The list reads like a who’s who of international women’s soccer. There’s the England duo of Leah Williamson and Beth Mead. Dutch star Vivianne Miedema is also included, as are France‘s Marie-Antoinette Katoto, Canada‘s Janine Beckie, and the American pair of Christen Press and Catarina Macario.
What do they have in common? They all will miss the 2023 Women’s World Cup with the dreaded torn Anterior Cruciate Ligament (ACL). Two other players, Australia‘s Ellie Carpenter and Spain‘s Ballon d’Or winner Alexia Putellas, made it back in time for the tournament after suffering the same injury, but with so many talented players missing, the spate of injuries is casting a pall over the tournament.
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“I think the amount of ACL injuries in professional women’s soccer in the last two years has just been shocking,” Press said during a recent interview on ESPN’s Futbol Americas. “And I think if the caliber of players from Beth Mead to Miedema to Alexia [Putellas], in every league; international players doing double duty, stars. … If this happened on the men’s side, we would’ve immediately seen a reaction of how are we going to solve this and figure this out and make sure that these players are going to be available at the biggest moments of their career.”
The medical community has long known that women athletes tear ACLs at a rate two to eight times more often than their male counterparts. The results of most studies fall between four to six times. According to a paper published in the Journal of Orthopedics and Orthopedic Surgery, one in 19 women soccer players tear ACLs.
Where’s the research? “We did it 20 years ago.”
For Silvers-Granelli, the biomechanical aspect — including the tendency for females to have a muscle imbalance between quads and glutes/hamstrings — qualifies as the low-hanging fruit in ACL injury mitigation. In 2000, Silvers-Granelli was part of a group that developed one of the first PEP Programs (Prevent Injury, Enhance Performance), which comprised a 15-minute dynamic warmup — without the ball — of exercises designed to improve strength, balance, jumping technique, etc. The program was tried on 14- to 18-year-olds in Southern California. The results were staggering, including an 88% drop in ACL injuries.
“I was stunned because we were thinking maybe like 35%, 40% hypothetically,” Silvers-Granelli said.
Naturally suspicious of a statistical blip, the program was repeated the next year. That group recorded a 72% drop from the baseline. Those results drew interest from the Center for Disease Control, and the program was tried out on 61 NCAA women’s soccer teams. That morphed into a 2005 trip to Norway, and the subsequent study in handball players saw a 45% reduction in ACL injuries. This eventually turned into the FIFA 11+ program, which was adopted for men’s teams too, with similar results.
“That’s the irony of what’s happening right now,” Silvers-Granelli said. “When everyone’s clamoring, ‘Where’s the research?’ I’m like, ‘We did it 20 years ago.'” She added, “I’m not saying we solved this 20 years ago, and no other work needs to be done. I’m just saying, ‘Look, if the dam’s been breached, we have a pretty good patch. So let’s start there.'”
Silvers-Granelli is also in favor of what she calls “movement diversity” as a way of combating the tendency of young athletes to overspecialize at an early age. A wider variety of sports and activities will help aid in the coordination and strength of the entire body, rather than one set of muscles.
“There’s less bike riding, less skateboarding, less scootering, less playground play and less street play,” she said. “There is a lack of proficiency just because kids just do not do that as much as they did.”
Silvers-Granelli hesitates to call what’s currently going on with ACL injuries an epidemic. She points out that there are more playing opportunities for women than there were 15-20 years ago due to more women’s leagues becoming professional. It stands to reason that with more opportunities, more practices and more games there will be more ACL injuries. But progress seems uneven. Silvers-Granelli recounted how one major NCAA women’s program recently suffered 22 ACL injuries over a four-year span. Another Division I program, Wake Forest, saw six women’s soccer players tear ACLs during the 2021-22 season.
