ACL Injuries in Women’s Football (Soccer): What the Research Tells Us

In recent months, women's football injuries - especially ACL tears - have gained widespread media attention again. FIFA is now funding a landmark year-long study at Kingston University exploring how menstrual cycles might influence ACL injury risk.

But what do we already know from the existing science? Here’s a summary of current research into ACL and lower limb injuries in women’s football, what we can do now to reduce our risk, and where future studies are heading.

The Stats

Risk Factors of Non-Contact ACL Injuries

The increased risk of non-contact ACL injuries in female soccer players is highly multi-factorial.

They result from a complex interplay of biomechanical, anatomical, hormonal, environmental, and training-related factors. Importantly, these factors are not causes of injury on their own—but rather correlations that increase the likelihood of injury occurring under certain conditions [1-11].

Understanding these interconnected risk factors helps us better target prevention strategies—not by eliminating risk completely, but by reducing it where possible.

Source [1-11]

Evidence-Based Injury Prevention Programs for Women

Injury prevention is key for female athletes at every level of competition, whether you're a weekend warrior or an elite athlete.

While ACL injuries are a complex mix of factors, evidence-based strategies can help reduce the risk. A 2024 meta-analysis found that exercise-based prevention programs reduced ACL injuries by up to 45% [12, 13, 14]. They've also been shown to reduce risk of other common soccer related injuries such as ankle sprains and hamstring strains.

✨✨What we know works?

• Multicomponent Programs: Interventions that incorporated a combination of different exercises such as strength training, plyometrics, balance exercises, and neuromuscular control were more effective in mitigating ACL injury risk.

• Neuromuscular Training: Programmes emphasizing neuromuscular training, such as the FIFA 11+ warm-up routine, demonstrated significant reductions in ACL injury incidence.

• Programme Adherence: High compliance with the prescribed exercise routines was crucial for maximizing injury prevention benefits. In particular, ensuring routines were started through preseason to ensure sufficient conditioning prior to the league season were important.

• Dosage: To achieve a preventive effect it is necessary to carry out the training session for at least 15 minutes, 2-3x/week for 3 to 12 months.

  
  

⚽💪🏼 Injury Prevention Program Options

Programs are made up of a warm-up for trainings and separate conditioning-based programs to perform at the end of training or alternative day. All follow a similar format, but Perform + include additional injury prevention exercises.

FIFA 11+

Access online pdf via the link or below.

fifa 11.pdf

Download PDF • 4.95MB

Football Australia Perform+

Access online pdf via the link or below.

Football Australia Perform+ (Full Instructions).pdf

Download PDF • 2.71MB

Final Thoughts: Keeping Women in the Game

ACL injuries are complex and multi-faceted - but one thing is clear: we need to do more to keep women on the pitch. Female players deserve:

• Access to proven injury prevention programs

• Properly fitting gear and safe playing surfaces

• Research that focuses on their unique risk profiles

• An understanding of the barriers that prevent them from accessing resources

This isn’t just about avoiding injury - it's about protecting women’s ability to move, play, connect, and thrive. Staying injury-free means women can continue enjoying the physical, mental, and social benefits of football. And that’s something worth investing in - for everyone in the game.

Team Pitch x

References

1. Renstrom, P., et al. (2008). Non-contact ACL injuries: Risk factors and prevention strategies. Journal of the American Academy of Orthopaedic Surgeons.

2. Mancino, F. (2023). ACL injuries in female athletes: Risk factors and prevention. Knee Surgery, Sports Traumatology, Arthroscopy.

3. Hewett, T. E., et al. (2005). Biomechanical measures as predictors of ACL injury risk. American Journal of Sports Medicine.

4. Krosshaug, T., et al. (2007). Mechanisms of ACL injury in elite handball and football athletes. American Journal of Sports Medicine.

5. Kamitani, T., et al. (2021). Fatigue and landing stability in female football players. Journal of Sports Science.

6. Wojtys, E. M., et al. (1998). The association between the menstrual cycle and ACL injuries. American Journal of Sports Medicine.

7. Herzberg, S. D., et al. (2023). Hormonal fluctuations and ACL injury risk. British Journal of Sports Medicine.

8. Albright, J. C., et al. (2020). ACL laxity and relaxin receptor concentrations. Journal of Knee Surgery.

9. Pasquini A., et al. (2025) Effect of vitamin D on anterior cruciate ligament injury rates and post-reconstruction function-A systematic review. J Exp Orthop. Apr 1;12(2)

10. Okholm Kryger, K., et al. (2023). Training load inequities in women's football. BMJ Open Sport & Exercise Medicine.

11. European Club Association (2023). Women’s football boot comfort and fit survey.

12. Magaña-Ramírez, M., et al. (2024). What exercise programme is the most appropriate to mitigate anterior cruciate ligament injury risk in football (soccer) players? Journal of Science and Medicine in Sport, 27(4), 234–242. https://doi.org/10.1016/j.jsams.2024.02.001

13. Crossley KM, Patterson BE, Culvenor AG, et al. Making football safer for women: a systematic review and meta-analysis of injury prevention programmes in 11 773 female football (soccer) players. British Journal of Sports Medicine 2020;54:1089-1098.

14. Gomes Neto, M. et al. (2017). Effects of the FIFA 11 training program on injury prevention and performance in football players: a systematic review and meta-analysis. Clinical Rehabilitation.