The Football Association (FA) and WSL Football have announced a major research project in collaboration with Imperial College London and sports knee surgeon Simon Ball, aiming to improve understanding of anterior cruciate ligament (ACL) injuries in women’s football and identify ways to reduce their occurrence.
The PhD research, sponsored by The FA and led by Hanna Lehtovirta at Imperial College London, will investigate the various factors contributing to ACL injuries among female footballers, bringing together scientific evidence and the experiences of players and professionals working within the game.
ACL injuries remain one of the biggest challenges facing women’s football, with players frequently facing lengthy spells on the sidelines, difficult rehabilitation programmes and uncertainty over their future careers. As the women’s game continues to experience significant growth, the need to understand why these injuries occur and how they can be prevented has become increasingly important.
Although previous research has identified several potential risk factors, including anatomical differences, hormonal fluctuations, neuromuscular patterns and environmental conditions, much of the existing evidence has examined these elements individually or in controlled laboratory environments.
The new project aims to address those limitations by examining how different factors interact within the everyday demands of elite football, providing a more comprehensive picture of injury risk.
Every club competing in the Barclays Women’s Super League and WSL2 will be invited to participate, with players and staff from medical, performance and coaching departments contributing to the research.
Understanding Why ACL Injuries Disproportionately Affect Female Footballers
An ACL rupture is one of the most serious injuries a footballer can experience. The ligament plays a crucial role in stabilising the knee joint, particularly during rotational movements, sudden changes of direction and high-impact actions.
For professional players, sustaining an ACL injury can mean spending nine to 12 months away from competitive football, undergoing surgery and completing an extensive rehabilitation programme before being considered for a return.
However, the risk is not distributed equally between male and female athletes.
Research cited in studies of comparable sports suggests female athletes can be between three and eight times more likely to sustain an ACL injury than their male counterparts. In football, the difference has been estimated at approximately four times, although the precise figures vary between studies and playing populations.
Several biological factors may help explain this disparity.
Hormonal fluctuations throughout the menstrual cycle have attracted increasing attention from sports scientists, particularly the potential influence of oestrogen on ligament structure and stability.
Changes in hormone levels may affect ligament laxity, collagen properties, and neuromuscular control. Some research suggests that periods of higher oestrogen levels could influence how the knee responds to high-impact movements, potentially increasing susceptibility to injury.
Anatomical differences are another area of investigation. Female athletes typically have a wider pelvis and a greater quadriceps angle, which can influence knee alignment during movements such as landing and changing direction.
Combined with differences in muscle activation and strength, these factors may contribute to increased stress on the ACL.
However, hormonal and anatomical characteristics do not provide a complete explanation. Training environments, playing surfaces, fatigue, strength and conditioning programmes and access to specialist support can also influence injury risk.
Importantly, the extent to which individual biological factors contribute to ACL injuries remains an area requiring further research.
Addressing The Historical Research Gap In Women’s Sport
One of the wider challenges surrounding ACL injuries is the historical lack of research specifically examining female athletes.
For decades, much of sports science has been developed using male participants, with findings and training approaches subsequently applied to women despite important physiological and biomechanical differences.
This has contributed to concerns that existing injury prevention strategies may not fully address the needs of female footballers.
Strength and conditioning programmes, for example, play an important role in reducing ACL injury risk by improving stability, strength and movement mechanics.
Targeted exercises focusing on the hamstrings, glutes, hips and core can help athletes develop better control when landing, pivoting and changing direction.
However, female players have historically had less access to specialist strength and conditioning support, particularly outside the fully professional game.
Differences in funding, facilities, coaching resources and medical provision can also influence the quality of preparation and rehabilitation available to female athletes.
The consequences can extend beyond the initial injury. Players may face difficulties accessing specialist rehabilitation, returning to their previous performance levels and securing long-term opportunities within an increasingly competitive professional environment.
Psychological recovery is another important consideration. Fear of sustaining another injury, reduced confidence, and the pressure of returning to competition can all affect an athlete’s rehabilitation journey.
Research has suggested that female athletes can experience lower psychological readiness scores following ACL reconstruction, while concerns surrounding re-injury can create additional challenges when returning to football.
For players operating in a developing professional environment, lengthy absences can also create uncertainty around contracts, selection and their long-term careers.
