More sprinting, extra games? Why more footballers are getting ACL injuries
The rise in ACL injuries in football is down to the increasing intensity of the game and not just the number of matches played, says one of the world’s leading knee surgeons.
Player workload has become a thorny topic in the sport, with the expansion of major competitions adding extra games to the calendars of top players and prompting threats of strikes and legal action from unions.
But Spanish doctor Ramon Cugat, whose Barcelona practice treats thousands of injuries every year and is the favoured medic of Manchester City manager Pep Guardiola, has highlighted what he believes is another, less recognised factor in ACLs.
“Soccer is an increasingly athletic sport. The number of accelerations, decelerations, jumps and contacts increases with each passing season. This makes the sport more attractive for the fan, but it also implies a greater risk of injury for those who practise it,” he told BBC Sport.
Performance data appears to corroborate a link between match intensity and ruptures of the ACL – the anterior cruciate ligament.
The number of sprints per game in the Premier League has risen from 251 in 2020-21 to 288 in the current season, according to statisticians Opta. A previous study published in 2016 reported that sprinting in the English top division had increased by 50 per cent in 10 years.
Meanwhile, ACL injuries in the Premier League are at an eight-year high. Ten players, including Manchester City captain Rodri, Arsenal striker Gabriel Jesus and Manchester United defender Lisandro Martinez, have been ruled out for the season with cruciate ligament problems.
Not all causes of ACL injuries understood yet
The volume of games – or perhaps more accurately, the shortage of recovery time in between them – is also a factor. Hamstring injuries have also been commonplace this season, with Arsenal manager Mikel Arteta citing the lack of rest footballers are afforded.
This season the Champions League expanded to accommodate extra teams and more matches. Some sides have already played four more European games than last season in order to reach the last 16 of the competition.
There will be little respite for some even at the end of the campaign. Fifa’s revamped Club World Cup has mushroomed from a 10-day mid-season affair to a month-long tournament every four years, in which the finalists will play seven times.
Cugat’s roll call of previous patients includes Manchester City stars Kevin de Bruyne and Sergio Aguero, Andres Iniesta and Xavi in their Barcelona heyday and Fernando Torres, then of Liverpool. Chelsea, Arsenal, Manchester United and Tottenham have also been clients.
Yet he admits that even he can’t be sure of all of the factors that may make a footballer more liable to suffer an ACL injury. The problem is acute in women’s football, where the risk is statistically three to six times higher.
“The human body has its own mechanisms to cope with such physical demand. Correct nutrition, adequate rest and sleep, and good management of physical load help the tissues of our body to recover from the micro-injuries suffered during intense exercise,” he said.
“There are many more factors that go into an anterior cruciate ligament injury. The type of shoe, the state of the grass, the mental health of the athlete – the list goes on, and we are convinced that we have not yet discovered all the aspects that play an important role in the injury.”