By: 22 August 2023
New data sheds light on prevalence of ACL injury

New data on ACL injury identifies key causes and gives recommendations for prevention and rehabilitation

 New data presented at the Isokinetic Football Medicine Conference in London reveals both optimum prevention and rehabilitation techniques for female footballers with ACL injuries. ACL injuries are arguably one of the most debilitating injuries in women’s sport.

In a ground-breaking number of new studies focusing on women specifically and presented at the Isokinetic Football Medicine Conference in London the following recommendations / data shows that:

  • German researchers have identified four distinct match situations that lead to ACL injury in women’s football
  • Early use of hydrotherapy pool is essential
  • Need for immediate and early access to rehabilitation to prevent loss of overall performance
  • Players want staff education, and knowledgeable discussion of menstrual cycle and close monitoring
  • Specific intervention training can help alleviate likelihood of ACL injury

Isokinetic Medical Group specialises in sports medicine and rehabilitation. It is recognised as a FIFA Medical Centre of Excellence and is a reference point in international orthopaedic and sports rehabilitation sectors. The power of innovation is found in the strategic positioning of its “Education and Research Department” at the heart of the Isokinetic system.

Dr Jesus Olmo, Isokinetic Sports Doctor and former Real Madrid CF Medical Director said; “It is important for players to know that we can reduce the risk of ACL injury in women happening in the first place with our Movement Analysis Test (MAT). Analysis with a doctor in the clinic’s biomechanical lab (Green Room) measures of neuromuscular control by understanding each player’s movement patterns with the MAT test. Targeted Neuromotor training in the Green Room with augmented and real-time feedback on video-walls to optimize movements and neuromuscular control. Everything before challenging the players in further testing to monitor the improvement. After injury we are also able to rehabilitate following ACL surgeries to give the player the ability to have increased performance and lower risk of re-Injury.

“In specific relation to Keira Walsh’s injury, it is non-contact and abrupt stop when lunging to reach a ball. There is probably a last milliseconds mechanical perturbation caused by the ball, but not from other opponent.

1. Four distinct match situations in Women’s Football that cause ACL injury            Four Distinct ACL injury Match Situations in Professional Women’s Football – L. Achenbach, H Bloch, C. Klein, T. Damm, M Obinger, M Rudert, K Fehske, W. Krutsch, D Symski – Julius-Maximimilians-University Wurzburg, German Statutory Accident Insurance for the Administrative Sector, Hamburg, University Wurzburg, University of cooperative Education for Sports and Health, Baunatal, University of clinic Regensberg

The German study analysed in depth  35 ACL injuries in professional women’s football between 2016 and 2022 and sought to identify mechanical patterns. They found:The four distinct match situations are:a) non-contact ‘defensive pressing and abrupt stop’;b) non-contact landing and twist;c) Indirect contact mechanism ‘parallel sprint and tackle’;and d) direct ‘knee to knee’

  • 43% were non-contact injuries
  • 40% indirect contact injuries
  • 17% direct contact injuries
  • Of non-contact injuries nearly half (47%) were sustained during the first 15 minutes of the match
  • Horizontal movements dominated (i.e. sprinting 20%; change of direction manoeuvres 14%; stopping 14% and lunging 14%)

Dr Matthew Stride, Isokinetic Sports Doctor and former Club Doctor at Brentford FC, said: “In direct relation we should note that in the 2021 Euros, England women’s national team did not have any injures and there is a strong correlation between success and player availability.”

2. Hydrotherapy

Early Pool Neuromotor Training: A Case after ACL reconstruction – s. Maretti, A. Marzi, A. Pizzirani, G. La Rosa, Isokinetic Bologna, Isokinetic Medical Group

The aim of the study is to highlight how early neuromotor training in water can allow an optimal recovery of specific movement patterns in terms of quality of time. The main targets of the pool period were R.O.M. (recovery of movement), core stability improvement and gait normalization. The study took place over 30 days on the pool based on 10 sessions per week.

