“We are keen to explore this further,” AFL women’s football chief Nicole Livingstone says.
Kay Crossley – a La Trobe University professor, physiotherapist and researcher specialising in knee injuries – says they're hoping to do more research on the issue soon.
“There is a suspicion that female hormones may be related to injury and possibly to how women respond to training, but a lot more work needs to be done in that space," she told the Herald Sun.
It's an area of increasing focus, with research on the link doubling over the past decade. A 2017 systematic review and meta analysis published in Orthopaedic Journal Of Sports Medicine found an association between hormonal fluctuations and ACL injuries. Research published in the Journal of Athletic Training found women have a higher risk of ACL tear during the pre-ovulatory phase of their menstrual cycle than the post-ovulatory phase of their cycle.
Some studies have also suggested oral contraceptives can offer a 20 per cent reduction in risk.
Chelsea Women recently became the first football club in the world to tailor training programs to their players' menstrual cycles in a ground breaking initiative to enhance performance and cut down on injuries.
“It is fair to say, I am a female coach in an industry where women have always been treated like small men,” manager Emma Hayes told The Telegraph. “The application of anything from rehab to strength and conditioning to tactical all come from the basis of what men do."
Hayes explained that given we go through "something very different to men on a monthly basis" it's important to have a better understanding of its flow on effects. The idea came about after the team lost the 2016 FA Cup final against Arsenal.
“We had a lot of players in and around their period for that game,” she said. “I remember watching players close the ball down and thinking everything was reactive and second-best. That was the starting point.”
“The menstrual cycle is an inflammatory process and excess inflammation can result in an injury,” Bruinvels says. “It’s not solely down to high levels of oestrogen, but tracking the cycle is also very important in terms of bone-injury risk.”