Why are women footballers facing an ‘epidemic’ of ACL injuries?

Published

2 years ago

July 15, 2023

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Keyhole surgery is perhaps a misleading term: despite the technology, expertise and extreme finesse involved, it’s also hugely physical.

Sky News watches as surgeon Luke Jones performs an anterior cruciate ligament reconstruction in an operating theatre in King Edward VII’s hospital in central London.

Mr Jones (male surgeons are referred to as Mr rather than Dr) doesn’t just remove a hamstring: he pulls it out with force.

Drills bore through bone. Flesh smokes as it is cauterised. There’s a fair amount of hammering: “Mallet, please,” Mr Jones asks his assistant.

The ACL is a small band of tissue running through the middle of the knee that keeps it stable.

But watching the operation, it’s easy to understand why tearing it is so devastating. Even though the patient will only have three tiny scars, their knee has taken a pummelling.

“There’s 90 minutes in theatre with me,” Mr Jones tells Sky News, adding: “And then there is one year of rehabilitation with your physiotherapist afterwards.”

That’s why ACL injuries are so feared, especially by one type of athlete: female footballers.

‘Way too many’ women’s players with ACL injuries

Between 25 and 30 players – enough for an entire extra squad – will miss the upcoming World Cup because of ACL injuries. England stars Beth Mead and Leah Williamson have been ruled out. Data from ACL Women Football Club suggests 195 elite players have suffered the injury in the last year.

It has been described as an “epidemic”. And it is an epidemic that affects women far more than men: they are 2.5 to 3.5 times more likely to rupture an ACL than a male athlete. And we don’t really know why. Even as the women’s game has boomed, research has lagged behind.

One player who is going to the World Cup is England defender Jess Carter. Speaking before departure at St George’s Park, England’s national football centre, she tells Sky News: “There’s been way too many women’s players who have had ACL injuries and not enough research that’s been done about it.

“Why are there so many injuries? How can we prevent it? Why are they happening? A question I sometimes ask is: if this was happening to high profile men’s players, would more work be going in to try and improve things?”

Nature versus nurture

The problem is that there isn’t just one answer.

“I’ve made a list the other day, and I think there are 30 reasons that have been discussed in the literature that I could find,” says Kat Okholm Kryger, a sports rehabilitation researcher at St Mary’s University Twickenham and a medical researcher for FIFA.

“And I think we can split it into two main categories. And I like to call them nature and nurture.

“So the nature is like the biology: the genes, the way the body is shaped and muscle mass, etc… But also the nurture of the environment that the women are in. So the way that young female players are managed compared to male players, the facilities, the professionalism around the sport, the quality of the staff that they have available.”

I ask whether research into injuries in the women’s game has received as much attention as men’s.

“Attention? No. But generally that’s across all research in football and in sports medicine. The male has been the norm,” she adds.

Research will end up benefiting the men’s game too

Take one issue from the realm of ‘nurture’ that Kat is studying: football boots. The male foot was the norm. It’s only in recent years that boots designed specifically for women have become available. And even then we don’t understand the differences properly, which is why Kat has done 3D scans of hundreds of feet, to map them.

That research will end up benefiting the men’s game too because Kat is also charting the differences between ethnicities. Because the default foot isn’t just a man’s, it’s a white man’s.

The male is also the norm when it comes to other environmental factors, like booking a pitch.

On a Thursday evening in Kent, the Gravesham Girls and Women’s Football Club, founded in 1999, is training ahead of the start of the season. About 20 players, kitted out in yellow, are doing shooting drills and balls are flying. A Sky News camera operator cops one in the belly but bravely continues.

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Toni Allen and Keylie Oliver have both ruptured their ACL in the past. “I just screamed – everyone thought it was a fox,” Allen says. Both were out for a year.

“It’s quite daunting, and especially when you realise it’s not just football that it can impact, Oliver says.