These wider issues demonstrate why improving understanding of ACL injuries requires more than simply examining the physical characteristics of the knee.
Two Research Phases To Combine Scientific Evidence And Player Experiences
The new FA-backed project will consist of two main research phases, bringing together information from players who have experienced ACL injuries and those who have remained injury-free.
The first stage will involve player surveys designed to collect information across a range of potential risk factors.
Participants will be asked about their injury history, training and match workloads, alongside hormonal, nutritional and psychological considerations.
Players who have sustained an ACL injury since the 2018/19 season will have their information compared with that of uninjured players, helping researchers identify characteristics and circumstances that may be associated with an increased risk of injury.
The second phase will build upon the survey findings through interviews with players and staff.
Those conversations will provide an opportunity to explore individual experiences, perceptions of ACL injuries and the approaches currently used by clubs to manage training, performance and injury prevention.
Medical, performance and coaching staff will also contribute, offering perspectives on the practical challenges involved in supporting players and implementing preventative measures.
By combining quantitative information with personal experiences from across the professional game, researchers hope to identify patterns that may otherwise be overlooked when examining scientific data in isolation.
The involvement of every Barclays WSL and WSL2 club will also provide an opportunity to gather information from a broad range of professional environments.
FA and WSL Football Underline Importance Of Player Welfare
Ritan Mehta, Head of Women’s Medical at The FA, highlighted the importance of bringing together expertise from football, healthcare and academia to tackle one of the biggest challenges facing female players.
“We are proud to be partnering with Imperial College London, WSL Football and Simon Ball from the Fortius Clinic on this important research project,” Mehta said.
“By working collaboratively, we can bring together expertise, data and lived experiences to deliver one of the most comprehensive studies into ACL injuries in the women’s game.“
“ACL injuries remain one of the biggest challenges facing female footballers. While significant progress has been made in understanding the factors that may contribute to these injuries, there is still much more to learn.”
Mehta added that the research could help shape future approaches to injury prevention and rehabilitation, ultimately allowing more players to remain healthy and perform at their best.
Dr Abosede Ajayi, Medical Governance Lead at WSL Football, also emphasised the significance of the collaboration and its potential to influence medical standards across the women’s game.
“What makes this project particularly exciting is the partnership between football, healthcare and academia,” Ajayi explained.
“The insights generated have the potential to strengthen ACL injury prevention strategies, inform medical standards across the women’s game, and ultimately create safer, healthier environments for current and future generations of players.”
Simon Ball, Sports Knee Surgeon at Fortius Clinic, stressed that prevention must remain a priority alongside continued improvements in surgical treatment and rehabilitation.
“ACL injury is devastating for professional athletes. Whilst we have made huge progress in the management of ACL injury, there is no doubt that prevention is better than cure!”
Ball added that further research was owed to both current and future generations of female footballers, with the aim of reducing injury rates as much as possible.
Meanwhile, Lehtovirta believes the partnership will provide an important opportunity to examine ACL injuries in the context of the professional game.
The research postgraduate in Imperial’s Department of Mechanical Engineering said: “Working with The FA and WSL Football gives us a valuable opportunity to study ACL injuries with elite players in their real-world context, looking at a wide range of potential risk factors from minutes played and injury prevention practices at clubs to how players developed before they entered professional football.”
She added that combining different forms of data and perspectives could help develop a better understanding of the factors contributing to injury risk and produce findings that inform practical solutions.
A Significant Step Towards A Safer Future For Women’s Football
With participation, investment and visibility continuing to increase across women’s football, improving player welfare must remain central to the game’s development.
ACL injuries have become a particularly prominent concern, with their physical, psychological and professional consequences extending far beyond the months spent recovering from surgery.
Although existing research has identified several possible contributing factors, the interaction between biological differences, training environments and the demands of elite competition remains an important area for further investigation.
The new partnership between The FA, WSL Football and Imperial College London represents an opportunity to address some of those unanswered questions through a more comprehensive approach.
By placing players’ experiences alongside scientific evidence and the knowledge of medical and performance professionals, the project aims to move beyond identifying why ACL injuries happen and towards developing more effective ways of preventing them.
Ultimately, its findings could help shape future training practices, medical standards and rehabilitation strategies, providing valuable benefits not only for today’s professional footballers but also for the next generation entering the women’s game.
