Women hit where it hurts

Knee injuries can end a career prematurely - and there is a worrying trend in the women's game.

One of the unique selling points of the Westfield W-League is that it allows fans of Women-s football to see national team stars on the pitch, each and every week.

This weekend was no exception, the ABC television match was Brisbane Roar v Adelaide United and after the game, PFA and FFA Female Footballer of the Year, Elise Kellond-Knight stood near the sideline chatting to teammates.

Unfortunately, KK as she is better known, hadn-t raised a sweat, wasn-t in her Roar kit and wore no boots or shinpads - her only accessories, a pair of crutches.

Her sunny smile was firmly in place, hiding the frustration she feels at the long recovery ahead from knee surgery after tearing her ACL in a Champions League game in Denmark.

Sadly she is not alone, rather the latest in a long list of female players now warming a seat in the stands due to knee injuries.

In fact, in the Brisbane/Adelaide clash alone, Ashley Spina and Lauren Colthorpe for Brisbane plus Ruth Wallace, Victoria Balomenos, and Angela Fimmano for the Reds, took the total of players out with knee problems to six - while player of the match, Adelaide keeper Sian McLaren is only just back this season after missing the last for the same reason.

From a numbers perspective this causes concern at club level, but it-s an even more worrying trend for the national team, and one that the medical staff at the Matildas have been focusing on for some time.

Matildas team doctor, James Ilic is particularly aware of the problem - having added Kellond-Knight to a list that already includes Kate Gill, Sam Kerr, and the aforementioned Balomenos and Colthorpe. A list which before them has "boasted" the likes of Amy Chapman, Jenna Tristram, Kim Carroll, Joey Burgess, Colette McCallum, Thea Slatyer, Alicia Ferguson, Sarah Walsh and Hall of Famers Di Alagich and Joey Peters.

While Colthorpe, Wallace, Fimmano and Walsh have dealt with different knee-related issues that are prevalent in any sport and pertain to either gender, the others have all suffered damage to their anterior cruciate ligament - an injury that is all too common in female athletes.

Records show that female footballers are two-seven times more likely to suffer ACL injuries than their male counterparts, but the reason for this statistic remains for the most part, a mystery.

Theories abound, ranging from a difference in hormone levels which allegedly cause the knee ligaments to be more unstable and relaxed in women; to anatomical differences which cite the wider pelvis on the female frame as the antagonist, causing a more acute attachment angle for the knee ligaments.

There are even suggestions that developmental differences could be in play. That perhaps the frequency of high contact "rough and tumble" if you like, and earlier introduction to contact sport that most males experience as part of growing up, helps the part of their brain that deals with proprioception (awareness of one-s body in space) to learn and adapt better to rolling movements at an earlier age.

Dr Ilic has seen all the theories, and while he accepts that any or all could have some merit, he says that the only proven facts relating to a susceptibility to knee problems are: playing on hard pitches; a genetic predisposition; and prior problems with the other knee. i.e. if you-ve done one knee, then the likelihood of the other one following suit is statistically quite high. All factors, he adds, that apply to both sexes equally.

Without any concrete evidence available to rule out knee injury in women, the focus is on prevention.

Speaking from the AIS Recovery Symposium 2011 in Canberra, where he has joined other experts to share information and current trends on recovery strategies, Ilic is keen to use the time to also further address the "knee issue" with like minds, including head coach Tom Sermanni.

His feeling is that programs in the past have worked well, but are often only implemented in short doses while the team is in camp. Now it is much more important for the future of women-s football, that an appropriate, simple, and adaptable program is rolled out for younger players when they first enter elite programs at a state based institute. A program that may not eliminate the frequency of ACL injuries, but can certainly work towards reducing them.

Being proactive he says is the key. “Once a player has had a reconstruction, that knee is not the same. It gets them back on the pitch but doesn-t put it back to normal and usually there will be eventual degenerative changes that can curtail a successful football career”.