“We have lives outside of football and it impacts that as well… At grass roots, the ladies always have a two o’clock kick-off. And that is because in our world, men’s football takes priority over women. We always have to play after – so the pitch is always ruined.”

The importance of the factors can change

Another difficulty is not just that there are lots of factors involved, it’s that the importance of the factors can change.

Professor Kirsty Elliott-Sale is professor of female Endocrinology and Exercise Physiology at the Manchester Met Institute of Sport.

She works closely with clubs, including Arsenal, to study how the menstrual cycle, or taking the Pill, can influence injuries. Research seems to suggest that some hormones can make ligaments looser, increasing the risk of rupture.

So over the course of the season Prof Elliott-Sale measures the laxity of players’ knees, charting that against their hormones, and cross referencing it with other factors like match congestion.

“It’s definitely a jigsaw,” she says. “And it’s about sort of putting all the pieces together.

“But once we have all the pieces, we don’t necessarily know which factor is going to play a bigger role on any given day. So it’s not like all of the pieces are the same size. Some days, a particular factor that might influence this type of injury might be amplified, whereas on another day, it might be turned down.”

Biology remains a large part of the answer

But even then the difference between female and male body types – which in the past led to some dismissing women as too “fragile” to play traditionally male sports – may not be as much of a factor as previously thought.

Because in some sports, the ACL injury discrepancy disappears.

“If you compare sports, where males and females start at the same age, have the same training intensity throughout their sporting life, and perform the same movements during that sport, then actually, the rupture rates equalise,” Mr Jones, the surgeon, says.

“And a very good example for that is elite dancers. So elite dance athletes, where the males and females start their training at the same age, they perform the same pivoting, jumping, twisting movements, and they have the same intensity of training and the same conditions. If you compare their rupture rates, they’re actually equalised.”

“And what that suggests is the impact of your training and your conditioning is really essential and avoiding this injury.”

Every expert I spoke to stressed the role of strength and conditioning in preventing injury. Here, nurture influences nature.

“We have that attitude of, you know, women do yoga, and pilates and men lift heavy things in the gym,” Ms Kryger says.

“But the reality is everyone needs to lift heavy things occasionally to prevent injuries and have a healthy body.”

The good news is that quantifiable progress is being made here.

Matt Whalan is a sports scientist who works with the Australian men’s and women’s football teams – the Matildas who will be competing in the World Cup. He spoke to me from the men’s under 23s camp there.

Football Australia introduced a programme called ‘Perform+’, which can be worked into warm ups, that has reduced injuries, including ACLs, by 40%.

And crucially, it’s not just for elite players.

“This is designed so that mom and dad coaches can just go online, take down the programme, all the videos are there, there’s information about how you can deliver it with your athletes, and from under-sevens through to 55-year-olds, 95-year-olds, if you want to, you can do these exercises,” Mr Whalan says.

“The benefit of that for us at the higher end level, working with national teams, is if we have players that have been doing that, since they’re 12,13,14 years old, it makes our lives a lot easier.”

That remains in the future. When the World Cup starts next week, it will do so without a host of stars.

As England forward Chloe Kelly tells Sky News: “Having suffered the ACL injury myself, it’s so sad when you see so many players suffering that injury. Hopefully, we get the research that we need to stop these injuries happening so often.”

UK

Royal Navy intercepts Russian warship and tanker

Published

10 hours ago

November 23, 2025

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Royal Navy intercepts Russian warship and tanker

A Royal Navy patrol ship has intercepted two Russian vessels off the UK coast, the Ministry of Defence has said.

It comes after Defence Secretary John Healey announced last Wednesday that lasers from Russian spy ship the Yantar were directed at RAF pilots tracking it, in an attempt to disrupt the monitoring.

The MoD said on Sunday that in a “round-the-clock shadowing operation”, the Royal Navy ship HMS Severn has intercepted Russian warship RFN Stoikiy and tanker Yelnya off the UK coast in the past fortnight.

The Russian vessels sailed through the Dover Strait and westward through the English Channel, the MoD said.

HMS Severn later handed over monitoring duties to a NATO ally off the coast of Brittany, France, it said, but continued to watch from a distance and remained ready to respond to any unexpected activity.

The ministry added that the UK’s armed forces are on patrol “from the English Channel to the High North” amid increased Russian activity threatening UK waters.

Last week, Russia accused the British government of “provocative statements” after the defence secretary warned the Yantar was nearing the UK.

At a news conference in Downing Street on Wednesday, Mr Healey said the spy ship was on the edge of British waters north of Scotland, having entered wider UK waters over the last few weeks.

He said it was the second time this year the Yantar had been deployed off the UK coast and he claimed it was “designed for gathering intelligence and mapping our undersea cables”.

Mr Healey said the ship had “directed lasers” at pilots of a P-8 surveillance aircraft monitoring its activities – a Russian action he deemed “deeply dangerous”.

In a clear message to Russian President Vladimir Putin, the defence secretary said: “We see you. We know what you are doing. And we are ready.”

The ministry said while tracking the Yantar, Royal Navy frigate HMS Somerset and other civilian ships in the area “experienced GPS jamming in a further demonstration of unprofessional behaviour, intended to be disruptive and a nuisance”.

Russia’s UK embassy dismissed the accusations and insisted the Yantar is a research ship in international waters.

The defence secretary also repeated government plans to increase defence spending and work with NATO allies to bolster European security.

And he stressed how plans to buy weapons and build arms factories will create jobs and economic growth.

A report by a group of MPs, also released on Wednesday, underlined the scale of the challenge the UK faces.

It accused the government of lacking a national plan to defend itself from attack.

The Defence Select Committee also warned that Mr Healey, the prime minister and the rest of the cabinet are moving at a “glacial” pace to fix the issue and are failing to launch a “national conversation on defence and security” – something Sir Keir Starmer had promised last year.

The UK has seen a 30% increase in Russian vessels threatening UK waters in the past two years, according to the MoD.

But the ministry maintained the UK has a wide range of military options at its disposal to keep UK waters safe.

Three RAF P-8 Poseidon aircraft have deployed to Keflavik Air Base in Iceland in the largest overseas deployment of the RAF P-8 fleet so far, the MoD said.

They are conducting surveillance operations as part of NATO’s collective defence, patrolling for Russian ships and submarines in the North Atlantic and Arctic.

The operations come just weeks after HMS Duncan tracked the movements of Russian destroyer Vice Admiral Kulakov, and frigate HMS Iron Duke was dispatched to monitor Russian Kilo-class submarine Novorossiysk.

UK

Ban on Maccabi Tel Aviv fans for Aston Villa game ‘based on false hooligan claims’

Published

10 hours ago

November 23, 2025

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Ban on Maccabi Tel Aviv fans for Aston Villa game 'based on false hooligan claims'

West Midlands Police has defended the ban on Maccabi Tel Aviv fans attending an Aston Villa match after it was claimed that false intelligence was used.

Supporters of the Israeli club were barred from the Europa League fixture at Villa Park on 6 November.

West Midlands Police chief superintendent Tom Joyce told Sky News before the game that a “section” of Maccabi’s fanbase engaged in “quite significant levels of hooliganism”.

According to The Sunday Times, West Midlands Police claimed in a confidential dossier that when Maccabi played Ajax in Amsterdam last year, Israeli fans threw “innocent members of the public into the river”, and added that between 500 and 600 supporters had “intentionally targeted Muslim communities”.

The report also said 5,000 Dutch police officers had been deployed in response.

However, the Netherlands’ national police force has questioned the claims, reportedly describing information cited by its British officers as “not true” and in some instances obviously inaccurate.

Sebastiaan Meijer, a spokesman for the Amsterdam division, told The Sunday Times that he was “surprised” by allegations in the West Midlands Police report, which had linked 200 travelling supporters to the Israel Defence Forces (IDF).

Mr Meijer denied that his force had such intelligence, adding that the claim was meaningless given the country had a policy of conscription.

Also, Mr Meijer said that Amsterdam’s force “does not recognise” the claim in the British report, attributed to Dutch law enforcement, that Israelis were “highly organised, skilled fighters with a serious desire and will to fight with police and opposing groups”.

The Dutch police added that the only known case of a fan being in the river appeared to involve a Maccabi supporter. While being filmed, he was told he could leave the water on the condition that he said “Free Palestine”.

In an interview with Sky News before the game, West Midlands Police referenced disorder when Maccabi played Ajax in Amsterdam last November.

Mr Joyce said ahead of the Villa Park match: “We’ve had examples where a section of Maccabi fans were targeting people not involved in football matches, and certainly we had an incident in Amsterdam last year which has informed some of our decision-making.

“So it is exclusively a decision we made on the basis of the behaviour of a sub-section of Maccabi fans, but all the reaction that could occur obviously formed part of that as well.”

Maccabi’s visit to Birmingham came amid heightened tensions due to Israel’s war on Hamas in Gaza.

A safety advisory group (SAG) recommended that Maccabi fans should be banned from attending the fixture on the advice of the police. The ban drew criticism, and Prime Minister Sir Keir Starmer said it was the “wrong decision”.

West Midland Police’s statement in full

Following The Sunday Times report, West Midlands Police stood by its “information and intelligence”, adding that the “Maccabi Fanatics… posed a credible threat to safety”.

In a statement to Sky News, the force said: “West Midlands Police’s evaluation was based primarily on information and intelligence and had public safety at its heart.

“We assessed the fixture between Ajax and Maccabi Tel Aviv in Amsterdam as having involved significant public disorder.

“We met with Dutch police on 1 October, where information relating to that 2024 fixture was shared with us.

“Informed by information and intelligence, we concluded that Maccabi Tel Aviv supporters – specifically the subgroup known as the Maccabi Fanatics – posed a credible threat to public safety.

“The submission made to the SAG safety advisory group was based on information and intelligence which helped shape understanding of the risks.

“West Midlands Police commissioned a peer review, which was conducted by UKFPU [United Kingdom Policing Unit], the NPCC [National Police Chiefs’ Council] and subject matter experts.

“This review, carried out on 20 October, fully endorsed the force’s approach and decision-making.

“We are satisfied that the policing strategy and operational plan was effective, proportionate, and maintained the city’s reputation as a safe and welcoming place for everyone.”

Sky News has approached Dutch police for comment.

UK

Titanic couple’s pocket watch sells for record £1.78m

Published

10 hours ago

November 23, 2025

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Titanic couple's pocket watch sells for record £1.78m

A gold pocket watch that belonged to an elderly couple who drowned as the Titanic sunk has sold for a record-breaking £1.78m at auction.

The 18-carat Jules Jurgensen engraved watch was owned by first class passenger Isidor Straus, who died when the ship sank in April 1912.

He and his wife Ida were portrayed in the film Titanic as a couple who held each other as the ship went down.

When he was offered a seat on a lifeboat due to his age, he replied that he would not go before other men.

His wife refused to leave him, and the couple were last seen alive sitting on deckchairs, facing fate by each other’s side.

They were among very few first class passengers to perish in the disaster.

The watch was recovered from Mr Straus’s body along with other personal items and returned to his family.

It had been a present for his 43rd birthday in 1888 – the same year he became a partner in the New York department store, Macy’s.

The watch, which had remained in the couple’s family, was sold at Henry Aldridge & Son Auctioneers in Devizes, Wiltshire.

The £1.78m for the item is the highest amount ever paid for Titanic memorabilia, according to the company.

A letter written by Mrs Straus on Titanic stationery and posted while onboard the ship fetched £100,000.

The previous record was set last year when another gold pocket watch presented to the captain of a boat that rescued over 700 passengers from the liner sold for £1.56m.