They’re the three letters no athlete wants to hear: ACL (or anterior cruciate ligament).

The ACL is a ligament in the knee that provides stability. Most ACL injuries are caused by sudden deceleration, jump landings or changing direction so many sports such as basketball, netball and soccer have a high risk of injury. Often, surgery will be required along with a period of rehab. Even then, not all athletes will return to the same level of play, which is why this injury can be so devastating for athletes.

With more women tackling contact sports, including Australian football and soccer, the rate of knee injury among players is also on the rise. In Women’s AFL, it’s estimated female players are up to 6 times more likely to injure their ACL than men. While we are yet to see what the 2023 season will bring for AFLW players, we sat down with TeamCSSM and AFLW athlete Katelyn Cox who is currently in pre-season mode for Richmond.

We find out why Katelyn’s training schedule is heavily focused on preventing this sort of injury.

How concerned are you that female footballers are 6 times more likely to suffer an ACL injury than their male counterparts?

It is extremely concerning that females are more likely to suffer an ACL injury than males.

However, there are many factors that need to be taken into consideration regarding these stats.

· Men – full time vs women – part time (AFLW level)

· Exposure to AFL from an early age vs exposure later in life (which will change in due course)

· Access to resources (still evolving at AFLW level) / elite programs from an earlier age (which is currently changing – like the boys, we now have NAB league competitions for girls)

Hopefully as time goes on, women’s AFL progresses, and research evolves, the rate of ACL injuries will decrease.

Is this a common concern amongst your team mates?

Unfortunately, it is very common to know numerous females that have injured their ACL/’s, with many suffering the injury multiple times. There is almost at least one ACL injury each round.

It is certainly something we are concerned about. However, as a general collective, it is not something that worries us enough to not play. We put in a huge amount of work to ensure our preparation is satisfactory and with time and research, it will hopefully only get better. We also accept that injuries are a part of sport, and the focus is on preparing as well as we can.

Are there particular exercises included in your training to try and avoid an ACL injury?

· A dynamic warm up that consists of the ‘prep to play’ program. This program targets women and girls footy to improve performance and reduce injury.

· Education around the common mechanisms for ACL injury – tackling, evading, and landing.

– We are exposed to these elements in main trainings sessions, access to a specialist tackling coach to help with tackling technique, as well as a range of drills at match intensity to replicate the demands in a game where risk of injury is higher.

· We also gradually implement contact and change of direction into drills throughout preseason to enable the body to adjust to certain movements, exercises and load.

Do you incorporate any exercises or strengthening programs into your week with this in mind?

· Plyometric and landing exercises are regularly implemented into the program to challenge landing mechanics and control of the knee.

· More of a unilateral exercise focus to ensure lower body strength deficits are better targeted.

It seems there’s still so much we are to learn about why females are injuring their ACL at a higher rate – do you think there should be more research?

There absolutely needs to be more research. There is still so much to learn as women’s AFL progresses.

The following factors have been raised as potential issues that increase ACL injuries:

· Menstrual cycle

· Hips/body shape compared to men.

· Less exposure to footy (as a generalisation)

· Also, arguments of incorrect tackling technique – ACL injuries due to contact rather than COD.

At CSSM, our team of experts at working to keep you playing and training for longer whether it’s prevention or getting you back on the field playing again. If you’ve injured yourself, a rehabilitation program for both pre and post-surgery is important. Talking to a physio early, is an important step.

Returning to running is only a small component of the overall picture and requires adequate muscle strength and single leg balance prior to being attempted. Your physiotherapist can help guide your recovery and will conduct regular strength testing to assess your readiness to progress to running, hopping, change of direction, returning to training and then ultimately returning to play.

BELOW: CSSM Physiotherapist Kobi Phelan talks ACL rehab – what to expect before surgery and why rehab is so important.

About the author

Katelyn Cox is a sponsored athlete as part of CSSM’s Athlete Sponsorship Program 2023.

In June 2022, Katelyn was drafted to Richmond AFLW and says she is living out her childhood dream. For Katelyn, footy is an escape no matter what is going on in her day to day life. Currently training with Richmond for pre season, we can’t wait to see season 2023 kick off in August. We will be watching!