#ACL Injury

[desperate-gay]

giggling, blushing, kicking my feet

[arsenal-womens-1]

The footballers diary

19/11/22 

 

Today was like any other match day. I woke up showered, got ready, waited to be picked up from my apartment. Training was normal, so was the bus ride. Everything leading up to that moment was normal. It was extra time. I was near the goal. The only thing I saw was Beth and Hannah Blundell both running towards the ball. Out of nowhere, Beth dropped her knee in her hands. Pain was written across her face. 

 

20/11/22

 

I woke up to the sound of my phone blowing up and picking it up. The first thing I saw was the first text Vivian sent. 

 

Viv: Beth wanted me to tell you all that they did some tests and she has ruptured her acl. 

 

2:23 am 

 

15/12/22

 

Its been exactly 27 days since Beth did her acl todays yet another home game. I didn't start the game a few seconds into extra time from where I was sitting. You couldn't see what happened. Lyon plays run into a group hug and the fans cheer. The match restarts. Viv gets the ball, passes it to lotte, who then passes it forward to Lia. Three Lyon players close on her and get the ball. Viv goes for it and tries to knock the ball a way from the Lyon player. She falls straight to the floor. Lia passes the ball to Katie. She must have seen. She passes the ball back to Frida. The ref blows her whistle. 

 

16/12/22 

 

It was like deja vu. Only this time it's a text from Beth. I opened my phone and clicked on the Arsenal group chat. 

 

Beffy: Viv asked me to text you all she doesn't know how to tell you all. so she asked me to text and tell you all that she tore her ACL last night. 

 

18/4/23

 

Tomorrow is match day, and I'm scared. A lot of the girls are it’s like this team has some sort of bad luck in under 4 months. It's the World Cup, and everyone is scared that they will be next. 

 

19/4/23

 

Match day nerves ran through the team we were playing in a 4-3-3 i have no clue what happened i had just been sent off less than 5 minutes before for a tackle on ella toone  it was a shit tackle i know but she was pissing me off i was in the changing room when i heard the sound of football boots 2 horse after it was confirmed leah had ruptured her acl im scared im going to be next 

 

1/5/23

 

What the actual fuck? It has been 13 days since Leah did her ACL. I just got the text confirming that Laura has ruptured her ACL. What is happening? 

 

5/5/23 

 

I just got the call from Sarina Wigwam asking if I would like to go to the World Cup. Of course, I said yes. 

 

22/7/23

 

We played Haiti, and we won 1-0. Georgia scored the goal. Apart from that, there's nothing much to say today. 

 

28/7/23 

 

We played Denmark today, and we won yet again. 1-0 lj was the one to score. In other news, I saw a kangaroo today. A few of us made some tiktoks and went for a walk. 

 

1/8/23 

 

We won 1-6. I'm tired, so there's not a lot to say. 

 

16/8/23 

 

Forgot about this. Sorry, we won today 1-3, which means we are going to a final. I can't wait. 

 

21/8/23 

 

Well, we lost, Spain won. I dont know what happened. All I can think about is the pop. I knew what it was the second I went down. I have had it described to me a thousand times. Now I am sitting here on the other side of the world in the same place. Four of my team members have been Why did it have to be me?

[square-watermelon]

Why are we acting like Gavi died 😭😭😭 Y'all seriously had me thinking he broke both legs or sm

[diosamorosa]

feeling grounded within myself more & more every day

[wosoandstuff]

I just read that in just 27 days so far in 2024 we already have 11 cruciate ligament ruptures in players.

How many more players will it take to finally get to do extreme studies to avoid the injury?

I mean, I know some have started investigations but idk, I feel like they're not making enough effort🤷🏻‍♀️

Also, if you want to keep up with players who have suffered from ACL, I just found this user on X (aka Twitter) who keeps the info up to date: https://x.com/aclwfc?t=Cec0ip3AyLwxD8lSOxXEmg&s=09

[nakhra]

look, i know that workload isn’t the only factor contributing to the ACL epidemic, but the fact that it’s not even 30 days into 2024 and you could already field a starting 11 of woso ACL injuries, and fifa only want to add more games to the load with that club world cup in 2026? they’re just hungry for money.

on paper, a club world cup is awesome. but there’s about 38303849 things that need to happen first. yeah, there needs to be research, but there already has been so much research that clubs aren’t using. better playing surfaces, equipment made for women, more PTs per player, more staff in general, diet planning around menstrual cycles, better accommodations, i could go on and on. and clubs and federations around the world need less disparity within their own leagues.

there is research, but it’s all fucking useless if no one USES IT.

(the tailoring of nutrition around cycles bit is really interesting and i would suggest listening to the episode of the recap show where christen and tobin interview dawn scott. i’ve linked the episode here but you can also find it on youtube and skip to the interview)

[leennaan]

I just realized that Leah will be almost back on the pitch after the winter break 🤩🥰

War is (almost) over🥹

[faofinn]

9. White Coat Syndrome

Holidays were a rare treat for the Cunningham-Cole crew. Both Taidgh and Harrisons jobs were difficult for raising a family, but they refused to let it get in the way. Each day out was precious, even a few hours at the park, a walk to feed the ducks, the tiny things that meant the world to both dads.

With the kids old enough to actually be a contender in races, Harrison often brought his running blade to join in - he wasn’t going to let Tai have the fun. So that's where they found themselves on a warm Sunday morning, charging around the park like idiots. They'd planned to stay the day, picnic packed and ready. Levi was old enough to join in, though he didn't always undenal the rules of whichever game they were playing, occasionally ending up in tears. 

Frisbee was easy enough, so they eventually moved onto that. The park was quiet enough, though the hum of other families laughter carried across the air.  Even Harrison's laughs carried across, Alfie having his life and loving it. Scout was just as bad as them, haring around the park and herding his family. 

Tai loved their weekend days out, when the whole family could mess around together. It was a warm day, the sun shining over the grass. The kids were rowdy, on their last few weeks of school holidays, and it had been good to get out of the house. He’d been haring about with them that morning, trying to catch up with the kids, but his knee had twinged and he’d ended up sat on the picnic blanket watching them play Frisbee, Scout rushing madly between them as he tried to catch it mid-air. He let them play for a while, before his stomach growled at him and he couldn’t ignore the food he was sat next to any longer. 

“Hars! Kids! Come on, lunch! I’m starving to death over here!” He called. 

They raced over, Scout leading the way with his bounding strides. The boys were close behind, but Harrison lagged slightly, his own leg starting to ache.

Harrison settled by Tai, wrapping an arm around his waist as he pressed a kiss to his cheek, the pair like lovesick teenagers. Of course, the kids made their displeasure known, a quiet chorus of gross as they laughed. 

Tai leaned into Hars, grinning at the kids. “You’ll get it when you’re older.”

"Ew, no! It's gross!" Kieran laughed, his nose scrunched. 

“You’ll get a kiss too, if you’re not careful!” Tai teased, reaching out for him. 

"No! Alfie, help!" Kieran wriggled away, shouting and laughing. 

“I’ll get you both!” Tai said, as Alfie piled in, and Scout tried to join in too, barking and hopping excitedly. 

Harrison sat back with a smile, looking proudly on at the chaos he'd created. He grabbed a sandwich while the others were distracted, sneaking Levi a piece of cheese his youngest had been eyeing up. 

Eventually the chaos died down, the twins and Tai flopping back on the blanket breathless and grinning. He reached for the food, grabbing a sandwich. 

As the kids dug in, Harrison nudged Tai's thigh. "Hey."

“Hey, you okay?”

"More worried about you. I saw you twist it."

“Just a little twinge, I just didn’t want to do any more damage to it."

Harrison rubbed his thigh. "Are you in pain?"

“Not now I’m sat down.”

"Are you sure?"

“Yeah, it’s not bad. I just didn’t want to be haring around on it and making it all swollen. If they don’t do this op tomorrow I’m going to have a breakdown.”

Harrison hummed, fingers trailing over skin. "Yeah, I know."

“Are you sure work are okay with your time off?”

"As if I'd give them a choice."

“And Steve’s okay with having the kids?”

"He's looking forward to it."

“Mm, okay.” He said, and kissed his cheek again.

Harrison reached a hand to cup his cheek, tilting his face up to kiss him properly. His thumb stroked his cheek as he pulled back. "It's going to be okay. I love you."

Tai smiled. “Love you too.”

He quickly pressed a kiss to Tai's nose before moving to lean against him and reaching for his can of pop. "You know I'll be there for you, whatever you need."

“Pass me another sandwich?” He asked cheekily. 

