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ACL Injuries in Women’s Football and the Role of Weak Hip Flexors

Introduction
In recent years, the world of women’s football has seen remarkable growth and progress. The skill and athleticism displayed by female players have reached new heights, drawing larger audiences and increased interest. With this increase in popularity and opportunities to play the game, more and more girls are taking up the sport after being inspired by the success of the Lionesses, but this then leaves these young girls susceptible to potential ACL injuries, which can end a career before it’s even started. As women’s football continues to grow and evolve, it is essential to prioritize the well-being of the athletes who inspire us with their skill and determination on the field.
This blog will delve into the alarming increase in ACL injuries in women’s football, examining the role of weakened hip flexors and the differences in pelvic angles between males and females in contributing to this issue, and what strategies can be used to reduce the risk of ACL injuries in Women’s football.

Understanding ACL Injuries:
The anterior cruciate ligament (ACL) plays a vital role in stabilizing the knee joint, preventing it from excessive forward movement. Unfortunately, ACL injuries are common in sports that involve sudden changes in direction, pivoting, and jumping, such as football. The injury occurs when the ligament is overstretched or torn, leading to pain, swelling, and in some cases, surgery and extensive rehabilitation.
Studies have consistently shown that female football players are more susceptible to ACL injuries compared to their male counterparts. According to research, the rate of ACL injuries in women’s football is two to ten times higher than in men’s football. This alarming disparity has prompted researchers and sports medicine professionals to explore potential contributing factors specific to female athletes.
Pelvic Anatomy Disparities: Unveiling the Angle Difference
An often-overlooked aspect contributing to the higher prevalence of ACL injuries in women’s football is the distinct anatomical differences between the male and female pelvis. One of the key dissimilarities is the angle at which the pelvis is positioned. The female pelvis tends to have a wider angle between the hip bones, known as the Q-angle, compared to the narrower angle in the male pelvis.
The Q-angle creates an increased mechanical load on the knee joint, potentially leading to improper tracking and alignment during movements. When coupled with weaker hip flexors, the misalignment further heightens the vulnerability of the ACL to injury. This combination of factors creates a perfect storm that leaves female footballers at a heightened risk of ACL tears.

This wider angle can create a situation known as “valgus collapse” when a female athlete lands from a jump or changes direction suddenly. Valgus collapse occurs when the knee moves inward toward the centre of the body, placing excessive stress on the ACL. This is a crucial difference as male athletes tend to have a narrower angle in their pelvis, which provides more stability to the knee joint during high-stress movements.

Hip Flexors and ACL Injuries:
One key factor that has emerged is the role of hip flexors in stabilizing the knee during movements. Hip flexors are a group of muscles located in the front of the hip, responsible for bending the hip joint and bringing the knee towards the chest. These muscles are vital for maintaining proper alignment and stability during physical activities.
Weak hip flexors can lead to an increased risk of ACL injuries. When hip flexors are underdeveloped or lack strength, the knee may experience excessive inward movement (knee valgus) during dynamic movements. This inward collapse places greater stress on the ACL, making it more susceptible to injury during quick changes in direction or landing from jumps. This can increase the risk of ACL injuries in the following ways:

1. Poor Landing Mechanics: Weak hip flexors can result in poor landing mechanics, causing the knees to collapse inward upon landing. This inward movement of the knee is a known risk factor for ACL injuries.
2. Altered Running Gait: Inadequate hip flexor strength can lead to an altered running gait, where the knees move excessively inward or outward during running. Such irregularities in gait can predispose female footballers to ACL injuries over time.
3. Reduced Dynamic Stability: Dynamic stability, the ability to control the body during rapid movements, is crucial in football. Weak hip flexors can compromise an athlete’s ability to maintain proper alignment, leading to ACL injuries during quick changes in direction or pivoting.

Addressing the Issue
Recognizing the link between weak hip flexors, anatomical differences in pelvises, and the rise in ACL injuries among female footballers is essential in devising preventive measures and injury management protocols. Here are some strategies that Regain Pain Management can implement to address this issue:
1. Strengthening Programs: Implementing targeted hip flexor strengthening exercises within training programs can enhance stability and reduce the risk of ACL injuries in female athletes.
2. Neuromuscular Training: Integrating neuromuscular training, which emphasizes proper movement mechanics and body control, can significantly reduce the occurrence of ACL injuries.
3. Sport-Specific Techniques: Teaching proper jumping and landing techniques can minimize the impact on the knee joint and reduce the risk of ACL injuries.
4. Injury Prevention Education: Educating players, coaches, and parents about ACL injury risk factors, symptoms, and preventive measures can foster a safer sporting environment

Regain Pain Management has over 80 years of experience working with high level athletes and amateur sports people of all ages, to become stronger and avoid the potential injuries associated with weak hip flexors.

