A number of FA Women's Super League (WSL) players with lived experience of returning from an anterior cruciate ligament (ACL) injury are attending the Project ACL launch event in London, England on Wednesday 11 September.
FIFPRO, the Professional Footballers Association, Nike, and Leeds Beckett University are collaborating to accelerate research into the concerning number ACL injuries in women's football.
The partners will work proactively with clubs and players in the WSL to better understand their current working environment, identify best practice and provide solutions to support the reduction of ACL injuries.
The event in London, which will be hosted by former England goalkeeper Rachel Brown-Finnis, will feature player reflections and insights on ACL injuries and recovery, as well as showcasing player participation in the project.
Arsenal and England striker Beth Mead is one of several high-profile players who was side-lined for nearly a year with an ACL injury, missing the Women’s World Cup in the process. Mead sat down with FIFPRO to discuss her experiences and highlights what she feels is currently missing around the conversation of ACL injuries in women’s football.
FIFPRO: Beth, can you describe your ACL injury and the recovery process? What are some of the things you reflect now when you look back on that period of your career?
Beth Mead: Players typically pick up ACL injuries in the first half of a game and a lot of them are non-contact, but mine was actually in the 93rd minute, with contact, when trying to keep the ball in play. I initially felt a lot of pain in my knee. Then quite quickly it settled down. In the past, I have seen players come back on [the pitch] after an ACL injury and I can understand why that happens. I can also understand why it doesn’t when you suffer that pain.
At the time I was off the pitch with the injury, so I got subbed off, walked around the pitch and then off it. I’m a positive person and because I was walking, at the time I thought I got away with suffering a serious injury, but a scan the day later confirmed that I had an ACL injury. Mentally it is a tough one because you know the recovery will be at least nine months. At that time, I knew the World Cup was coming up and that I was going to most likely miss that. But through my rehab, I used that as a motivation to push as close to the World Cup as I possibly could. It wasn’t meant to be but that was my mindset to try and push and go to Australia and New Zealand.
Can you give us an insight into what rehab is like with an ACL injury?
It can be very tedious. It can be a slow process. You learn to run on an AlterG, an anti-gravity machine which takes your body weight off you a bit and you get used to running again. Most people that have done an ACL will know about extensions and flexions – the most tedious things ever. There are so many different processes that as an athlete you’re motivated to hit, but there are some days that you think you’re never going to get there, or it takes a bit longer than you thought it would.
There are a lot of bumps in the road with ACL injuries. It’s not just the knee that causes you issues; as you’re out for such a long period of time, the rest of your body is trying to catch up again. Personally, I had a stress response in my shin coming back that put me off the pitch for another 10 days. A few of the other girls have had calf and hamstring injuries coming back. You have to grind it out and hope that you have got a good enough support system around you to try and get you through such a long and gruelling process.
As a player, how much do you need to trust in the recovery process?
I’m not an over-thinker, so I trusted in the nine-month process of coming back. Everything I did – and every tedious thing I did – was for a reason. And then whenever I went back on the pitch, I had to trust that everything I had done was for a reason. I knew that my knee was at the ultimate strength. Coming back from an ACL, your knee should be stronger than it was beforehand.
I was the first out of the [Arsenal] girls to suffer an ACL injury and the way in which you saw people go down, you could tell when it wasn’t good. I’ve not always known what an ACL injury is and I’ve seen it happen to people, but I never fully understood it until I went through that process. When you experience it yourself, you understand the pain people have gone through, the mental strain of knowing the process ahead and even the surgery itself is not the nicest thing, followed by the recovery process after it.
I think it’s all about mindset coming back. You’ve been taken away from the game for so long that you can’t wait to get back out there. And I used that as a positive: I’ve not been able to play football for 10 months, so let me go out and enjoy it and get back on that pitch and do what I love doing again.
People can just see ACL injuries through the lens of when you get the injury and when you’re back playing. Can you give us some insight into how isolating the injury can be during that long recovery period?
I had company as some of the other [Arsenal] girls also had the injury, but I put myself in the mindset that I’m going to have a lot of hard days. People don’t see when we come in earlier in the morning, before the footballers who are playing, to start our rehab early because you spend 3-4 hours in the gym and not moving from that gym. The girls come in to warm-up, then go out to the pitch and then they finish training, leave, and yet you’re still stuck in that same gym.
We’ve got an amazing group at Arsenal and a lot of the girls would come in and say bye, or have a good session, and try and be around you as much as possible. But there are a lot of hours that you’re physically on your own, just with the same physio, doing the same tedious things. Mentally that is very tough. When I was on my own, and the first to do it [the injury], I’d say bye to all my team-mates and there’d be a buzz in the gym to it just going silent. Being on your own like that can take a toll.
Even now when we go back to the pitch, if there is anyone alone in the gym, we would make sure we say goodbye, say have a good session. It does go a long way that people give you a bit of energy before they leave the room. You see this narrative of the bad and then the happy when you come back, but people don’t see everything in between. There are a lot of long days. We’re in a team sport and you get energy bouncing off your team-mates. You go from that to feeling isolated and that’s very tough and something which is hard to adapt to.
What do you think is currently missing from the conversation on ACL injuries?
Viv [Miedema] and I have done a lot of research into it as much as we can, picking people’s brains – is it bio-mechanics, is it menstrual cycle, is it hormones, is it stress, is it scheduling? We sat in a room with so many researchers and there is no definitive answer as to why this injury is happening. Everyone has their own opinion but there is nothing definitive that you can say, ‘yes, this is the reason’.
I doubled my minutes within the year; the season before I had played 2,000 odd minutes and the season later, I did 4,000. It’s a big jump within a year and my body may not have been used to that. Obviously, mine was a bit different, so would mine have happened if I hadn’t received that contact, at that moment, in that second? The game has also become more competitive. It’s quicker, it’s faster. We’re competing on every inch of the pitch and we do that a lot more regularly than we used to. The scheduling is also not ideal. There are so many different factors, so it’s hard to pinpoint one thing.
I do think people are on the right lines but as a narrative, we need to have a definitive answer of what the issue is and how we can minimise it. There is so much research into the men’s side of the game but there is minimal research into the women’s game in comparison. This is why we’re here and trying to change that. Hopefully, we can push on with research and try and get more answers.
Why is this Project ACL partnership between FIFPRO, PFA, Leeds Beckett University and Nike a step in the right direction?
Being a Nike athlete, I’m proud that Nike have jumped on board and are wanting to figure this out. We’ve got players who have missed a lot of football because it could potentially be something that they could help with. You want to see the best players in action, yet 25 percent of the top players have been out with this injury. I’m proud that I can be a part of this and that FIFPRO and Nike are invested in this to help push this forward.
Why is it vital to have the player voice at the centre of all this?
It's important that we all give our own individual experiences on how it happened, how we felt it’s gone, and what the support has been like because we’re all different. We all react differently. Every rehab is different, both mentally and physically. There could be positive days for someone, but that other person has a bad day and goes 10 steps back. I think people don’t see that and thus don’t understand that side of this injury.
Someone can sit in a lab, watch someone run and try and understand it, but the people who understand it are the people who have gone through it and understand how the injury is. Don’t get me wrong, you can be a specialist on ACLs, but you might not have done one yourself. I think there’s a difference between physically and mentally going through this injury and actually having knowledge about the injury. Combining those two aspects is how we’ll hopefully advance this a lot further.
