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In spite of the growing popularity of women’s football, there has been little research on the incidence and risk factors for injuries sustained by female football players. This supplement of the British Journal of Sports Medicine attempts to address that deficit and to stimulate the scientific discussion on gender-specific issues in football.
An understanding of the incidence, characteristics and circumstances of injury in elite female football players in top-level international tournaments is a prerequisite for design and implementation of injury prevention programmes. Although the rate of injury in top-level women’s tournaments is within the range reported for match injuries among elite male players, the diagnosis, mechanism and patterns of injury differ substantially, highlighting the need for gender-specific injury prevention counter-measures.
One key gender difference in the causation of injury are the distinctly different tackle mechanisms that lead to injury. Video analysis techniques have helped to provide a better understanding of injury situations in football. Interestingly, staying on feet and vertical jump actions leading to injury have been sanctioned more frequently by referees but no differences were observed for sliding tackles, which previously have been reported to have the highest injury potential in women’s football. The laws of the game or more specific training for referees to identify and penalise dangerous or injury-causing tackles may need further consideration in women’s football.
Whether the incidence of injuries when playing or training on artificial turf is different compared with when playing or training on natural grass has been the subject of much research. This supplement presents three original cohort studies dealing with this issue. The studies found no major differences between the incidence, severity, nature or cause of training or playing injuries sustained on new generation artificial turf and grass by either men or women, which is reassuring when considering the design of new stadia and the playing surfaces that may be used.
A gender difference in injuries is the higher incidence of head injuries, such as concussion, among female players; these injuries are particularly important because of the potential for long-term cognitive deficits. Many athletes are not aware of the seriousness of concussive injury and the injury is often under-reported. There is a need for clear guidelines to assist players, coaches, support staff and referees to increase awareness of appropriate strategies for returning to play. Another gender difference relates to the incidence of injuries of the anterior cruciate ligament (ACL). Female football players are at higher risk of sustaining non-contact ACL injuries than their male counterparts. An understanding of injury mechanisms is essential for identifying gender-specific risk factors and developing prevention strategies for non-contact ACL injuries.
There is little published information on the nutritional habits of female football players at any level of the game. Consequently there is shortage of specific information on the correct nutrition and hydration strategies that players should adopt. Dehydration adversely affects skill and stamina in women as in men, so individualised hydration strategies should be developed. With regard to nutritional factors, energy balance and body composition need to be addressed as prolonged energy deficits cannot be sustained without harm to overall health, bony integrity and physical performance. Iron deficiency in women athletes is well recognised and it seems to be a particular issue among female football players, therefore possibly requiring additional consideration. Bone health is also an important issue for all exercising women and all female athletes and those involved in their care need to be familiar with the “female triad”. Dieting behaviour and lack of knowledge related to energy needs of the player often lead to energy deficit, menstrual dysfunction and an increased risk for loss of bone mass. Football training seems to increase bone mass in the weight-bearing limbs, with positive implications for bone health in later life, but some players may be at risk from inadequate dietary calcium intakes.
The overall aim of this supplement is to clarify some of the specific sports medicine aspects of female football. The research presented in this supplement raises a number of questions that still need to be investigated to improve the general health of female players at different skill levels and to promote football as a safe and health-enhancing leisure activity for all women.
Guest editors: Jiri Dvorak, Astrid Junge, Collin Fuller and Paul McCrory