ACL injuries, FemTech, and insurance
As the Women’s Super League (WSL) season recently kicked off, Paddington FC have adopted improved training programmes, such as extra strength and conditioning sessions, to prevent injuries. Paddington FC believe that it is vital the team don’t suffer a repeat of last season, when three of Elle’s teammates were out of action due to one of the most damaging knee injuries a sportsperson can endure: a tear to their ACL (Anterior Cruciate Ligament).
Elle knows that ACL injuries are becoming more common in her sport, and studies suggest that female footballers are at a significantly higher risk compared to their male counterparts. Vivianne Miedema, Beth Mead, Leah Williamson and Sam Kerr are all unlucky illustrations of this.
Why are ACL injuries more common in women’s sports?
ACL injuries are increasingly more common in women’s football than in the men’s game, as some studies have shown that female players are between three to eight times more likely to be struck by an ACL injury than male players.
In fact, over the past 18 months, nearly 200 elite female players have suffered from this debilitating injury, and between 25 to 30 players missed the 2023 Women's World Cup because of ACL tears. These injuries have impacted the player’s careers and their teams’ performances, and some studies claim that up to 25 percent of the injured players are unlikely to make a full return. This high incidence rate, and reduced rate of recovery, has led to heightened calls for more injury prevention strategies that are tailored to women and women’s sports.
It is not yet fully understood why this injury seems to affect female players more so than male players. Some cite the anatomical differences between men and women and the hormonal influences and cycles in women, as possible reasons for the higher ACL incidence rate. Others suggest that the rise in these types of injuries in female sport could be linked to various biomechanics and training (for example, the way female athletes run, jump, and move in general, and the way they train could be playing a role), as well as the less developed playing infrastructure in the women’s game (e.g. pitch conditions and playing surfaces, players’ boots). Also, there may be less extensive support from physios, strength and conditioning coaches than in the men’s game.
These factors have all been identified as having a potential impact upon, or contributing towards the increased number of ACL injuries in female sport.
More research is required into both the cause and prevention of ACL injuries in the women’s game. Some health specialists have noted that in sport and exercise science research, only six percent of the studies have been done exclusively on females and female athletes.
In 2023, UEFA committed to a long over-due initiative to better understand ACL injuries in women's football, and in 2024, a three-year research project was announced, which is being funded and carried out by FIFPRO, the Professional Footballers Association, Nike, and Leeds Beckett University, to accelerate research into reducing ACL injuries in women’s sports. Furthermore, educating the players, coaches, and medical staff about the risks of ACL injuries and informing them of the various prevention mechanisms and strategies (such as biomechanically informed exercises which focus on enhancing knee strength and stability) will also serve to foster a proactive approach to injury management.
FIFA has followed suit in April this year and is to fund research, conducted by Kingston University London into whether hormonal fluctuations during menstrual cycles could be contributing to the rise in ACL injuries in women's football.
Could FemTech be the answer?
FemTech has emerged as a dynamic and rapidly growing segment of the healthcare industry. Figures vary, but the market for FemTech is estimated to be worth between $500m to $1bn, yet FemTech companies reportedly only receive 3% of all digital health funding.
FemTech includes technologies able to address women’s healthcare, fertility and reproductive health, pregnancy and family care, and fitness and wellness. In the instances where FemTech meets fitness and wellness to help athletes, there is seemingly real progress being made, for example:
Lululemon’s Blissfeel shoe was one of the first women-specific running shoes designed after carefully scanning 1000+ women’s feet and analysing the biomechanics of female runners.
In football, sportswear providers such as IDA have designed female specific footwear, by highlighting the anatomical differences between male and female feet and designing footwear with female biomechanics in mind.
Wild.AI, is an online training platform that syncs with women’s life stages and symptoms to deliver tailored training, recovery, and nutrition guidance. The platform takes hormonal cycles or pregnancy and postpartum into consideration to deliver realistic activity goals.
Investment into this industry and the technology it can offer will play a pivotal role in addressing women’s health issues in general. When it comes to ACL injuries, more work is required, but the hope is that FemTech can rise to the challenge of supporting women in recovery, prevention, and research.
Insurance as a way to mitigate the impact of injury
Injuries are an unfortunate part of sports, so having the right insurance coverage is crucial. At the top end of the game, the FIFA Club Protection Programme insurance policy protects all professional players employed by clubs affiliated with a FIFA National Association, but this covers only the injuries that are sustained whilst a player is representing their national A-team in a FIFA sanctioned event.
Since the 2022-23 season, WSL and FA Women’s Championship players now receive long-term sickness pay that mirrors the injury rights of male players. The players are provided with their basic wage for the first 18 months of a long-term injury such as an ACL, and then half of their wages for the remaining length of their injury, provided they are still within the validity period of their employment contract. That said, typically women’s contracts are shorter in duration that men’s contracts, so these contractual protections may provide limited support in practice.
Practically, its prudent for players to seek insurance for long term/ career ending illness and injury. The likes of Miller Insurance have developed insurance cover specifically for female players, given the prevalence of ACL injuries.
Conclusion
Elle now understands that the increasing research and understanding of female footballers’ ACL injuries will play a crucial role in levelling the playing field between the women’s and men's game. Investment and support into FemTech, along with its technological advancements, will also be vital in addressing female sports injuries and women’s health issues more broadly.
Whilst the sector and understanding around women’s ACL injuries continues to develop, it is equally important that players take appropriate steps in the meantime to ensure they are protected against such unforeseen circumstances and debilitating injuries that may have an adverse effect on their careers in both the short and the long-term.
To learn more, please visit our Women’s health and technology page and our Insurance in sport page.