In January this year, Matilda's star and Chelsea striker Sam Kerr injured her anterior cruciate ligament (ACL) at a pre-season training camp in Morocco. And while fortunately, thanks to top tier medical care, she’s BACK BABY, as it turns out, ACL injuries are more common for female athletes.
In Warrior Girls (2009), American journalist Michael Sokolove cites studies showing that young women who play soccer, basketball and volleyball suffer tears to their ACL (which btw, is the band of tissue that stabilises the knee joint) up to eight times as often as men in the same "jumping and cutting" sports.
There isn't enough data on female athletes to say exactly why this is the case, but research shows risk factors include women tend to be more “quad dominant” than men, hormonal differences across the month (a Norwegian study of professional handballers showed women were more likely to be injured just before and just after getting their period), and resourcing differences between female and male athletes at both the amateur and professional level.
We spoke to a commercial partnerships manager for the Sydney Swans, who notes that male and female AFL players train under different conditions.
Being a professional AFL player is a challenge full stop, but for women, the situation is trickier. For example, AFLW Swans players train on less well-kept grounds across random spots in the Inner West of Sydney while male players have full time access to the Sydney Cricket Ground, often wear boots designed for men rather than women, and are more likely to be overstretched mentally and emotionally due to the need to work other jobs (both paid and unpaid labour) than their male counterparts to keep up their participation in the sport.
An MP survey found that among 16 female athletes, they were on average 27-years-old at the time of injuring their ACL, most likely to be playing AFL or soccer, and the majority were playing a normal in-season game at the time.
MP then asked respondents to rank the biggest challenges for them in recovery.
The number one challenge in recovery by far was emotional - unsurprisingly, female athletes feel better when playing sport, and when they can't play, it's pretty tough. Coming in at number two was financial - paying for a physiotherapist, surgery, and taking time off work. And number three was identity challenges- as an athlete, who are you when you can't play?
From the emotional and physical toll this injury takes, to what they'd tell other young women on how best to approach recovery, here’s what four female athletes from the MP audience had to say.
Missing Perspectives ACL injury survey results February 2024
Sarah McConville, late 30s, National Accounts Manager at Walker Books in Sydney:
Sarah started playing basketball at age 10, but now only interacts with it as a fan after rupturing both ACLs and having both reconstructed. The gym is her replacement form of exercise, but the sense of community and camaraderie she once sourced from basketball just isn't the same.
Sarah sustained her first injury in her early twenties, where family support was a boon but working a casual job meant being out of action was tough on her finances.
“The first time, I stayed with my Mum for two weeks, which was helpful because I couldn’t take the splint off for anything – so we kind of had to MacGyver a cover for when I wanted to shower – and her bathroom and shower was just walk in whereas mine had a bathtub, so there was no way that was happening,” she says.
She says she noticed a distinct difference in terms of the quality of care and recovery time between her first surgery and her second. But recovery is still a long process.
“It usually takes around 12 months to recover. And this is probably more personal to me, but if you’ve never had surgery before, try and find out if you’re allergic or to anesthetic or not before having the surgery,” she says.
Jen Appleton, 36, works in the government emergency services sector in Canberra:
Beyond her day job, Jen is the vice president of a female-only soccer club. It's a sport and community that she feels strongly connected to.
However, her ability to play hasn't always been a given. In March 2020, Jen sustained an ACL injury in a preseason competition, taking her out of the game for 799 days. She's been back on the field for a season and a half, and credits the having a really excellent physiotherapist by the name of Tim McGrath as a big part of why.
Jen noted that during her group rehabilitation classes, at least three of her fellow rehabees were going through emotionally turbulent times in their life at the moment of sustaining the injury – from divorcing abusive partners to close family members falling ill.
The rehab process is protracted and requires a lot of mental fortitude – recovering athletes carefully graduate through a process of relearning how to straighten their legs, running, jumping, hopping, and ultimately, pivoting. As such, Jen thinks having a “why” in mind is critical for recovery.
“Think about what you’re doing it for. Because the whole process sucks – the surgery is hard. But knowing you have something to go back to really helps – and I stayed involved in the football club. Having the connection to the sporting community gave me that want to get back to. If I didn’t have something to get back to, it would be far easier,” she says.
Jen says beyond the physical recovery, it’s also about learning to trust yourself again while playing sport. So often, women sustaining ACL injuries during a fairly routine manoeuvre – like a tackle or landing on their foot – so the injury can leave emotional scars beyond the physical damage.
“When I got back into playing – even doing a tackle, it was scary. It’s a brain injury too – you need to relearn to trust your knee. I’m very thankful,” she says.
Noni Paling, 43, occupational therapist and mother of three children:
But not everyone gets back to playing. At 27-years-old, while in peak physical fitness and with no one around on the field, Noni Paling tore her ACL playing soccer, a game she first got into as a player at age 10. Now 43, she wishes she hadn’t waited so long to get back into playing.
To this day, Noni suffers from osteoarthritis in her knee joint as a result of trauma from her injury and subsequent surgery she had in her twenties, she can’t run or play football, or do lunges without feeling pain. She’s heartened to see that things have come a long way in the medical world since her injury, but she wishes that she’d had better medical advice and care for herself.
“If I went back in time, I’d have just gone back and played sooner. Don’t wait, just play. You’ve only got one time to do all this,” she says.
Ebony, 26, UX designer in Melbourne:
When she's not mocking up beautiful user experience Ebony, 26, a UX designer in Melbourne, sustained an ACL injury in 2022 while playing soccer for Melbourne University. She has played with Melbourne University for around five years, which includes twice weekly training sessions and a fairly intense schedule.
Ebony has played sports casually and competitively since she was five years old, and considers it a huge part of her identity as a child, teen, and now as a woman.
Getting an ACL injury has been a huge challenge in her sporting career, and for the past eighteen months, she has been on the slow journey of recovery.
During a game, she went in for a header, another player bashed into her body, whereupon she felt “the most pain I’ve experienced in an injury and in a game before.”
“It’s quite common for people with ACL injuries to walk off the field. I went down for a few minutes and I was crying, which was quite unusual for me,” she recalls.
She had a physio assessment the next day, who initially told her it was not her ACL, but an MRI a few days later showed she had a fully ruptured ACL in her right leg and damage to her meniscus. Across a period of eighteen months, she has slowly recovered to the point of being able to play again. Her message to other amateur athletes is that although recovery is gruelling, if they can manage it with their other responsibilities, it is worth it to get back into the sport you love.
Many female athletes want to “get back out there” as soon as possible. But pushing through the pain is not advisable.
Take any pain seriously as soon as possible, advocate for yourself until you get the right treatment, and slowly work up to various levels of movement without pushing past the pain barrier. The rewards for that are not a continued lifetime of playing sports, but rather, suffering from chronic pain or moving like an elder before your time.
Happy playing, and stay safe!