An injury crisis has hit women's soccer and we are past the time to sound the alarm

This is a column by Shireen Ahmed, who writes opinion for CBC Sports. For more information about CBC's Opinion section, please see the FAQ.

As the summer months and a FIFA Women's World Cup quickly approach, we're in full swing in the women's Champions League in European soccer.

Earlier this week I watched the semifinal between my beloved Arsenal women's side and the uber-talented Wolfsburg of Germany. The level of competition and excitement was incredible, but late in the match that went into extra time, Laura Wienroither went down, clutching her knee as her worried teammates gathered around her. 

When the medical team carried her off in a stretcher, I thought, "Not again!" That same sentiment reverberated through chat groups and online.

It was later confirmed she had suffered a tear of the anterior cruciate ligament (ACL). Another one to add to the already long list of formidable players on the Arsenal squad who have suffered ACL injuries, including Vivianne Miedema of the Netherlands and England's Beth Mead and Leah Williamson. With Wienrother, who plays for Austria, all are expected to miss this summer's Women's World Cup, which begins July 20 in Australia and New Zealand.

That rings familiar to us here in Canada as the women's team will be missing one of its own key pillars in Janine Beckie. Beckie tore her ACL playing with the Portland Thorns in the National Women's Soccer League in March. When it happened Beckie posted a message on social media: "Heartbroken is an understatement." 

Beckie received a lot of messages of support, but her focus is now not only on surgery and rehab, but on amplifying the conversation around why these injuries are so pronounced in women's football. An ACL crisis has hit women's soccer and we are past the time to sound the alarm. 

There are factors to investigate, including whether women playing more games have the adequate resources to support them. Do they get sufficient nutritional support or physio? Is there enough medical research on this topic? If they were paid more would it reduce their need to play as much and reduce risk of injury? 

In basketball, for instance, Breanna Stewart of the WBA's New York Liberty tore her Achilles while playing overseas for Dynamo Kursk during the WNBA off-season. One of the reasons many players play overseas in the off-season is because the paycheques are much larger. Most pro male athletes aren't faced with the same dilemma.

Their bodies are the main tool women use for their athletic work. Being mentally and emotionally centred is crucial, but their bodies need to be in competitive form to do what they love. 

Last year, five players on international women's soccer teams — Americans Christen Press and Catarina Macario, Spain's Alexia Putellas, Marie-Antoinette Katoto of France and Northern Ireland's Simone Magill all sustained major ACL injuries.

According to some research, the ACL tear is an injury women athletes are two to eight times more likely to experience than men. The ACL is the ligament in the knee that connects the femur to the tibia, and while strong it has little elasticity. If it is pushed too quickly in a perilous motion, it tears completely. This particular injury is more common in sports that require quick pivoting, like soccer or basketball. 

So why isn't there a robust amount of research to reflect this and to protect and help women in sports? 

Beckie pointed out that that lack of information is part of an inequity in sports. Dr. Stephen Guy, a specialist in sports medicine, echoed her sentiments by citing the staggering difference in men's and women's "psychosocial" factors and team resources, such as access to facilities and medical staff.

"Probably all these things make a difference," he told Reuters' Lori Ewing. "And they are slightly disgraceful."

Hana Marmura, a PhD student in physical therapy at the University of Western Ontario, researches outcomes in young athletes undergoing ACL reconstructions. She talked about it on the She Scores Bangers podcast with Mariam Kourabi. 

Injuries are not monolithic and have multifaceted and complex factors, but I asked Marmura why there is little research regarding women's ACL injuries when they are increasing.

"Women tend to be excluded from exercise research because of the predominant belief that menstrual cycles introduce a complexity of physiological changes and variability in response to exercise, which may influence research outcomes, and are difficult to control in studies," Marmura told me over email.

She pointed out that men's sports often have more funding and resources dedicated to them for research in injury prevention and rehabilitation, which can manifest as more research dedicated to improving the outcomes of injuries to male athletes.

So this is a clear example of how women's sports are sometimes disregarded in the field of scientific research. Marmura does believe that the amount of research focusing on female athletes will increase and researchers are starting to acknowledge the contextual differences with men's versus women's sports; training, resources and competition, and how they affect injuries.

"More attention is being given to the social and environmental factors that can influence risk and recovery," she said. 

That Beckie and the others will miss the Women's World Cup because of their ACL injuries should keep the pressure on football institutions like FIFA to invest in medical research, not only to grow the women's game but help understand it more thoroughly. 

"Actions like increasing funding and resources for both research in this area and for components of women's sports such as strength and neuromuscular training programs, knowledgeable health care professionals, and safe and effective development of young female athletes prior to them entering the professional space could all be steps in the right direction," Marmura said. 

She does recognize that this kind of research is a lengthy process that requires high-quality studies that can look at similar results in a variety of settings. But we do know that the process must start quickly and if national associations band together for a problem that is global, it will benefit the sport as a whole. 

It is absurd to expect that results and research from the men's side can automatically apply to women athletes. This is a part of equity in sport. 

As important as it is to boast sellout crowds in stadiums, buy merchandise or sign elite players, it is also crucial to have support for those players in terms of medical support from professional clubs, countries and even the highest levels of football regulation in the world. If we are going to support women's soccer, we need to do it wholly — knees included.