April 2025
In the last 12 months, we have supported 13 female athletes with ACL injuries, helping them return to play safely and effectively.
At P3RFORM, we specialise in minimising injury occurrence and rehabilitation, with extensive experience helping athletes return to play stronger and more resilient than before. In this article, we’ll explore why female footballers are more susceptible to ACL injuries, the best strategies to prevent them, and what an effective rehab process looks like.
Why Are Female Players More Susceptible to ACL Injuries?
Several factors contribute to the higher incidence of ACL injuries in female footballers. These include anatomical differences, hormonal influences, and biomechanics, all of which can increase the stress on the knee during high-intensity movements like cutting, pivoting, and landing.
1. Biomechanical Differences
Women tend to have a wider pelvis than men, which can create a greater inward angle of the femur (thigh bone), known as the “Q-angle.” This angle can put extra stress on the knee joint, making it more susceptible to injuries, especially during rapid directional changes.
2. Hormonal Influences
Estrogen and other hormonal fluctuations can affect ligament laxity, making the ACL more prone to overstretching or tearing, especially during certain phases of the menstrual cycle. While research is ongoing, some studies suggest that strength and neuromuscular training can help counteract these effects.
3. Muscular Imbalances and Strength Deficiencies
Many female athletes exhibit a quadriceps-dominant movement pattern, meaning they rely more on their quads than their hamstrings when decelerating or landing. Since the hamstrings act as a natural stabilizer for the knee by reducing anterior tibial translation (forward movement of the shin bone), weak hamstrings can leave the ACL more vulnerable to injury.
How to Prevent ACL Injuries in Female Footballers
While some risk factors cannot be changed (such as anatomy or hormones), by implementing a targeted S&C programme the risk of these injuries can be mitigated. The key is improving strength, stability, movement mechanics, and overall neuromuscular control.
1. Strength & Conditioning
Building lower body and core strength is essential for knee stability. A strong foundation reduces unnecessary stress on the ACL and improves movement efficiency.
Key areas to focus on:
- Quadriceps
- Hamstrings
- Calf
- Glutes
- Lumbo-pelvic control
- Plyometrics
At P3RFORM, we incorporate individualised strength programmes to address each athlete’s specific weaknesses and movement patterns.
2. Neuromuscular Training & Movement Mechanics
ACL injuries often occur when landing, pivoting, or making sudden changes in direction. Training the body to move safely and efficiently under these conditions can dramatically lower injury risk.
Key training components:
• Landing mechanics: Initially, coaching athletes to land softly, as they progress into running, then developing the capability to tolerate higher ground reaction forces as they land in both bi and unilateral positions. This prepares the joints for higher force and torque they’ll experience on the grass.
• Agility & cutting drills: Practicing change of direction and braking
• Proprioception training: Balance exercises to enhance body awareness and joint stability
3. Flexibility & Mobility Exercises
Tight hip flexors, calves, and hamstrings can alter movement mechanics, increasing knee stress. A structured flexibility and mobility programme should be included in every training routine.
4. Fatigue Management & Load Monitoring
Many ACL injuries occur when players are fatigued, leading to poor movement control. Managing training loads, ensuring proper recovery, and emphasizing good nutrition can help reduce the likelihood of injury.
Coaches and players should track training intensity, ensuring that workload increases progressively while allowing adequate rest periods. GPS tracking software provider StatSports support our rehabilitation work in this area – they have products available to purchase here
Sleep, hydration, and fuelling strategies also play a vital role in injury prevention – Becoming a P3RFORM client gives you unlimited access to experts across these key areas
Rehabilitation After an ACL Injury
Even with the best prevention strategies, injuries can still happen. ACL tears often require surgery, followed by an extensive rehab process before a safe return to play. The key to a successful recovery is a structured, progressive program focusing on strength, stability, and confidence-building.
Please note: this is not a rigid structure for progression but more so a guide. Different phases will crossover at different times depending on the player and how they’re progressing.
Phase 1: Early Recovery (0-6 Weeks)
• Reduce swelling and restore range of motion.
• Gentle activation exercises for the quadriceps and hamstrings.
• Begin weight-bearing as tolerated with crutches, transitioning to normal walking.
Phase 2: Strength & Stability (6 Weeks - 4 Months)
• Progressive loading exercises to rebuild strength.
• Single-leg balance and proprioception training.
• Controlled movements, focusing on proper mechanics.
Phase 3: Sport-Specific Training (4-9 Months)
• Introducing plyometrics and agility drills.
• Gradual exposure to football-specific movements (cutting, sprinting, pivoting).
• Psychological preparation and confidence-building exercises.
Phase 4: Return to Play (9+ Months)
• Full integration into team training.
• Ongoing strength and conditioning to prevent re-injury.
• Performance testing to assess readiness before competition.
At P3RFORM, we guide athletes through each stage of recovery with expert oversight, ensuring they return stronger and more resilient.
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How P3RFORM Can Help
At P3RFORM, we have extensive experience helping athletes prevent and recover from ACL injuries. Our team of experts uses evidence-based training programs, cutting-edge rehabilitation techniques, and individualised return-to-play protocols to ensure you come back stronger.
Whether you’re looking to reduce your injury risk or need a structured recovery plan after an ACL tear, P3RFORM offers the support and expertise you need.
Conclusion
ACL injuries can be career-altering, but they are not inevitable. With proper strength training, neuromuscular conditioning, and fatigue management, female footballers can significantly reduce their risk. And if an injury does occur, a well-structured rehab program is essential for a safe and successful return to play.
At P3RFORM, we are committed to helping athletes stay strong, resilient, and injury-free. If you want to take proactive steps toward injury prevention or need expert guidance for ACL rehabilitation, contact us today and let us help you perform at your best.