"What's the magic word?" He teased, dangling it out of reach. 

“Mm, please?”

Harrison grinned. "Nope."

“Hey!”

"You gotta say the magic word!"

“Please is the magic word!”

"Nope!"

“Come on!” He whined, kissing him on the cheek again.

Harrison's resolve cracked. "It's a good job I love you."

“And I love you too.”

Their day was heaven, a picnic in the warmth followed by more stupid games after they’d eaten. Eventually, though, they headed home, all of them just completely shattered. It was a job to corral sleepy kids to bed, Tai and Hars exhausted themselves. Scout had spent the evening sprawled out asleep on the rug in the living room, looking like they felt. 

Even Tai and Hars had headed to bed early that night, aware they were up early the next morning. They fell asleep with Tai’s head resting on Harrison’s shoulder, warm and comfortable. When their alarm went off the next morning, Tai just snuggled up against him, refusing to move. 

He was eventually coaxed out of bed and got dressed, enjoying the last glass of water he was allowed. Steve arrived to look after the boys, and after some hugs and fuss, the pair of them headed to the hospital. It was weird, driving their familiar commute for something other than work. 

Harrison knew Tai was stressed. He could feel it a mile away. Of course, he was worried too, not just for the operation, but his recovery and everything that came with it. The operation itself was rubbing a little too close to home for Harrison, having had so many himself. It was the right leg, too, which only stirred up more emotions for him. He shook his head to clear his mind, taking Tai's hand as they headed in. 

Tai squeezed his hand gratefully, heading through the doors into the day surgery unit. It was unfamiliar, which was both good and bad, but he signed in at the desk and then it was a waiting game, his left leg bouncing anxiously. 

"You've got your bag, you've got stuff for after, some juice and some throat sweets." Harrison murmured, mainly to himself. "And you've got your sweets for emergencies, and I put an extra juice box in for you, too. I've got the insulin and I'll give it to the nurses when we get there."

Tai glanced over at him. “What would I do without you?”

"Probably be a lot less stressed." He admitted with a laugh. 

“A lot more stressed, more like.” 

"Mm, maybe."

“Got you to look after me.”

"I'll always look after you."

“Yeah.” Tai said, moving to rest his head on his shoulder. 

"Sickness and in health. All that bullshit." He pressed a kiss to his hair. "And anyway, we've got the kids. I can't manage them alone."

“You could.”

"I wouldn't."

“I hope they’re okay with Steve.”

"I think it's the other way round." Harrison managed to joke. "I think dad's gonna regret offering."

“Probably, they’re nightmares.”

"I can't even stand up for them. I know I should." He said sagely, trying to keep a straight face.

“They’re feral, but hopefully yesterday tired them out enough.”

"I hope so. Scout was bloody knackered, bless him."

“Looked how I felt.” Tai agreed. It wasn’t long before they called him through, and he gripped Harrison’s hand as he stood. All he wanted was to go home, but that wasn’t possible. They asked him to change, and they’d be back for obs and things. He hesitated, looking at his fiancé. “Can I just sack this off and we just go home?”

"Don't be daft." He shook his head, though wanted nothing more than to do the same. "You need this sorted. Just think, this time tomorrow, all the operations and stuff will be done. And you'll only have the physio to do."

He pulled a face. “Even worse.”

"What, you're not looking forward to physio?" He feigned shock.

“Nobody looks forward to physio, knob.” He shot back.

"And after all the shit you gave me?"

“I’m allowed to give you shit, we’re getting married. Besides, I’m already doing physio.”

"Yeah, well, I'm doing a physio."

He snorted. “That’s a terrible joke. Can we go home? I don’t want to do this.”

"No, we can't." Harrison sighed. "And I'm not being a dick, but you need to take a few deep breaths, try and relax as much as you can. I can feel your anxiety from over here, and it's not gonna help you."

He forced himself to take a breath, his lips pressed tightly together. His shoulders slumped as he let it out, reaching for Harrison. “I hate hospitals.”

Harrison stood, moving to wrap his arms around his fiance. "I know, I know. I've got you."

He leaned into him, taking another deep breath and focusing on the smell of him, washing powder and aftershave and something that was just him. Some of the tension drained from his shoulders, his body softening against Harrison’s. 

"That's it, well done." He praised, kissing his forehead. "Another slow breath.'

He nodded. “Feel all sick and anxious.” He admitted. 

"I know, I know. It's fucking shit." He soothed. "But you'll get all the good drugs soon, get a nice little nap, and you'll wake up with your leg sorted."

“I’m such a baby, jesus.” 

Harrison couldn't help his smile. "I know it's the wrong time and all that, but I really love your accent."

“Piss off.” He grumbled good-naturedly. “It gets softer all the time, being stuck here with you.”

"We should go across, once you're better. I'm sure your mum would appreciate it."

“She would, it’s been too long since she’s seen the boys.”

"Tell you what, Christmas? Steve said he'd come too, we'll go over for the two weeks. Stay in a cottage, have Christmas there." He said, feeling Tai relax into him. 

“As if you’ll get two weeks of leave at Christmas.”

"Watch me."

“Only if you forge a sick note will you get that much time off. And don’t even think about it.” He teased. “I don’t even think I could get that much off, but maybe a few days before new years?”

"We'll manage it."

“What about going to Fao’s? Won’t you miss that?”

"You miss your family for mine."

“I love your family.”

"My point still stands."

“Mm, it would be nice to go back. You won’t understand a word.”

"Be nice for the kids to have the accent though." He smiled, glad Tai was relaxing more. "Be like mini yous."

“We’d need to move for them to have the accent, really. Right now they’re just gonna end up like Fao.” He joked. 

"Oh, I don't know which would be worse." He teased, his face falling as the door pushed open. 

Tai tensed, his jokes forgotten as the door creaked open. 

"Hi, Tai? Ah, excellent, you're all changed. I'm just gonna grab a few obs off you, and then we'll pop you through."

He nodded, swallowing thickly. “Okay.” He untangled himself from Hars, sitting down. 

Harrison mirrored his actions, sitting and fidgeting with a stray thread. The nurse was nice enough, but Harrison couldn't focus on their conversation, his eyes trained on the monitor. 

Tai did his best to try and relax, focusing on his breathing. He’d looked to Harrison, but he was just staring at the obs machine, and that didn’t help. He tried to think of something else, of the Christmas trip they’d been planning, but the stupid thing had sound and he could hear how fast his pulse was, the way the blood pressure cuff squeezed so tight his fingers tingled and he prayed it wouldn’t be ridiculously high. 

The nurse made a soft noise. “Oh, those are a bit on the high side, aren’t they?”

“I’m, uh, a really nervous patient. White Coat Syndrome and all that.” Was Harrison going to be pissed he was anxious again?

Harrison frowned at the obs, and stood up. He moved back to Tai's side, kissed his cheek and hopped on the bed next to him. He laced their fingers together, bringing their knuckles to his lips. 

"Deep breath together?" He said softly. "Make you feel better."

He nodded, forcing himself to take another deep breath with Harrison.

He kissed their knuckles. "And again? All the way down, from your head to your toes."

“Gonna make me go dizzy.” He grumbled, but did as he was told after a few moments, focusing on drawing the breath all the way to his feet. 

"Don't make yourself dizzy." Harrison murmured with a gentle laugh. "Defeats the point."

“I know.” His pulse had come down, and the nurse hummed. 

“I don’t suppose you do your blood pressure at home, do you?”

Tai nodded. “Yeah, they asked me to at pre-op, given my anxiety. Last one was 121/83.” 

“Oh, perfect.”

"He's the fittest person I know." Harrison said. "And I know I've gotta say that, but it's true."

“Well, I’ve not been so good recently, but I do my best trying to stay fit.”

Harrison stroked his thumb over the back of his hand. "You know, he even does the physio he's supposed to."

“Only because if I didn’t, I’d be the world’s biggest hypocrite. Practice what you preach and all that.”

The nurse laughed, leafing through the paperwork. "Ah, yeah, here we are. You've got your blood pressures for the week. Bless, you really are nervous, aren’t you?"

He nodded. “Really nervous. I’m awful, I hate needles and I’m not overly fond of hospitals as a patient.”

"I don't blame you, not one bit. They're not nice to be in." He smiled. "Unfortunately though, we will have to put a little needle in when we go through."

“Yeah, I know.” He said. “I’d rather that than no anaesthetic, but I’m not a fan.”

Harrison huffed a laugh. "Hey, maybe they can get you a sticker for being such a brave boy? Finn did it to me for my last one."

“Oh, piss off.”

