Why ACL Injuries Are So Common in Women’s Football — And What Actually Needs to Change

Why is it common for women’s footballers to suffer ACL injuries?

ACL injuries are far more common in women’s football than in the men’s game, but the reasons are complex and multifactorial. They involve a combination of anatomical differences, hormonal influences, training environments, competition structures, and social factors.

One of the most significant contributors is early strength and neuromuscular training. While no method can fully prevent ACL injuries, research consistently shows that neuromuscular control training, strength development, and proper movement mechanics are the most effective ways to reduce risk.

In the men’s game, boys in elite academies typically receive structured strength, conditioning, and injury-prevention training from around the age of nine. In contrast, many girls do not receive comparable training until their mid-to-late teens, often after puberty. This gap in physical preparation may partially explain why women are more likely to suffer ACL injuries. This issue is further amplified by the long-standing stigma around girls lifting weights or appearing “too muscular,” which has historically limited access to strength training.

Women are estimated to be two to eight times more likely to rupture their ACL than men, according to Pure Sports Medicine and numerous orthopaedic studies. Anatomical and biomechanical differences play a role, including wider pelvises, different hip alignment, greater knee valgus tendencies during cutting or landing, smaller ACL size, and increased joint laxity. These factors can place additional stress on the knee during high-intensity movements.

Training and competition demands also increase injury risk. Women’s football often features smaller squad sizes, limiting player rotation and increasing match load. With congested fixtures across multiple competitions, players may have insufficient recovery time, particularly when playing multiple matches per week.

Outside the WSL, there are fewer teams, fewer playing opportunities, and reduced access to specialist medical, technical, and strength and conditioning support. This can limit long-term physical development and increase injury vulnerability.

Specialists emphasise that the most effective injury prevention strategies focus on neuromuscular control, hamstring-to-quadriceps strength balance, and hip and core stability. Female biomechanics differ from male biomechanics, and women naturally move and land differently. For this reason, direct comparisons between men and women can be misleading. Many injury-prevention protocols used in women’s football are adapted from male-based research, which may not fully address female-specific movement patterns.

Clubs can reduce overuse risk through improved player rotation and more carefully managed match loads. However, specialists still do not fully understand how fixture congestion, pitch conditions, or equipment interact to affect injury risk in women’s football.

There is limited scientific evidence directly linking poor pitch quality to ACL injuries. While data on surface-specific risk remains inconclusive, players’ perceptions of unsafe or uneven pitches may subconsciously alter movement patterns, potentially increasing injury risk.

Hormonal factors have also been investigated, particularly fluctuations in oestrogen levels during the menstrual cycle. Some studies suggest that increased ligament laxity around the pre-ovulatory phase may raise ACL vulnerability, although findings remain inconsistent. There has also been growing interest in the impact of hormonal contraception, though research is still ongoing.

There is no strong evidence linking football boots directly to ACL injuries. However, better personalised footwear may improve comfort and movement efficiency. Many women still wear boots designed for men due to cost and availability. One study found that 82 percent of professional female players reported discomfort wearing male-designed boots, which may influence landing mechanics and movement patterns.

As one orthopaedic surgeon summarised, “It’s not just strength. It’s neuromuscular control. You train the nerves to fire the muscles in the right way, and that’s what helps prevent ACL injuries.”

Ultimately, there is a clear need for more research focused specifically on women and ACL injuries. At present, the most consistently supported protective factor remains access to strength and neuromuscular training from a young age.