The results showed that patients achieved a good quality of movement in a relatively short period of time (131 days from surgery). This allows the patient to move onto on-land high intensity neuromotor training in optimal condition. The higher level of functional strength was supported by a better psychological profile of the athlete (ACL-RSI) and increased ability to carry out an optimal Movement Analysis Test (MAT).

3. Early intervention rehabilitation

Isokinetic Testing in a Female Footballer Following ACL reconstruction – N. Pickford, Prime Health Manchester

Reported on a female footballer whose rehabilitation plan lacked focus due to the Covid-19 pandemic resulting in overall slow and below average improvement and specifically creating low limb strength. Overall, because of a lack of immediate rehabilitation her scores on quadriceps, hamstring were lower affecting high speed running performance.

The case study illustrates the need for immediate rehabilitation programmes to maintain strength and performance in the rest of the body and allow the patient to return to full performance as soon as possible.


4. Players want menstrual cycle monitoring and management

Menstrual Cycle Experiences in Elite Women’s Football: A Qualitative Study – T. Martinovskae, O. Materne, K. Sharp, B. Drust, S. Shanmugum – Glasgow Caledonian University, Rangers Football Club, university of Birmingham

International professional female footballers were monitored at Glasgow Rangers football club. Interviews and questionnaires were used to assess the perceived physical and psychological effect of menstrual cycle. A combination of deductive and inductive (reactive) questioning was used.              Most players recounted experiences of Menstrual Cycle being taboo in their youth experiences of football and all reported negative symptoms during their cycle. Most players agreed that sharing and tracking their cycle with club medical professionals would have a positive impact on performance and mental health.

Players want coaching staff to be aware and knowledgeable about symptoms and management. Players would like to be checked in on by staff members. This could be achieved by improving education regarding menstrual health across all stakeholders withing the team, especially crucial to alleviating anxiety in younger players.


5.  Modification of player movement can reduce risk           Biomechanically Informed Approaches to ACL injury Prevention in Sport – G. Weir, New York YankeesThe New York Yankees study identities and recommends in advance screening of player movement to modify an athlete’s technique to reduce the externally applied  loads to the knee, increase muscle support around the knee and improving an athlete’s perception of the task.Specifically the study identified four key training messages to shape a training intervention and these are:

  • Increase knee flexion at foot-strike
  • Improve dynamic trunk control
  • Increase gastrocnemii muscle strength and activation
  • Mitigate dynamic knee valgus postures (knock knee or where the angle between femur and tibia is smaller than it should be on the inside of leg)


Andrea Tartaglia, Managing Director, Isokinetic London, said; “There is an epidemic of ACL injuries that has sidelined many stars and sparked fear among players. The exact reasons for higher ACL tear rates in women vs men are debated and amongst the theories are anatomy, hormones, and other factors. We want to further the pool of research to alleviate the uncertainty and anxiety for players. Data is beginning to show us that a heavy game workload and intensity with insufficient recovery resources may contribute. There are also structural issues like poor fields, unsuitable gear and shoes. We need to give players answers and solutions to make them feel safer on the pitch. We know that preventing recurrent ACL tears is challenge – 40% tear again within 5 years and multiple ACL rehabs take mental toll – some retire early out of fear of re-injury. Women’s football needs more resource and better injury prevention.”

Isokinetic believes that exercise is medicine, treating the whole person in a unique environment to optimise healing and positive change. Trusted by FIFA as a global Centre of Excellence, Isokinetic are organisers of the world’s most renowned Football Medicine Conference. Isokinetic London has been at the heart of London’s Harley Street area for a decade but stems from a network of other 7 clinics in Italy. Together they have accumulated over 35 years of experience in the prevention, diagnosis, treatment, and rehabilitation of sports and orthopaedics injuries. The unique pathway is meticulously tailored to patient recovery. From welcome reception, appointment making, and treatment, everything is geared to the individual patient whether we are treating an elite athlete preparing for competition or a person experiencing a degenerative condition like osteoarthritis.

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