"I'm not even joking. He found a little cat one, and I woke up with paed tape on my cannula and a "good boy" cat sticker stuck to me." He laughed. "Ely was in on it, I swear. So was Fao."

“I don’t remember that.” He said softly. 

"Oh, I shouldn't have said anything. I've ruined my surprise."

“Arse.”

He kissed his cheek. "I know."

The nurse smiled at the pair. "Your heart rate has come right down to normal now."

“He usually makes it go up.”

Harrison blushed immediately, his ears tipped red. "Tai."

“I didn’t mean it like that! I meant you’re always stressing me out!”

The nurse laughed again. "Right, before Harrison here melts, why don't we get you through? The sooner you go down, the sooner you can be in recovery."

Tai couldn’t help the anxiety that shot through him. “Already? Thought I’d have to wait longer.”

"You're top of the list. We'll pop you through to the room and the anaesthetists are waiting for you to have a quick chat and then they'll take you down."

He nodded. “And Hars can stay?”

"For now, yeah."

"I've already spoken to them." Harrison said quickly. "They know."

“Okay then.”

Harrison squeezed Tai's hand. "We've got this. You’ve got this."

[ineedfairypee]

When your anxiety convinces you that it’s been so long something must have gone wrong but you can’t check if something’s gone wrong cause if it has then the people who could tell you something’s gone wrong would need space 😩😭💔

(She was absolutely fine and came out wearing the hilarious T-shirt I made her)

[wtficedance]

hi! i don't necessarily follow women's football but i know some things and i noticed there's a high percentage of ACL injuries in female footballers. i wonder if there's a similar case of ACL injury in women skaters as well? do female footballers and female skaters use their legs differently, biomechanically speaking?

Q #203:

Hi Anon,

First of all, apologize for taking this long. This has been sitting in my notes and I’ve been adding to it for a few weeks. You have come to the right place to talk about the biomechanics of injury, especially in footballers (as someone who grew up playing competitively for over a decade). Football, basketball, volleyball are all lateral impact sports. There’s lots of landing and pushing off to the side and hard planting to quickly change direction. The planting, that really sharp force and change of momentum, is often where athletes tear their ACLs. It’s almost always non-contact, the ligament just experiences too much torsion and shear stress and tears. Skating is less of a lateral sport, because of the glide (in comparison to running where there’s an impact with the stride) so while stroking uses some exterior rotators (the glute medius, piriformis, etc) there’s not a jolt of force in the knee like there is without skates.

In field sports (football, American football, lacrosse, field hockey, rugby) there’s an element of cleats having too much traction with the turf, and getting stuck while the body’s momentum goes another way that wouldn’t happen in a sport like volleyball or basketball. This is also more of a factor on artificial turf than grass, which is why there’s been a major push in women’s football for international games on grass, even in the NFL there has been an increase in demand for grass. That’s not as much a factor in skating.

For female skaters, like Kaitlin Hawayek, who are unlucky enough to tear their ACLs it’s a lot more likely that it’s a contact injury, with a force being applied on the outside of the knee so it caves in and the ACL tears trying to stabilize it. This can happen coming out of a lift or a freak fall, but it’s less likely to a routine stroking motion like a crossover or turn like it is for field athletes. I’m guessing that Kaitlin’s ACL happened on a curve lift dismount gone wrong where her skate got caught and then lots of outside force was applied to her knee.

Female footballers have a uniquely high rate of ACL tears (and other ligament injuries) compared to peers in other sports and their male peers in football. Here’s a few of the reasons that researchers point to as risk factors:

- There’s a social factor that female athletes are more discouraged from strength training which helps balance the strength of the quads and hamstrings which is often a contributing factor to knee stability. And generally female athletes begin puberty earlier and are at a critical part of their musculoskeletal development when they’re most insecure about their body’s and most discouraged from doing resistance training for injury prevention.

In this 2020 literature review [2] of 12 studies on injury prevention protocols in women’s football, they found that “there is low-level evidence that multicomponent, exercise-based programmes reduce overall and ACL injuries by 27% and 45%, respectively.” It should be noted that this literature review included 9/12 studies focused on adolescents (9-18yo), which is that critical period for musculoskeletal development & a time period of extreme social vulnerability.

