We are not all doctors but, in the moment, you did not need to be when viewing the replay.
Leah Williamson’s knee appeared to buckle, then release itself with an unnatural bend, the joint popping forward with a tell-tale judder. Clearly, the England captain’s appearance at the World Cup was in question. It was a sadly familiar scene.
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A befallen player surrounded by physios and club doctors carrying out their assessments following an often innocent-looking foot plant or a twisted knee.
Four months earlier, the Arsenal manager Jonas Eidevall watched his star striker Vivianne Miedema’s knee spring back in the same circumstance. Without contact, chasing a loose ball; an abnormal movement in the knee like a doll jerked out of its packaging.
Sometimes, it feels as though the world of women’s football is just waiting for its next ACL injury. One list puts the number at more than 110 in elite women’s football in the past year and a half. Among them are Ballon d’Or winners and nominees and Olympic champions — star names deprived of playing in World Cups and European Championships.
Part-time footballers are crowdfunding to escape NHS waiting lists; players like Tottenham Hotspur’s Ellie Brazil who, at 24, is partway through rehabilitation for her second ACL injury in three years.
The Danish national team announced on Thursday — less than 24 hours after Williamson limped off the pitch against Manchester United — that Stine Larsen will miss the World Cup with an ACL injury. Again and again they come.
ACL injuries are more prevalent in female footballers than their male counterparts. They are between three to six times more likely to be injured this way. We have held this knowledge for more than 20 years, being first reported in the 1990s. The British Journal of Sports Medicine has calculated that despite this research, there has not been a decrease in the ACL injury rate in the general population of girls and women.
Assess the advances made over a similar time period in men’s sport and with male bodies. How ACL injuries were considered career-ending 30 years ago but that rarely being the case now. The same cannot be said for female players further down the pyramid, with the lack of progress alarming but also unsurprising considering around only six per cent of sport and exercise science studies relate exclusively to women. ACL injury rates have also decreased among boys and men in that 20-year period.
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A footballer haunted by questions — why me, and why now? — will find few concrete answers. There are the beginnings of links (some tentative hypotheses), but nothing definitive. There have been successful results with injury prevention programmes, although there is not always the resources to adopt them.
Research and media coverage has focused on biological factors like the menstrual cycle and joint alignment. The picture, however, is incomplete. In any case, the sport cannot view players’ bodies as removed from the conditions they play and train in, especially when the disparities between the men’s and women’s game are so wide. Female footballers, for example, wear boots designed with men in mind, play on subpar pitches and are part of smaller squads with fewer support staff.
An unprecedented run of women’s international tournaments — five in as many years from 2020 to 2025 — has brought an increase in both workload and profile but, the truth is, we do not know whether the game is able to keep up in the same way to guarantee player safety. This is all new ground.
The irony is that there has never been a greater time to be a female footballer; Williamson and her contemporaries are the envy of every previous generation. But there may also have never been a worse time. Are players enduring the demands of elite sport without the infrastructure, squad sizes and decades of scientific knowledge needed to truly protect them? Do we have the understanding and foresight to allow players to safely maintain this kind of intensity, especially in a Women’s Super League that only turned fully professional in 2018?
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The fact that two of the three Champions League-competing members of England’s back four, Williamson and Millie Bright, have suffered injuries in the past few weeks suggests not. Those in the game now are paying the price of the failings of generations before them, of decades of underfunded research into women’s bodies and perhaps the outdated view that women are equivalent to small men.
We do not yet know how to slow the ACL endemic of women’s football. Sport has lived 30 years with the knowledge that women are vulnerable, and this is the progress it has made. Little enough that the World Cup will be without a clutch of star names — and England without its captain.
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(Top Photo:by Naomi Baker/Getty Images)