Our Director, Mathew Jerome, was Physio for Bradford City Women’s Football team, before he became Head of Injury & Rehabilitation at their Elite Development Football Programme. He uses a treatment protocol called ‘Muscle Activation’ that gets the muscles firing in the correct sequence, making the body, and especially the legs instantly stronger. This has been a really successful therapy in reducing the amount of lower limb and knee injuries that he has had to deal with over the last 4 years among female footballers.

He also works closely with a number of Junior and professional football academies across the region, advising, treating and educating players, parents and coaches about Injury prevention, and what can be done at home in-between training sessions to maintain fitness.

Matt Grace Our Strength & Performance Coach, has devised a range of programs aimed at making the hip flexors, ankles, feet and knees more stable, reducing the chance of ACL tears. He delivers online 1 on 1 sessions, or face to face in clinic appointments.

Melanie Roberts who is our Manual Therapist, can help to improve nerve signal, proprioception, and increase core stability with her amazing hands-on therapies. She can also identify any potential weaknesses in the body before they manifest into something more serious by doing some simple body work testing.
We also have Deepika Surve who is our Physiotherapist, and can diagnose any niggle or injury, so that you get the correct treatment and speed up the return to playing the beautiful game again.

Conclusion
The concerning surge in ACL injuries among women’s football players demands a comprehensive understanding of the contributing factors. While numerous elements may be at play, recent research highlighting the role of weak hip flexors and the anatomical disparities in pelvic angles has shed light on a potential avenue for proactive intervention.
By focusing on hip flexor strengthening, biomechanics training, and personalized conditioning, the football community can work together to address this issue and ensure the long-term health and success of female players. As awareness grows and preventive measures take centre stage, women’s football can continue to flourish as a sport where athletes thrive and injuries become a rarity rather than a norm.
Mathew Jerome
Director – Regain Pain Management

Deepika - Physiotherapist

Welcome to Deepika who joins us as our new physiotherapist. Deepika will be working from our Rodley clinic. 

Deepika has an enthusiasm and passion for helping people, and her multi-faceted approach to diagnosing pain, sets her apart from other therapists in her field.

She comes to Regain Pain Management having achieved a master’s degree in Physiotherapy and Sports & Exercise medicine at Leeds Beckett University, and gained experience dealing with patients in a hospital environment. She has worked with high profile athletes in India during the filming of Chakda Xpress, and she is a part time physiotherapist at Barnsley Football Club.

Deepika is also fully trained in Myofascial Release and is a qualified Nutritionist. 

EDUCATION

  • Leeds Beckett University, MSc Sport and Exercise Medicine Sept 2020-March 2022. Krishna College of Physiotherapy
  • Krishna Institute of Medical Sciences Deemed University (India), Bachelor’s in Physiotherapy July 2014-July 2018

LICENCES AND CERTIFICATES

  • HCPC Registered (PH128091) May 2022-April 2024
  • Member of Chartered Society of Physiotherapy (113661) May 2022
  • The FA Level 4 Intermediate Trauma Medical Management in Football (ITMMiF)
  • The Football Association (FA No- 67316423)

 May 2021-May 2024

  • Safeguarding Children Course- The FA Jan 2023
  • Certificate in Sports Nutrition, 
  • HWYM Healthcare Pvt Ltd

 March 2020

  • Certificate Course in Orthopaedic Manual Therapy,
  • Capri Institute of Manual Therapy

Oct 2017

  • Myofascial Release Therapy
  • Institute of Manual Therapy and Taping April 2017

Matt Grace – Strength and Rehabilitation Coach

Matt initially completed his Myofascial Release training at the same time as Mathew Jerome. He has since moved on to become one of the best performance rehab coaches in Leeds, Huddersfield, Barnsley, and surrounding areas.

His passion for helping people to function correctly, reducing the chance of injury occurring is what sets him apart from the rest. He also works with clients who have postural/muscular imbalance. Helping to get them back to full strength using a range of exercises and routines that balance the body and get it working at an optimum level again.

Matt started out doing sports massage therapy and Myofascial Release. And whilst he learned a lot from experienced therapists, he always felt like there was something missing. It was his own back injury that led to further research in to biomechanics and movement. And, having suffered from injuries in the past, he knew that there would be others who were frustrated with long periods of convalescence, and being unable to do what he enjoyed the most – exercising!

Matt’s research led him to find some amazing movement-based therapists that helped him to focus on breathing, the pelvis, ribcage and the feet. After which he carried out a self-assessment, looking at his own posture and marking down any alignment issues he found. This enabled him to explore which movements and exercises worked well for him, and what didn’t!

