Research suggests female footballers are two to six times more likely to suffer ACL injuries than male players. Funding is aimed at uncovering why.
Research funding
The FIFA Research Scholarship will fund research on whether hormonal changes during the menstrual cycle contribute to the rising number of ACL injuries in women’s football. This study builds on ongoing work by Kingston University London.
The research will focus on the potential link between menstrual phases and ACL injury rates. High-profile players such as Beth Mead, Vivianne Miedema, and Sam Kerr have been affected by this trend.
The study will run for one year. Researchers will analyse hormone levels from blood samples collected from elite and grassroots female footballers. PhD student Blake Rivers will lead the project. He will work alongside Kingston University sports and exercise science experts Dr Simon Augustus, Dr James Brouner, and Dr Michelle Richards.
Starting in June, the team will partner with football clubs in South West London, including Chelsea and Fulham. They will recruit players who will regularly visit the university for blood tests and physical performance assessments. The tests will measure female-specific hormones like estrogen and progesterone. These hormones have been linked to increased ligament laxity and slower neuromuscular responses.
Rising rates, risks, and prevention
As women’s participation in sports grows globally, ACL injuries are rising too. This increase is especially noticeable in adolescent athletes aged 10–19. Sports involving quick direction changes, jumping, and landing, such as football, basketball, and skiing, pose the highest risks.
Most ACL injuries in female athletes are noncontact. They often occur during deceleration movements like cutting, pivoting, or landing from a jump. These actions are common in many team sports. Unlike contact injuries caused by collisions, noncontact injuries point to deeper biomechanical and physiological vulnerabilities.
Dr Augustus said, “we want to examine whether athletes may be more predisposed to injuries due because of their functional changes in terms of their anatomy and physiology during during the menstrual cycle. We know hormones fluctuate during different phases of the cycle but we don’t yet know how much of an influence that may have on the risk of injury.”
Hormones, anatomy, and neuromuscular control
Researchers believe higher ACL injury rates in women stem from a mix of anatomical, hormonal, and neuromuscular factors. Anatomically, women tend to have wider pelvises. This creates a larger Q-angle at the knee, which may increase strain on the ACL. Hormonal fluctuations during the menstrual cycle, especially higher estrogen and progesterone levels, affect ligament laxity. This makes the ACL more vulnerable to injury during certain phases.
Neuromuscular differences also play a key role. Female athletes often show a pattern called quadriceps dominance. This means they rely more on their quadriceps muscles than their hamstrings during movement. This imbalance can reduce knee stability and increase injury risk, especially during sudden stops or changes in direction.
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In May 2024, research from University College London, the University of Bath, and St Mary’s University found that female footballers face higher injury risks during specific menstrual phases.
In response, the Professional Footballers’ Association (PFA), Fifpro, Nike, and Leeds Beckett University launched a three-year study focused on injury prevention. The research will examine environmental factors such as training facilities, staff availability, squad sizes, access to resources, travel demands, and match schedules.
They will also explore concerns like unsuitable footwear, inadequate equipment, and poor pitch conditions, which may increase injury risk.
Brighton FC’s chief executive, Paul Barber, told BBC Sport last month that the club is preparing research to ensure the surface at their new women’s stadium is suitable.
Women not only suffer more ACL injuries but also recover differently. Studies show only 65% of female athletes return to sport after ACL reconstruction, compared to 75% of males. Psychological readiness, physical recovery, and fear of reinjury are common rehabilitation barriers.
Prevention
While the injury rates are worrying, there is positive news. Neuromuscular training programs that improve strength, balance, and proper movement mechanics have significantly lowered ACL injury risk in female athletes. These programs work best when introduced during adolescence, before risky movement patterns develop.
As awareness grows and research continues, sports organizations and medical professionals are tailoring prevention and rehabilitation strategies for female athletes. These include hormonal monitoring and personalized strength training. The goal is not just to reduce injuries but to create a safer, more supportive environment for women in sport.
