Project ACL study highlights gaps in player support

• Twelve Women’s Super League clubs participated in a study examining the structure and working practices of multidisciplinary teams
• Findings reveal significant differences in staffing, access to facilities and resources across the league
• Research will help advise evidence-informed minimum working standards for professional women’s football

Significant differences in staffing, facilities and resources may be affecting the level of performance and medical support available to players across England’s Women’s Super League, according to new findings from Project ACL.

Launched in April 2024, Project ACL is examining the modifiable factors that may contribute to injuries in women’s professional football, with a particular focus on anterior cruciate ligament (ACL) injuries.

The project’s first objective was to better understand the multidisciplinary teams (MDTs) that support players across the WSL. These teams can include physical performance coaches, physiotherapists, doctors, psychologists, nutritionists and rehabilitation specialists.

FIFPRO and researchers at Leeds Beckett University distributed a questionnaire to MDT practitioners at every WSL club. The study examined staffing, training facilities, injury risk reduction strategies, player health monitoring, strength and conditioning, ACL rehabilitation and education.

“Multidisciplinary teams play a fundamental role in protecting players’ health and supporting their development and performance,” said Dr Alex Culvin, FIFPRO’s Director of Women’s Football and a former player who represented Everton, Leeds and Liverpool among others.

“If we want to understand injury risk in women’s football, we must look beyond the injury itself and examine the environment in which players train, compete and recover. That includes the people supporting them, the resources available and whether practitioners have sufficient time to deliver bespoke care.”

Staffing provision varies across clubs

All respondents reported having at least one full-time physical performance coach and one full-time physiotherapist at their club.

However, the employment of full-time doctors, psychologists, nutritionists and rehabilitation specialists was inconsistent. This points to significant differences in the support available to players competing in the same league.

Low staff-to-player ratios and gaps in specialist provision may make it more difficult for clubs to offer proactive and individualised support.

The research also identified challenges around workforce stability and experience. MDT staff had spent a median of two years in their roles, while 64 percent had no previous experience of working in women’s football.

Short tenures and limited experience within the women’s game may affect continuity of care, collaboration between practitioners and the accumulation of knowledge specific to women’s players. 

“We also know that high staff turnover is a globalised issue, not just specific to the WSL, and it is a factor that affects the consistency of care for players,” said Dr Culvin.

“The rapid growth of women’s football has brought greater physical and mental demands for players, but the structures around them have not always developed at the same pace.

“Players in the same competition should be able to expect a consistently high standard of care. The variability identified by this research shows why stronger benchmarks and more stable, appropriately resourced multidisciplinary teams are needed.”

Facilities exist but access not universal

Pitches and gyms were available at every club involved in the study, although only 86 percent of respondents agreed or strongly agreed that they could access those facilities whenever required.

Some practitioners also reported that their training grounds did not have swimming pools or dedicated childcare spaces. Thirty-one percent said a swimming pool was unavailable, while 41 percent reported no dedicated childcare facilities.

Limited access to recovery and rehabilitation spaces may affect the support practitioners can provide. A lack of childcare provision can also create barriers to an inclusive working environment for players and staff.

Time pressures affect injury risk reduction

Injury risk reduction strategies were widely implemented across WSL clubs. Practitioners identified player and manager support, effective communication and individualised programmes as important factors in their successful delivery.

However, staff also reported barriers including limited time, restricted access to facilities and resources and insufficient staffing capacity.

Strength training was identified by 51 percent of respondents as a key element of injury risk reduction. Yet 71 percent of physical performance practitioners said they had modified strength programmes because there was not enough time to deliver them as intended.

“Injury risk reduction cannot simply be added to an already crowded schedule without the necessary time, staffing and facilities,” said Dr Culvin.

“The finding that practitioners are having to modify important strength programmes because of time pressures highlights the relationship between the wider playing environment and player health.”

Professional development valued but inconsistent

Most respondents rated the support provided by their clubs for continuing professional development positively. However, some described that support as fair or poor, while the content and frequency of education varied widely between clubs.

This inconsistency makes it difficult to identify where knowledge gaps may exist or whether practitioners across the league have equal opportunities to develop their expertise.

“Taken together, the findings demonstrate the need for greater investment, improved workforce stability, better resource allocation and clearer benchmarks across professional women’s football,” said Dr Culvin.

Developing minimum working standards

The next phase of Project ACL will involve interviews with MDT practitioners. These conversations will provide further insight into their day-to-day working environments and the barriers they encounter when implementing injury risk reduction strategies.

The findings will be combined with a review of existing research and player-focused studies to inform the development of evidence-based minimum working standards for professional women’s football.

“Practitioners’ input is central to co-creating standards that are ambitious but also realistic and practical,” said Dr Culvin.

“This work is about building environments in which every player can access appropriate and consistent support. Establishing minimum standards would be an important step towards creating safer and more equitable high-performance workplaces across women’s football.”