Matt does clinics online, as well as in person. And his treatments work for people of all ages and abilities.

Rachel Brook – Therapist

After being diagnosed with ME aged 16, Rachel began researching alternative therapies, and by the Age of 20 she achieved a diploma in aromatherapy full body massage.

Rachel brings over 20 years’ experience as a therapist, during which time she has learned a wide variety of holistic therapies that she combines to deliver bespoke treatments to her clients today.

Previously a chronic pain sufferer, Rachel struggled with severe neck pain and SPD whilst pregnant with her 2 children. This experience opened Rachel up to Myofascial Release. A therapy which helped to resolve a lot of the problems she was experiencing. Due to her own medical past, Rachel often has a deep connection with clients who don’t feel listened to or feel that they aren’t receiving the appropriate support and treatment.

In addition to her extensive experience, Rachel recently became a qualified Oncology Masseur. This enables her to offer comfort and support to cancer patients at all stages of their care.

Moreover, at Regain we offer on-site, in house clinics for corporate clients. Rachel is our corporate therapist, delivering holistic therapies that will leave your workforce feeling refreshed and invigorated.

Rachel’s treatments also include – Myofascial Release, Swedish Massage, Sports Massage, Angelic Reiki, Indian head massage, Hot stone massage, Pregnancy Massage, Reflexology, Himalayan Salt Stone Massage, Fascia Cupping, Facials.

Melanie Roberts – Therapist

MELANIE ROBERTS  Member Federation of Holistic Therapists  

Melanie has been a complementary therapist since 2008 and became a teacher in 2018. Having trained and worked with world class teachers, she combines Eastern and Western techniques to offer Preventative therapies and helps improve the overall health of her clients, no matter what aches, pains, illnesses, and injuries as well as physical and emotional difficulties they may present with.

If you are unsure which therapy to book, do not worry. After an initial assessment and consultation, Melanie will discuss the appropriate treatment plan for you.
We recommend that you book 1.5 hour for your initial treatment, if possible, to allow plenty of time for consultation, postural & movement assessment, treatment & aftercare advice.


KORE Therapy ®️
KORE is a unique and highly accurate muscle testing & diagnosis system. It identifies the poor functioning systems, injuries & imbalances within the body & helps to find the root cause rather that just treating the symptoms. Treatments include Acupuncture/Acupressure, Tui Na Massage, Cranial Balancing, Cupping, & Anmo Fu. A combination of Eastern & Western therapies.

Myofascial Release
Fascia is the connective tissue that surrounds and supports all our internal body. From the bones, muscles and organs, the ligaments, and tendons down to each individual cell. So, when the fascia becomes tight or restricted due to lifestyle, activity, or surgery, it can cause pain, limit mobility, and affect our general health both physically & emotionally. Myofascial release uses gentle pressure to release tension in the fascia, allowing for greater flexibility, range of motion and improve our general wellbeing.

TMJ Therapy ®️
Melanie has trained with dental professionals to gain the best knowledge for what can be an extremely painful & debilitating problem. Melanie uses very gentle techniques to ease the affected temporomandibular joint and surrounding areas, including hips and pelvis as the jaw has a strong correlation to our whole-body movement and gait. TMJ Therapy®️ is ideal for Misalignment, Pain, Headaches, Tinnitus, Stress, Clenching, Teeth Grinding, Jaw Popping & Locking.

Women’s Health Wellness Practitioner.
Specialising in Women’s Health. With an holistic approach to help & coach women through the myriad of issues associated with Hormones, Periods, Fertility, Peri-Menopause, Menopause & Post Menopause. Including Stress, Anxiety, Immune System, Sleep, Nutrition, Digestion & Gut Health.

Acupuncture
Traditional Chinese medicine going back over 2000 years. Very fine needles are gently inserted in the skin at specific points along lines of energy (meridians), thereby stimulating the body’s natural healing process to restore your natural flow of energy and balance. It is used in the treatment of physical and emotional conditions and for Preventative care.

Facial and Auricular Acupuncture / Acupressure
The face & ears are microsystems of the whole body. We can see a person’s health by looking at these areas. By doing acupressure massage or by placing fine needles in specific points, we encourage a better flow of blood, lymph, and energy. Both helping our internal organs, balancing internal health, better body function, relieving stress & also improving facial complexion.

ScarWork
Gentle movements that help to improve mobility and reduce the appearance of scars. It works on the surface down to the deeper layers of fascia. No matter how old the scar, improvements can be felt & seen.

