specific reference was made to significant health risks amongst physically active women and girls, posed by low energy availability, with or without eating disorders, functional hypothalamic amenorrhea and osteoporosis. The priority for those working with female athletes should be the prevention, recognition and treatment of these conditions, and to ensure they maximise the benefits of regular exercise.

Later in the afternoon, Dr Nat Padhiar, Consultant Podiatric Surgeon, Royal London Hospital, described the female foot in great detail. Dr Padhiar described stilleto heels and fashion shoes as the modern equivalent of foot binding, with consequences for foot biomechanics and subsequent problems. In comparison to male feet, female feet have thinner cartilage and smaller joint surfaces, which may contribute to the specific differences in the development of injury patterns. The presentation focused on several case studies, and addressed the comparison of female to male feet, the role of footwear in foot shape and the types of problems that women may face in sport. Dr Padhiar also discussed the role of ultrasound image guidance in assisting with injection techniques.

Before the final whistle, Dr Sandra Wolfson, Principal Lecturer in Psychology and consultant for the Football Association, explained that soccer players are tribal, and defend their home territory! Dr Wolfson gave compelling evidence that the old wives tale of having an advantage when playing at home is true for male soccer players, but female soccer players do not seem to have such advantage. Could it be because only a few of the female teams have a real home ground? In any case, Dr Wolfson’s talk gave a lot of food for thought!

Even though the number of women participating in football is increasing exponentially the lack of funding means that sometimes, as a doctor for a women’s team, you feel rather by yourself! Having all the experts and other medical staff under one roof provided a great way to learn about this area of Sports medicine, and also to meet contacts. The talks were both informative and relevant and I will definitely be applying what I have learnt when I am with my team. All in all, a great day!

The next meetings are 9th December 2011 (Foot and Ankle plus Core Stability) and 16th March 2012 (Muscle Problems and Pathology).

For a booking form visit: or email Barry Hill at