2023/24 Soccer Thread

Gianni Infantino said (I'm not making this up, he really said it): "The new FIFA game – the FIFA 25, 26, 27 and so on – will always be the best egame for any girl or boy,” He also added that FIFA would “have news on this very soon”. That was in March.

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 an ACL.

As for why, there are multiple factors at play. Dr. Holly Silvers-Granelli has a Ph.D. in biomechanics and applied physiology, is the owner of Velocity Physical Therapy in Santa Clara, California, and is the chair of MLS' Medical Assessment Research Committee. Silvers Granelli points to six perceived risk factors -- emphasis on "perceived" -- that can explain why women soccer players tear their ACLs more often than men.

One factor is the physiological differences between men and women. In women, the ACL tends to be smaller, and the notch in the femur that the ACL passes through tends to be narrower. That leaves less room for the ACL to move, which means a greater likelihood of impingement on the ACL, and thus more risk of injury.

The second risk factor has to do with environmental factors -- grass vs. artificial turf, temperature, precipitation, choice of cleat be it molded or studded. It's worth noting that only in the past seven years have manufacturers started to produce cleats specifically designed for women.

A third is tied to hormonal surges during a woman's menstrual cycle, which affects the laxity or looseness of ligaments. A fourth risk factor is genetics in that if a parent tears an ACL, their child is more likely to do the same, though that could be down to an athletic parent exposing their child to sports. A fifth is equal access to resources such as quality facilities and knowledgeable coaches and training staff. The last is biomechanics: how an athlete runs, jumps, cuts, etc.

The first factor is what Silvers-Granelli calls "non-modifiable" in that there's little that can be done to undo millions of years of human evolution. The same goes for genetics. The rest, however, are what make solving the ACL problem something of a moving target. When asked if there was one factor that contributed more than others Silvers-Granelli said, "If this were a Venn diagram, it would look like a scatter plot" with little to no overlap.

Why are ACL injuries in women still so much of a problem?

One factor is what is referred to in the medical community as "compliance," otherwise known as convincing coaches that a dynamic warmup (aka "moving while you stretch") is worth doing. The tools might be out there, but they're not always being implemented by managers. And if they are, they aren't being used enough even though it's free and requires no additional equipment. The bare minimum for using a dynamic warmup is two times a week, though four to five sessions are considered ideal.

Dr. Rachel Frank is a Denver-based orthopedic surgeon who estimates she does "a couple of hundred" ACL reconstructions per year, and is also the team orthopedist for the Colorado Rapids. She said convincing coaches to implement such programs is a huge obstacle to reducing the number of ACL tears.

"You can advise a prevention program and teach [a dynamic warmup] as much as possible, but we've got to get people to do it, and it can't be just going through the motions," she said. "It can't be five minutes of running around the field doing some single leg hops and calling that a prevention program. It's got to be time and dedicated effort. And I think in 2023, time is a commodity, and if a training session for a team is 90 minutes, 20 to 30 of those minutes need to be focused on this prevention program, dynamic warmup, etc."

Lack of available practice time is often offered up by coaches as the main reason more teams don't implement a dynamic warmup, even though at 15 minutes, it's not cutting that much into training time. Coaches prize contact with the ball, and the dynamic warmup would cut into that, so the thinking goes. Silvers-Granelli also noted in her work with MLS teams, performance staff can become "a bit territorial" when it comes to such things as warmup routines.

The resistance seems mystifying. The more players stay healthy, the better the odds are of winning on the field, and coaches are ultimately judged on wins and losses. But access to resources, from both a socioeconomic and gender perspective, can also play a part. That goes for equipment, quality facilities and access to educated training staff.

You don't see this every day