Digestive & Gut Health Practitioner
Traditional oil-based massage that just focuses on the abdomen to release twists and torsions in the bowels and balancing the internal organs. By cleansing the digestive system, it creates a fantastic treatment for many stresses, bowel, lower back gynaecological and emotional problems. This has been beneficial to those suffering from IBS, Chron’s & Colitis.

Korean Hand Therapy
The hands are very closely linked to the brain. KHT is a micro system of the full body’s acupuncture system. By placing small needles, press pellets or magnets to corresponding areas, it can complement another treatment, can be used in an emergency situation or as a stand-alone therapy.

Massage
Advanced Clinical / Deep Tissue / Sports / Abdominal / Tui Na
Melanie combines different massage styles to provide a bespoke treatment for the clients’ requirements.

Cupping Therapy
Cupping has been used for centuries across different continents for healing. This involves warm glass jars being applied onto an oiled body as a therapeutic massage system. Designed to treat a wide range of physical problems from pain and muscle spasms, poor circulation, colds, and flu & cellulite. Also promotes faster healing & recovery.

Spinal Touch Therapy
A painless, light touch technique to encourage correct posture and good health. Suitable during pregnancy so a fabulous treatment for Pelvic Girdle Pain & Symphysis Pubis Disorder (SPD)

Reflexology & Thai Foot Massage
This deeply relaxing therapy promotes natural healing by working on the reflexes in the feet. Suitable for all ages.

Kinesio Body taping
Kinesiology tape is a stretchy tape that is applied to the body in different ways to reduce swelling and pain from an injury. It can help to protect an area of the body, increase mobility, and prevent muscle spasms. It is also used with athletes to help them recover at a faster rate as it enables a more effective lymphatic drainage.


QUALIFICATIONS

Diploma
• KORE Therapy®️
• KORE Clinical Acupuncture®️
• TMJ Therapy®️
• Menopause Wellness Practitioner
• Menopause Nutrition & Weight Loss Management Practitioner
• Naturally Managed Menopause
• Gut Health Practitioner
• Sleep Consultant
• VCT Level 3 Dip. Anatomy & Physiology
• VTCT Level 3 Dip. Reflexology
• VTCT Dip. Hopi Ear Candles


CERTIFICATE

• Myofascial Release I, II, III
• Active Fascial Release
• Facial Acupuncture
• Auricular Acupuncture
• Anmo Fu & Zang Fu Abdominal & Organ Massage
• Korean Hand Therapy – KHT I, II, III, IV
• ScarWorker
• BoneRolling
• BTech Level 6 Advanced Clinical Massage
• ITEC Level 3 Sports & Deep Tissue Massage
• VTCT Level 3 Swedish Massage
• Crainio Sacral Therapy I
• Spinal Touch Therapy
• Meridian Massage
• Thai Foot Massage
• Tui Na Body Massage
• Kinesio Body Taping & Magnet Therapy
• Kinesiology – Touch For Health I, II, III, IV

Mathew Jerome – Director

Mathew established Regain Pain Management after his own struggles with chronic pain.

His fascination with the human body started when he was just a child. And in 2003 he gained diplomas in Anatomy & Physiology Sports Massage therapies. Fast forward to 2008, and Mathew unfortunately developed lower back pain, which was eventually resolved in 2013 through Myofascial Release Therapy.  It was after this treatment that he set up the business, so that he could deliver this therapy to others who were struggling with unresolved chronic pain.

Since then, he has gained a reputation for helping people who have previously failed with traditional medical intervention, throughout the Leeds and Huddersfield areas. Through Myofascial Release Therapy, and other therapies he has seen and helped over 2000 clients, many of whom are now pain free and no longer on long term pain medications.

What’s more, with a long history with football, playing semi-professional for 10 years before going in to management and coaching, Mathew now works with footballers of all ages. And was recently employed at Bradford City as Head of Injury & Prevention for their Football Development Programme, where he spent 2 years overseeing the players overall fitness and injuries.

Mathew now sees many high-profile clients such as premiership footballers, Super League Rugby players and professional boxers.

Over the years Mathew has studied with some of the worlds leading therapists. And has built up a skill set that enables him to deliver bespoke treatments to each of his clients. Using his knowledge of the human body and his overall professional experience which sets him apart from his competitors.

CERTIFICATIONS: Level 3 Diploma Anatomy & Physiology; Level 3 Diploma Sports Massage Therapy; Level 3 Diploma Sports Fitness Therapies; Level 1 certification Integrated Myofascial Therapy; Level 2 certification Integrated Myofascial Therapy; Level 3 certification Integrated Myofascial Therapy; Myofascial Assessment & Integration; Myofascial Unwinding – Be Activated – Muscle activation Level 1; Be Activated – Muscle activation Level 2.

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