Alexia Putellas’ injury highlights the disproportionate number of ACL injuries in women’s football

For the second successive major international women’s tournament, the winner of the Ballon d’Or will miss out.

At the 2019 World Cup, it was Ada Hegerberg during her absence from the Norwegian team. This time, Alexia Putellas will play no part for Spain at Euro 2022 after tearing her anterior cruciate ligament (ACL) on the eve of the tournament and just three days before Spain’s opening game against Finland on Friday.

The midfielder has promised to “get back on track and finish what I started”, but said she would not dwell on “why now, why a day before the start of the Euros that I’ve been looking forward to and working towards for such a time.”

Putellas’ injury has reopened the conversation about why female footballers are more prone to such injuries. Angel City FC forward Christen Press (formerly of Manchester United) recently suffered the same fate as Putellas, while in the Australia national team, three players have ruptured their ACL in the last year – the most recent being Ellie Carpenter.

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According to the Yale School of Medicine, research has shown that women are two to eight times more likely to sustain ACL tears than men – and while the exact reasons for that discrepancy still need more research, the fact women have a wider pelvis alters how the joints and bones in the legs are affected by pressure.

Nathan Thompson, a lecturer in sports rehabilitation and conditioning at the University of Northampton, tells i: “It’s partly due to the demands of the sport, but also the anatomical and neuro-muscular differences between females and males.

“Females having a wider pelvis can affect knee angles and can make them more predisposed to ACL injuries,” Thompson explains. However, as there has historically been less female participation in sports research, most of it has been conducted on male athletes.

Women are also “more quad-dominant” with “less hamstring activation” compared to males, which makes them more susceptible when performing everyday actions in football like accelerating, deaccelerating, changing direction on the pitch and jumping in the air.

With more research now being dedicated to female athletes specifically, it’s been found that knee injuries are the most common injury that disproportionately affect women footballers, though ankle injuries are also included in that bracket. Injuries can also be influenced by the menstrual cycle due to its effect on the biomechanics of female players.

Many training exercises within women’s football are carbon copied from the men’s game, but not all are as well-suited to female athletes. “Most techniques would be fine, i.e. suitable for both men and women, but these should be coupled with – when necessary – nuanced female-specific adaptations,” Professor Kirsty Elliott-Sale from the Manchester Metropolitan University Institute of Sport tells i.

“This means that rather than disregarding the lessons learnt from the men’s game and starting from scratch, existing models and techniques should be adapted when needed to incorporate female-specific issues.”

The timing of Putellas’ setback could not be worse. The most high-profile European Championship in history has been robbed of one of its star attractions, Spain’s chances have been weakened and the 28-year-old has been struck down at her peak.



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