New data presented at the Isokinetic Football Medicine Conference in London reveals both optimum prevention and rehabilitation techniques for female footballers with ACL injuries – arguably one of the most debilitating injuries in women’s sport.
Data from a number of new studies focusing on women specifically and presented at the Isokinetic Football Medicine Conference in London, 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
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 optimise 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.”
Four distinct match situations in Women’s Football that cause ACL injury
A 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 per cent were non-contact injuries
– 40 per cent indirect contact injuries
– 17 per cent direct contact injuries
– Of non-contact injuries nearly half (47 per cent) were sustained during the first 15 minutes of the match
– Horizontal movements dominated (i.e. sprinting 20 per cent; change of direction manoeuvres 14 per cent; stopping 14 per cent and lunging 14 per cent)
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.”
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 normalisation.
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).
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.
Players want menstrual cycle monitoring and management
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.
Modification of player movement can reduce risk
Biomechanically Informed Approaches to ACL injury Prevention in Sport – G. Weir, New York Yankees
The 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: “We know that preventing recurrent ACL tears is challenge – 40 per cent 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.”