No More Tears: ACL Prevention for Women Soccer Players

ACL tears are the boogeyman for soccer players—just the thought of hearing that infamous “pop” strikes fear. This is even more true for women. Female players have a significantly higher risk of getting an ACL tear for anatomical reasons, and has been a notable reason why many players missed the 2023 FIFA World Cup. Thankfully, it’s possible to reduce the risk of ACL injuries with the right protocols.

Why ACL Injuries Affect Women More than Men

Differences in anatomy are the main reason why ACL injuries affect more women players compared to men. These include differences in skeletal structure, biochemistry, brain wiring and much more. But a few in particular standout.

ACL Injury Contributors in Women Soccer Players

• Wider Q-Angle - Women have a wider pelvis, which increases the angle of their thigh bone in relation to their knees. This is known as the q-angle. Because women have wider q-angles, it puts more stress on the knee, making sudden changes in speed and positioning more stressful to the ACL.
• Hormonal differences - Fluctuations in hormones, especially during the menstrual cycle can make the ligaments more lax (more likely to bend and tear). That includes the ACL.
• Muscle activation differences - Women activate their muscles differently than men. They have shorter activation durations in muscles that maintain stiffness and power in the leg. That could translate to muscle imbalances that put too much strain on the ACL when running, cutting or jumping.
• Neuromuscular control differences - Closely related to the point above, is neuromuscular control. Women tend to over activate their quads for stability, which can throw off their knee alignment and put more stress on the ACL.
• Altered landing mechanics - When women soccer players land after jumping, their knees collapse more inward (high knee valgus) than men. Higher knee valgus increases the load on the ACL and makes it more likely to tear.

Women have some other disadvantages such as thinner ACLs (which, in itself increases tear risk). There’s also a lack of adequate training from coaches to prevent ACL tearing in women’s leagues, and an abundance of poor playing surfaces (i.e., artificial turf). Regardless, ACL injuries don’t have to be inevitable. The first step is conditioning.

Dynamic warmups/neuromuscular conditioning

Neuromuscular conditioning is essential for women in soccer, as their nerve-to-muscle activation appears to be less efficient than men. The good news is that women can train their brain and nerves to activate muscles more effectively.

FIFA 11+ Neuromuscular Warm Ups

The FIFA11+ is a neuromuscular conditioning program designed by kinesiologists, sports scientists and biomechanics experts. They improve one’s sense of joint positioning and stability, body awareness, and make muscle activations more efficient. The training is a mix of aerobic, balance and stability exercise, and has to be completed in three parts.

It’s recommended that you follow the sequence and duration of the program to get the full benefits. You should incorporate these exercises before practices or games since their purpose is to warm up the nervous system and muscles.

Prevent Injury and Enhance Performance (PEP) program

The PEP program is a dynamic warm-up program that is specifically designed to reduce ACL injuries. It consists of stretches, plyometrics, agility and strength-training exercises, meant to be performed three times a week. They build strength, improve coordination and increase stability around the knee joint.

It’s crucial for players to perform these exercises with the correct posture and without excessive side-to-side movement. Think of it as a simulation for the real thing—there’s no need to overdo it here.

Deciding whether to rely on the FIFA11+ or PEP might take some trial and error. Both have been shown to be effective at reducing injuries while improving performance. Experiment with both programs, perhaps doing a periodization where you spend a few weeks doing one before switching to the other.

Nutritional Plans to Help Prevent ACL Injuries

Your ACL is only as healthy as the foods you eat. That’s more than our attempt at trying to come up with a catchphrase—your ligament health is directly tied to your nutritional status. A diet that promotes ligament strength will help keep the tissues supple and more resistant to tearing.

With that said, your ACL and ligaments need certain macro and micro nutrients to stay strong. They need collagen-boosting nutrients, in particular, because collagen makes up the bulk of a ligament’s structure.

Collagen-Boosting Nutrients for ACL Health

• Protein - Eggs, meat, fish, seafood, nuts and seeds, dairy products, and mushrooms.
• Non-starchy carbs - Avocado, asparagus, broccoli, cabbage, carrots, onions, peppers, peas, spinach.
• Glucosamine - Shell of shellfish, bone broths, prawn skin.
• Vitamin C - Apples, berries, bell peppers, kiwi, kale, oranges, and pineapples.
• Copper - Seeds, nuts, and chard.
• Sulfur - Cauliflower, eggs, garlic, onion.
• Zinc - Meat, eggs, fish, seafood, nuts and seeds.

Diet should be more personalized than exercise. Take factors into consideration like food sensitivities and allergies, weight goals, and palette preferences. But the nutrients listed above will give your ligaments the fuel needed to replenish their collagen stores.

Film Your Movement

Filming game and practice performance isn’t necessary to prevent ACL injury, but we still recommend it. It’s easier than ever too, with every smartphone coming with a high quality camera. And even if your camera person doesn't have the steadiest hands, you can get tripods to keep your phone stable. So there really is no reason to avoid it.

With that said, filming your performance during practices and games (where possible) will let you see your movement first hand. The camera doesn’t lie. You can look for two things: 1) How well you move, whether that be jumping, landing, cutting and sprinting, 2) Whether you’re performing exercises correctly.

Reviewing your footage helps you spot poor movement patterns and conditioning flaws that need correction. Video is a simple yet powerful tool because it provides instant feedback.

Wear the Appropriate Gear to Prevent ACL Tears

We have to make this clear, a disclaimer of sorts—there is no soccer equipment that can outright prevent an ACL injury. Nevertheless, there is equipment that can reduce the risk of tearing your ACL.

Let's start with the basics. Your cleats should fit well. Poorly-fitting shoes throw off your balance, making it more likely that you’ll twist your knee when running. So choose the right size from the get-go.

But also think about the type of cleats you get too. Cleats with conical studs don’t provide as much traction as bladed ones, but they allow your feet to twist more naturally on the pitch. That translates to a lower risk of ACL injury.

Also, consider wearing a knee guard, like our BodyShield line. They help stabilize the knees, preventing them from bending inward too much, a movement that contributes to ACL injuries. Our BodyShield knee guard also provides impact protection (against falls and tackles), and has turf burn resistance which protects your skin from abrasions while sliding on turf.

The Importance of ACL Injury Prevention Strategies

Preventing ACL injuries isn’t something for coaches and players to take lightly. First off, it usually takes six to nine months to recover from a torn ACL, meaning you’re sitting out for a whole season (if not more). Second, ACL injuries in women tend to have worse recovery outcomes and women are more likely to re-tear their ACLs.

And that’s precisely why there needs to be greater awareness and effort made to protect women who play footy. With that said, with ACL prevention strategies in mind, you can strike back at ACL injuries before they strike you.