Women's Football: How the role of Physiotherapist extends far beyond match day

Women’s football has become one of the fastest growing sports across professional, semi-professional, and grassroots levels during recent years. Following on from the Lionesses historic win, it is expected that women’s football will continue to grow. If you’re a keen footie fan or player, you’re probably aware of the presence of a Physiotherapist on the pitch side-lines. In this article, New Victoria Hospital’s Senior Musculoskeletal Physiotherapist, Ravina Daware, talks about the role of the Physiotherapist in football and why the need for one extends far beyond match day.

Common injuries in women’s football

Both male and female athletes can be elite on the field. They train and play with the same level of determination but there is one major difference between the two; women have to deal with constraints related to their sex.

For women, these fall into mostly structural and hormonal differences, that raise the risk of injury during the sporting event.

Frequent exposure to more physically demanding training and match play also increases the susceptibility of athletes, and in this case, female football players, to injury occurrence.

One Main Structural Difference: The Pelvis

ACL Rupture

The ACL, or anterior cruciate ligament, is one of the major ligaments found in the knee. It connects your thigh-bone to your shin-bone to keep your knee joint stabilised.

When you are playing sport and you stop abruptly, jump, and then land awkwardly on one leg, or pivot quickly on one foot, your ACL can tear either partially or completely.

Women have a higher risk of injuring this ligament because they move differently to men. For example, when landing from a jump, women tend to land more upright and with the knees closer together. When female athletes suddenly change direction, they tend to do so on one foot due to a having a wider pelvis while men tend to “cut” from both feet.

Ankle sprain

An ankle sprain gained from football can be mild, moderate, or severe. A severe sprain involves a complete ligament tear, rendering your joint non-functional and often causing severe pain.

Moderate sprains involve partially torn ligaments that can leave your joint unstable. Ankle sprains are a common injury amongst athletes, and a frequent complaint amongst sporting women because of the wider pelvis which alters the alignment of both the knee and the ankle.

Patellofemoral syndrome

Commonly known as runner's knee, Patellofemoral Syndrome is the term for pain and stiffness located by the kneecap.

Women suffer from this syndrome more often than men, again due to the structure of the pelvis, which throws off the alignment in the legs. This misalignment causes undue stress on one area of the knee, increasing your chance of injury to the kneecap and surrounding tissues on the pitch.

These conditions are generally treated by Musculoskeletal Physiotherapists, however sometimes surgery is needed. Even so, before and after surgery, a Physiotherapist will be able to assess the injury before your procedure and will help you with rehabilitation if needed.

Hormonal Differences

Stress Fracture

A stress fracture represents the inability of your bone to withstand repetitive bouts of mechanical loading, which results in structural fatigue and symptoms of pain and tenderness. If you are a female football player, your menstruation cycle can affect your susceptibility to this this type of injury.

As oestrogen levels fluctuate during menstruation, they cause your bones to become brittle for short periods of time making you prone to injury.

Stress fractures of the lower limb are also an important overuse injury in female football players. This is thought to be caused by a number of differences including menstrual irregularity, consuming fewer calories and lower bone density.

Concussion

When you experience a blow to the head, your brain shifts quickly within your skull. This brain injury can lead to cell damage or changes in your chemical composition.

There is no solid evidence as to why women athletes suffer a concussion more often than men, but according to some research it could be due to anatomical differences within the body and brain, or due to hormonal fluctuations leading to a difference in the brain’s reaction to the blow.

The Role of the Physiotherapist

Sports physiotherapists have a multi-faceted role which includes:

Injury prevention plan
Assessment of injury
Development of an individualised treatment plan
Rehabilitation - improving the strength and mechanics of the other parts of the body and applying a realistic timescale for return to sport

Pre-match

Your Physiotherapist will focus on injury prevention, identifying all the modifiable risk factors to an injury and implementing a plan to address them.

Match Day

Your injury assessment will require a careful and comprehensive questioning about your current injury as well as previous injuries to identify the root cause. Often the root cause is not where your pain is located so a whole body examination will most likely be carried out.

Physiotherapists work as part of a multi-disciplinary team; you will either be referred to the care of the immediate team e.g., coach, team manager, sports doctor, or you will be referred to the extended team e.g., sports psychologist or dietitian.

Post-match

After match day your Physiotherapist will work with you to develop an individualised treatment plan – this will address all of your weaknesses and imbalances so that you can come back stronger from the injury and prevent injury re-occurrence.

Your Physiotherapist will work with you to improve both the strength and mechanics of the other parts of your body. This is essential, especially if you need a period of time away from sport whilst you recover.

Lastly, your Physiotherapist will apply a realistic timescale for your return to your sport. This is a skill and only comes with experience. Injuries heal at different rates in different people.

Top Tips for injury prevention

As the number of women football players increases, it is important to be aware of the injuries that can occur, but more importantly to know how to prevent them.

Injury prevention programmes have been shown to reduce the occurrence of both ACL and ankle injuries if they are implemented over a sustained period of time.

Here are some tips to keep you fit and healthy for match day: