Dan Horan has spent two years undertaking a study of injuries in Irish women’s football, the findings from which will hopefully reduce the incidences and layoff for players in the future.
Horan is known as a former League of Ireland player and the Ireland squad’s fitness coach during Martin O’Neill and Roy Keane’s five-year spell but the chartered physiotherapist is now the head of football research and science for the FAI.
Funded by the Irish Research Council, his study, entitled ‘Injuries in elite level women’s football - a two-year prospective study in the women’s national league (WNL)’ covered the 2018 and 2019 seasons.
This was the first research project in Ireland of its kind and a welcome addition to the women’s game, where the dearth of such high-quality studies across the elite sector has been problematic.
“The protection of player’s health and welfare is central to all football governing bodies and this unique injury surveillance project in women’s elite football will be crucial to inform injury risk mitigation strategies in the FAI and in the clubs,” said Professor Martin Hägglund from Linköping University in Sweden, an expert on injury epidemiology in women’s and men’s football, and one of the report’s five co-authors.
“I am particularly happy that the project focuses on an under-researched area of women’s football. Soft-tissue injuries, such as knee and ankle sprains and thigh muscle injuries, were the most burdensome for the clubs and should be a particular focus for preventive measures.”
Once Horan completed his visits to WNL clubs, his methodology centred on collating monthly reports from each — all but one of the eight participated in each season — and through the analysis detailing trends in types of injuries and their spells on the sidelines.
This latter aspect, known as the injury burden, showed that anterior cruciate ligament tears accounted for the majority.
Eight ACL injuries occurred over the study period amounting to 28% of all the time lost due to injury. Rianna Jarrett suffered three ACLs outside the time-scale of this study during her spell at Wexford Youths and her fellow Ireland international Chloe Mustaki underwent a similar experience in early 2020.
The average number of days lost to the player per ACL injury was 247 (eight months). Knee meniscus/cartilage injuries, as well as lateral ankle and hamstring strains, were the other diagnoses that took longest to recover from.
Of the injury types registered, muscle, ligament and contusion injuries constituted the most common while the body sites they appeared on were, in descending regularity, ankle, knee and thigh.
Gradual onset injuries, those that worsened over time, accounted for 25% of topped of all time-loss injures, highlighting the importance of identifying players presenting with symptoms as early as possible. Other studies have illustrated that prior injuries are the biggest risk factor.
Another standout outcome from the deep dive was the fact that players were 7.5 times more likely to sustain an injury in matches rather than training.
Equally eye-catching was the disparity among WNL players called into the Ireland squad.
Although the layperson may consider the extra exposure of international football heightening the risk of injury, the 92 players on duty for Ireland at all levels had a lower incidence rate than the 174 involved solely in domestic action.
While the aforementioned statistics address the “what” question, explaining the “why” factors aren’t so prescriptive.
What appears to be primarily attributable is the discrepancy of resources across the male and female national leagues.
Despite Uefa classifying the WNL as elite, players are unpaid part-time amateurs.
Áine O’Gorman, one of only two home-based regulars in the Ireland team, expressed her desire at the start of the year to see the practice of “paying to play” becoming a thing of the past.
A decade on from its inception, that financial reality of the national league seeps into access to medical support for players.
Not all teams have a physiotherapist or doctor at every game, let alone attending the typical training regime of just two, maximum three, sessions per week.
This can have the effect of injuries not being reported or going untreated, exacerbating knocks that could otherwise be treated at source.
Research proves this isn’t a uniquely Irish challenge. A survey of players at the 2019 Women’s World Cup by Dr Geertsema et al (2021) showed similar issues for them at club level.
One third didn’t have regular access to physio, 40% to a team doctor, while there wasn’t a strength and conditioning coach available to half of those questioned. That would be unheard of at the equivalent men’s clubs, a high proportion of whom have established women’s sections over the past 20 years.
That’s a theme touched on by Dr Joanne Parsons, who cast her eye on ACL injuries through a different lens in her blueprint.
Gendered environmental disparities could be responsible, instead of the traditional physical differences between male and females, for the prevalence of these potentially career-altering setbacks.
This was magnified in March by the outing on social media of the difference in weight-room facilities for genders during the NCAA basketball tournament. An apology by the organisers for the inequality followed the backlash.
How Horan’s paper is embraced will determine its impact. The advent of GPS trackers has better prepared coaches to tailor training sessions but injury prevention programmes are yet to become an embedded feature across the board at clubs.
Dr Catherine Blake, head of UCD School of public health, physiotherapy and sports science, and another co-author, would like to see the report acting as a catalyst for
“This study provides all stakeholders with key insights that we hope will lead to the implementation of practical strategies to reduce the risk of injury in female footballers in Ireland and internationally.’
- The full study can be read here