Preventing injuries and protecting players: How scientific research can drive women's football forward

ACL injuries in women’s football have been the subject of attention for a long time, and in December 2023, UEFA created an expert panel to better understand their causes and prevalence.

In Lugano, members of that panel dispelled some of the myths surrounding ACL injuries in female players.

Research actually shows that the regularity of these injuries in female players has remained consistent over the past two decades, and while there are increased instances compared to male counterparts, contrary to media reports, there is no epidemic in the women's game – ACL injuries continue to affect 1-3% of players during a season.

What is crucial is implementing reliable and practical injury prevention techniques. Dedicated exercise-based programmes can reduce the risk of ACL injury by up to 50%.

By adopting this simple strategy, we can collectively combat fear of the so-called "ACL epidemic" and improve the outlook for players at risk of injury.

It is not just the risk of ACL damage that can be mitigated with effective strength and conditioning training.

A structured, progressive long-term athletic development (LTAD) plan helps to build a foundation that prepares young players for a senior career and is crucial for reaching optimal performance and reducing the risk of injuries.

Differences in maturation mean girls can be more susceptible to problems between the ages of 16 and 19, but this can be mitigated by tailored and age-appropriate strength and conditioning training, which should last throughout a playing career.

"LTAD is across the whole career, from grassroots through to the end, not just in youth development, and different attributes require different levels of focus at different times," stressed Paudie Roche, physical performance lead at Arsenal Women FC. "It takes patience, but once the players buy into it and understand this gym exercise will make them better on the pitch, it can be a success."

Limited coaching time is often cited as a reason for not implementing such physical work, but Dr Stacey Emmonds, associate professor in sports performance at Leeds Beckett University, believes medical and fitness experts can work alongside technical coaches to achieve shared goals.

"It is often overlooked how much [medical professionals] need to understand the coaching side of the game," she said. "You don’t necessarily need to have the same technical knowledge as a coach, but how to manipulate some of the drills they do to embed some of these LTAD ideas."

Prevention of injuries is one thing, but protecting players' wider health beyond the game is also crucial, and medical teams must play their part to ensure players are also cared for away from the pitch.

For example, 61% of female football players sampled report breast pain or discomfort, a higher figure than the general population and other female athletes. Leading research indicates that elite players still need more education to make better bra selections – appropriate and well-fitting sports bras can improve breast pain, comfort, support and performance. After individual bra assessments and fittings, 91% of players have reported an improvement in their comfort, showing that problems can be solved with the right guidance.

UEFA has already conducted extensive research into menstrual cycles and the impact on player well-being and performance. The aim is to empower and educate players, their coaches and medical teams to monitor their cycle so that they can train and compete to the best of their ability on any given day – there is no scientific reason why players cannot perform to a high level during their period.

This week's event also included discussions on pregnancy and how much activity is suitable for players expecting a baby. It is widely accepted that more research is needed in this area, with UEFA medical guidelines recommending that pregnant players do not compete but can still train to maintain base fitness.

Finally, former Austria international Viktoria Schnaderbeck, who won domestic titles in Germany and England, shared her experiences in dealing with mental health issues during her playing career.

Schnaderbeck stressed the importance of medical teams offering psychological support to their players. "You're expected to perform on the pitch, but nobody really understands what's inside of you," she said. "It would have been easier if physios and doctors were asking me these questions and offering help, because it's hard to ask."