Should girls worry about soccer injuries?

In recent years, participation in sports by females across the United States has steadily increased. Soccer continues to be one of the most popular sports for girls at both the youth level and through high school and college. But an increase in injuries in girls’ soccer has accompanied the rise in participation. Obviously, injuries can and do occur in all sports, but should female athletes be particularly concerned?

Knee brace soccer
ACL tears are not uncommon in female soccer players.

Recently two injury patterns among female soccer players have drawn attention. First, it has been shown in many studies that girls have a significantly higher rate of ACL injuries of the knee than their male counterparts. Depending on the age group and competition level studied, some researchers have found that females are anywhere from 2 to 10 times more likely to tear their ACL’s than males.

There have been many theories proposed about the underlying reasons for the higher risk, including menstrual cycles, wider pelvises, smaller knee ligaments, and others. But the reason appears to be related more to how girls land from jumps and how they turn. Unlike males, who land and turn with their knees bent, girls naturally land from jumps or turn to change direction with their knees fully extended. This fully extended position places much more stress on the anterior cruciate ligament than a flexed knee position.

And while ACL injury frequently requires surgical reconstruction to help an athlete return to sports, there is some concern that recovery isn’t as certain in girls’ soccer players either. A study presented recently at the American Academy of Orthopaedic Surgeons Annual Meeting looked at data from a Swedish registry of almost 18,000 ACL surgeries performed over a five-year period. Of note, while the incidence of reinjuring the surgically repaired knee or the opposite knee among all athletes was approximately 9%, the cumulative incidence of same-side or opposite side ACL injury among female soccer players aged 15 to 18 was much higher – approximately 22%.

Also, several studies recently have shown that concussions might also be more common in girls’ soccer than boys’ soccer. Media attention has focused intensely on pro and college football and hockey, but data showing that concussions are common in girls’ soccer has largely gone unnoticed.

In fact, in soccer at least, girls are approximately twice as likely to suffer concussions. In a study in the May 2011 issue of the American Journal of Sports Medicine, among high school athletes, the rate of girls’ soccer players suffering concussions per 1000 athlete exposures (1 game or practice for each athlete equals one exposure) was 0.35, compared to 0.17 among boys’ soccer players.  Another study in the November 2011 issue of the same journal showed that concussions make up over 15% of all injuries in girls’ soccer. And most worrisome is the evidence that female athletes are more likely to have concussion symptoms that persist for longer than 7 days compared to males. Tweet this statistic. 

I think that it is important to realize, though, that to a certain extent we can work to minimize these injuries in numbers and severity. While it is true that both ACL tears and concussions can occur in a contact or collision sport like soccer, there are ways to decrease the risks.

For ACL injuries, one key for females seems to be working to teach proper landing, turning, and jumping mechanics. Programs where female athletes practice proper landing and turning techniques and strengthen muscles of the hips, thighs, knees, and legs have shown promise in decreasing the rates of ACL tears. These exercises can be incorporated into the warmups performed before practices and games over the course of a season. While they will not prevent every ACL tear, if they even kept one player out of the operating room and physical therapy office, I would argue that would be a success.

Heading soccer ball
Some studies suggest that repetitive heading of the soccer ball can lead to long-term brain damage.

For concussions, I think it’s critical both to try to prevent them but also to raise awareness of their dangers. There is conflicting data about whether the repetitive act of heading can cause long-term brain damage. But there seems to be little question that traumatic blows to the head from contact with another player in the air, hitting the head on the ground, or hitting the head on a goalpost are dangerous. Teaching proper heading techniques and landing techniques and appropriate head and neck positions for heading might be helpful. Since contact with goalposts has been implicated in 18 deaths in soccer in the U.S. over a 13-year period, even the use of padded goal posts might be worth considering.

Lastly, I will say that the benefits of sports participation for young females might outweigh these risks. Research has shown that girls who play sports have lower rates of obesity, lower rates of teen pregnancy, better grades, and better self esteem. So I want to encourage more young females to play sports, and to push parents to encourage their daughters to play soccer. Then we all need to work to keep them as healthy as possible.

If you want to learn much more about injuries in female sports, ways to decrease the risk of some athletic injuries, and the benefits of sports to the overall health and wellbeing of female athletes, please check out Episode 28 of The Dr. David Geier Show, available Monday at or on iTunes!

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david-headshot I am an orthopaedic surgeon and sports medicine specialist in Charleston, South Carolina.

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