Across all sports, protocols using agility, plyometric, balance, mobility, and strength protocols are very effective at preventing injuries. “Systematic reviews confirm the efficacy of such programmes to reduce ACL injuries,35 for all athletes and all sports (OR=0.50; 95%CI 0.41 to 0.59), and female athletes specifically (OR=0.33; 95%CI 0.27 to 0.41).“ OR means “odds ratio” so for all athletes/all sports the protocols halves the risk of injury per incidence of risk and for female athletes it reduces it by 67%! Which is huge. And shows that well-rounded training programs are more-so important for female athletes because of general social attitudes that deter strength/plyo/agility training in favor of cardio.

Here’s a little chart of their multi-component studies just for comparison.

- Female athletes are more likely than their male peers to have eating disorders and to deal with malnutrition because of general social expectations. This can lead to weaker muscles, tendons, ligaments, and bones that are more prone to injury at the same impact forces that wouldn’t injure someone not suffering from malnutrition.

- Female athletes are given fewer resources when it comes to training centers, facilities, artificial turf/grass etc. Additionally, more female athletes work at least part-time if not full-time jobs which leads to greater fatigue, less sleep and recovery time, etc.

- Only 6% of orthopedic and sports exercise research is done exclusively on female athletes, so a lot of current sports and recovery science is done on male athletes and just generalized across populations, which ignores female-specific factors. And a lot of papers available on this matter that attempt to derive a conclusion about causality/risk are from reviews not necessarily cohort or longitudinal studies.

- I’ve talked about this previously but the Q-angle, the angle the hip socket sits from the sagittal axis relative to the knee, is more exaggerated the wider your hips are. And it’s almost always larger in women. The additional lateral force makes the knee more likely to bow in and causes shear strain in the ligament. This bowing makes the ligament more vulnerable to tearing than in male athletes who have narrower hips. Strength training with emphasis on external rotation, foot position relative to knees, and weight distribution is important to account for differences in bone structure, and why sports science that’s centered around only male athletes results in a flawed approach for injury prevention in female athletes.

- Football is an extremely fatiguing sport because of the length of games as opposed to sports like basketball and volleyball where there’s more natural stoppage of play. In addition to just endurance, explosiveness is needed in the 89th (and 119th) minute, and the intra-joint forces necessary to create that explosive power are quite large, and when fatigued incorrect body mechanics can lead those intra-joint forces to be applied to weaker structures in the knee.

From a 2021 study [2] focused on changes in biomechanics under fatigue in female footballers w/ 20 participants from 20-31yo: “Knee extension moment decreased in 8, knee valgus moment increased in 5 players. A subset of participants showed a drift of pivoting limb kinematics that matches the known ACL injury mechanism; other players displayed less definite or even opposed behaviors.” 

Valgus is a description of a pattern of movement in the knee other than extension/flexion. Particularly with regards to internal rotation from the hip, where internal rotators or ADDuctors (the inner thighs) overpower external rotators ABDuctors (gluteus medius), causing the knees to cave and rotate to face each other as opposed to forward.

This is an example of NFL quarterback Robert Griffin III landing from a standing broad jump, you can see as opposed to directing his knees outwards and forwards, he exhibits knee valgus. Griffin was known for his short, injury prone career. Including torn right ACL in college; right LCL sprain in 2012; torn ACL, LCL, meniscus in 2013; ankle issues, and a whole lot more. 

General consensus was that he was so injury prone in college and in the NFL (in non-contact situations) because of his excessive knee valgus that was never corrected.

There has been some general thought that the menstrual cycle (menstruation, follicular, ovulation, and luteal phase) potentially play a role in ACL vulnerability though there is no real consensus.

  A 2017 review [3] about the relationship between ACL laxity, menstruation, and contraception attempted to collate studies that relate the 3.

“Twenty-one studies totaling 68,758 participants were included: 5 on the menstrual cycle and ACL injury, 7 on hormonal contraceptives and ACL injury, as well as 13 on menstrual cycle and ligament laxity”

The literature collated suggests that the oral pill potentially reduces risk of tear by 20% but the strength of the evidence in these studies is low, related to overall bias and robustness of research methods/study design.

“Specifically, laboratory studies have found that exposure of the ACL to estradiol results in a dose-dependent reduction in fibroblast and collagen synthesis and that this effect is attenuated by the addition of progestins” estradiol is low during menstruation, peaks during the luteal phase, and then has a secondary, smaller apex halfway through the luteal phase (see pic below). Basically, estradiol peaks during the menstrual cycle create certain periods of time where fibroblasts-cells responsible for the creation of connective tissue-have their proliferation rates decreased, so connective tissue and collagen is being replaced and reinforced significantly less than during the rest of the menstrual cycle. In contrast, progesterone increases fibroblast rate of proliferation, creating a protective effect. 

So as you can see in the graph below, in the luteal phase the simultaneous rise of the two hormones cancel one another out whereas in the ovulatory phase, the peak in estradiol with no protective progesterone creates a window of vulnerability for all connective tissues in the body.

“The identification of estrogen receptor positive fibroblasts in the human anterior cruciate ligament strongly suggests female sex hormones may have an effect on the structure and composition of the ligament” [5]

“The proper function of a ligament depends on the appropriate type, synthesis, assembly, crosslinking, and remodeling of collagen. This complex interplay between synthesis and remodeling of collagen is influenced by hormones, exercise, and immobilization. Thus, it is clear the amount of collagen bundles and the individual types of collagen influence the ability of the tendon to withstand loading.”

Progesterone’s protective effect explains why the oral pill (either combined estrogen/progesterone or progesterone only) correlates to fewer ACL injuries. Progesterone essentially tricks the body into never entering ovulation, and prevents development of the follicle which is responsible for estradiol production. So even in the presence of estrogen, there is no massive increase in native estradiol concentration which weakens connective tissue. 

All of this to say, a lot more research needs to be done but we do have a preliminary understanding of how certain risk factors can be ameliorated, and that can help us understand what is potentially going wrong at clubs that have had a slew of injuries (looking at you Arsenal women). I love talking about this kind of science, because it is so understudied, so if you want to chat more anon I would love to! But also if this was too much info I’m very sorry I just find it fascinating.

And here’s all the papers cited:

1. Making football safer for women: a systematic review and meta-analysis of injury prevention programmes in 11 773 female football (soccer) players. Kay M Crossley, Brooke E Patterson, Adam G Culvenor, Andrea M Bruder, Andrea B Mosler, Benjamin F Mentiplay.

    1. https://bjsm.bmj.com/content/54/18/1089?ref=performancesporthacks 

2. Fatigue induced by repeated changes of direction in élite female football (soccer) players: impact on lower limb biomechanics and implications for ACL injury prevention. Matteo Zago, Sina David, Filippo Bertozzi, Claudia Brunetti, Alice Gatti, Francesca Salaorni, Marco Tarabini, Christel Galvani, Chiarella Sforza, Manuela Galli.

    1. https://www.frontiersin.org/articles/10.3389/fbioe.2021.666841/full 

3. The effect of menstrual cycle and contraceptives on ACL injuries and laxity: a systematic review and meta-analysis. Simone D Herzberg, Makalapua L Motu’apuaka, William Lambert, Rongwei Fu, Jacqueline Brady, Jeanne-Marie Guise.

    1. https://journals.sagepub.com/doi/full/10.1177/2325967117718781

4. Report on sex-related factors in sports medicine at the American Orthopaedic Society for Sports Medicine Annual Meeting, Mary K. Mulcahey, MD, of Tulane University School of Medicine

5. Combined Effects of Estrogen and Progesterone on the Anterior Cruciate Ligament. Warren D. Yu, MD; Vahé Panossian, MD; Joshua D. Hatch, MD; Stephen H. Liu, MD; and Gerald A. M. Finerman, MD

https://journals.lww.com/clinorthop/Fulltext/2001/02000/Combined_Effects_of_Estrogen_and_Progesterone_on.31.aspx

[fencergirl13]

peak fanfic writer moment is watching a long ass youtube tutorial video for ACL rehab exercises just to get one (1) little sentence factually correct in your fic

[wosoaus]

someone pls send me sam kerr acl/injury imagines

[katiemccabelover]

just woken up from a nap and it wasn’t just a bad dream. 😫💔

[wosoandstuff]

Oh shit

[hernightsky]

The World Cup 2023

No Leah Williamson

No Beth Mead

No Ellen White

No Jill Scott

Can all Lionesses sit their team games out till the World Cup please??

Someone put Mearps in a bubble 😬👀⚽

I don't think we stand a chance anymore.

*Immediately gets hit by a flurry of shoes*

.... you're all thinking it 😑

[leennaan]

Also a speady recovery to Tanja Pawollek who did her ACL on Thursday in the Champions League game against Barcelona.