“We know very little about Australian football and that’s why we’re doing this study, but in other sports it’s often the position of a woman’s hips and knees when they jump or land, so we need to change the way they move,” Crossley said.
“A woman who has had an ACL injury is up to six times more likely to develop osteoarthritis and twice as likely to require a knee replacement, so getting this data is critical to improving long-term health outcomes.″
Biomechanically, women have a wider pelvis, increasing the “Q-angle” (formed between the quadriceps muscles and patella tendon between the hip and knee), meaning without appropriate single-leg control, they are more prone to their knee dropping in towards the body, placing more stress on the ACL.
The Demons’ head doctor Laura Lallenec has worked across both AFL and AFLW programs and says the reasons are multidimensional.
“The risk factors include less years playing, which has an influence on sport-specific neuromuscular control, cross-code athletes, anatomical and biomechanical factors such as hip alignment and ligamentous laxity and possible hormonal factors,” she said.
These hormonal factors include estradiol, relaxin and progesterone, all shown to increase ACL softness, particularly between days 10 and 14 of the menstrual cycle.
While Crossley says menstrual tracking will be incorporated in the study, she says accuracy is challenging due to unreliable self-reporting.
Matt Green, the Brisbane Lions’ AFLW high-performance manager, hasn’t shied away from the topic, encouraging his side to track their cycles using an app.
The nature versus nurture debate begs the question of whether the game needs to be modified for female safety, but Lallenec believes eventually nurture will intervene over time.
“As more players enter the national league having played throughout their youth and been exposed to prevention programs, we expect to see a reduction in rates,” she said.
Nicole Livingstone, the AFL general manager women’s football, said player health and safety remains paramount. “The AFL will continue to support research and implement best-practice injury prevention programs across all levels of female football,” she said.