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The relationship between health and athletic performance go hand in hand, and elite sports couldn’t be understood without the direct supervision of specialized doctors. This relationship becomes even closer as competitive demands increase, as in the case of F.C. Barcelona’s first women’s team: participating in more tournaments and playing more matches during the season is a major challenge for the medical department. Women’s football has its own medical needs, which in some areas are different from men’s football, but these needs are not always supported by sufficient scientific publications. There’s less specific medical research literature focussed on women’s football than for men’s football, and also less if we compare it to other women’s sports.
Dr Eva Ferrer, from F.C. Barcelona’s first women’s team, highlights the three most relevant areas: the effects of the menstrual cycle in high-performance competition, the high prevalence of cruciate ligament tears in women, and the so-called “athlete triad”.
Knowledge of the menstrual cycle and its effects on the individual physiology of each player is fundamental. These effects are not the same for all women, nor are they the same for elite sportswomen compared to women who play amateur sports. Some studies show that the daily physical exercise tends to reduce the premenstrual syndrome symptoms in amateur athletes, but in an elite environment, the competitive demands are so high that alterations of the reproductive hormone response can take place. The scientific literature on female physiological response to high-performance physical activity is still being studied; generic studies, as well as specific disciplines in other sports, have been published, but there are very few studies on women’s football. That is why it is particularly important to obtain information on the physiological evolution of each player, as well as to ensure that all of them understand the importance of maintaining a regular menstrual cycle.
The “athlete’s triad” is a set of bodily problems that can affect women who practice high-performance sport. These include eating disorders, amenorrhea (interruption of the menstrual cycle) and osteoporosis (low bone mineral density), although a more evolved concept called REDS or Relative Energy Deficiency in Sport has begun to be used. According to the REDS model, the old triad can be explained by insufficient intake of nutrients in relation to the intensity and amount of training, a deficit that can occur if the athlete does not nourish herself to the extent required by the physical activity undertaken, or if she carries out this activity in excess of what is recommended. There is little scientific literature that approaches this issue in women’s football. Published studies have addressed this problem concerning runners, swimmers or gymnasts, but there are no studies that delve into the prevalence of REDS in football players. Dr Ferrer confirms that low bone density cases have not been detected in the club, but given the conditions of elite competition, it could occur.
More worrying is the high incidence of cruciate ligament rupture. This knee injury, which is one of the most severe injuries that an elite football player can experience, occurs much more frequently in women than in men. This disparity is related to the characteristics of female anatomy. Women have lower hips and a wider pelvis, which influences the “Q angle”, the degree of alignment between femur and tibia: the greater the Q angle, the less alignment present between both bones and the greater the stress on the knees. This leads to different supports when executing certain movements and football techniques, which could stress the ligaments more. In addition, the diameter of the ligament is smaller in women, and its laxity during a certain stage of the menstrual cycle can make it more susceptible to rupture. In contrast to the menstrual cycle and REDS study, there is a lot of scientific literature in regard to ligament injuries in female players, exemplifying this is a matter of great concern, as this injury can take a player out of the pitch for a whole season.
FIFA has training programmes as the 11+, which are designed to prevent this type of injury, but the high prevalence of ligament tears indicates another need in women’s football: the development of specific training programmes that are not inherited from programmes developed for men’s teams. Most of the baseline data from these science journals have been obtained from male players, and existing training protocols follow these parameters intended for men. Medical and performance staff for women’s teams have to adapt these protocols with the difficulty that, due to the scarcity of female reference data, there is no certainty that they are working strictly within the appropriate margins. It is, therefore, crucial to collect data from the players themselves so as not to have to resort to male references. That’s what is happening at F.C. Barcelona women’s team, we are working with tests performed during pre-season, in the middle of the season and at the end of the season; the idea is to accumulate data on the athlete’s performance evolution, as well as injury follow-ups. Once the season is over, that data allows for improved adaptation of protocols that were originally developed based on male references, developing a new model with personalised data extracted from the team’s own players.
The Barça Innovation Hub team
An article published in The Orthopaedic Journal of Sports Medicine —in which members of the club’s medical services participated— now suggests to consider the detailed structure of the area affected, and treating the extracellular matrix as an essential player in the prognosis of the injury.