Epidemic of ACL injuries in women’s football brings mental health toll

Marlee Nicolos had thought it almost a given that she would one day tear an ACL. It seemed to happen to everyone, and one day it would happen to her too.

That didn’t lessen the blow when the Santa Clara women’s soccer goaltender suffered a knee injury late in her first season. Then when she tore it up again in September 2021, it just felt cruel.

“It’s a club I didn’t want to be a part of,” she said. “But now that I’m here, I’m so proud of everyone who’s been there.”
Although studies have revealed the prevalence of these injuries in athletes, who number in the hundreds of thousands each year, and specifically among female soccer players, who are four to six times more likely to tear their ACL than their counterparts male researchers and medical professionals are only just beginning to grasp their mental impact.

Injuring yourself while playing a sport is its own form of loneliness; a player not only loses their ability to participate in something they’re really good at, but also their sense of community. Sure, she can hang out with her teammates and watch games, but that’s not the same as when she’s a contributor.
This is the reason why 40% of athletes who tear their ACL suffer from anxiety and depression afterwards, according to the Stone Clinic.

The world of sport is facing a mental health problem. This story is part of a series examining the challenges faced at all levels of competition and how they are overcome.


Stanford striker Emily Chiao’s history of knee trauma hasn’t prepared her for the mental rigors of nine-month rehabilitation after tearing up her ACL moments in the 2021 season opener.
“It’s really traumatic, like I’ve completely pushed (the game) out of my mind,” Chiao said. “So sometimes, lying in my bed, I thought, here’s what happened then. I never wanted to see the video and I still haven’t. I can play everything in my head.

“An ACL is really intimidating in general,” she said. “You have to master the fact that you wake up in your bed and you can’t lift your leg. It feels like a milestone every day.
About 34% of football players who tear their ACL do so a second time. A study published in the Journal of Athletic Training stated that any primary ACL injury causes an impaired neuromuscular control cascade that influences the risk of a second injury.
Nicolos wasn’t as shaken the second time around by the changes beyond his control – the fact that his legs were different sizes as his muscles receded, for example – and tried to focus on the grueling process of rebuilding. leg strength.
Between his past experience and the growing list of football players in his life who could give qualified advice, it felt like another rite of passage.
“I had a little comfort that I knew what to expect,” Nicolos said. “It’s sad, but it’s part of women’s soccer. I have so many friends who have done it.

Above: Santa Clara goaltender Marlee Nicolos tore her anterior cruciate ligament twice. Left: USF freshman midfielder Cade Mendoza (17) suffered an ACL injury while still in high school.

Scott Strazzante, staff photographer / The Chronicle

Nicolos, a communications student who will have two more seasons with Santa Clara, made a film about ACL recovery after her second injury for one of her classes.
“Once it happened to you, it’s close to your heart,” she said.
For some, like Jordan Angeli, it happens three or more times.
“Everyone has always called me mentally tough,” said the former Santa Clara (2004-06) player who now works as an analyst on Columbus MLS broadcasts. “And then I was struggling mentally, and I thought wow, if I’m this, it must be difficult for everyone. No amount of mental strength will get you through this. You have to learn to put some of those thoughts aside .

The Journal of the American Academy of Orthopedic Surgeons cited a study that stated that “patients with ACL injuries experienced seven times more depression from baseline and experienced mood disturbances and lowered self-esteem”.
Angeli’s first two surgeries took place less than a year after her chart surgery was not done correctly the first time around. She tore it up again on a non-contact play during a header, and a third time when tackled in her first professional season.
“I knew it shouldn’t be like this,” she said.
In her isolation, Angeli found community in the physical and mental trauma of ACL recovery. She founded the ACL Club in 2015 and a podcast that highlights athletes who have come through injury.
“I felt like people were craving a community,” she said. “It’s traumatic when you feel it. Your knee is basically dislocated and then the ACL is torn. It’s a feeling you never want to feel again. It’s such an unnatural feeling.
With ACL recovery times faster and surgeries less invasive than in decades past, the rise in notoriety among elite female athletes can be attributed to playing year-round in a only sport from an early age, said Nirav Pandya, associate professor of orthopedic surgery at UCSF.
“The hardest thing was at lower levels,” Pandya said. “I’ve seen girls who need surgery and I’m like, God, you’re 10 and you just tore your ACL.”

Santa Clara's Sally Menti (right), who is recovering from an ACL injury, stands on the sidelines with teammate Lucy Mitchell, who is recovering from an ankle injury.
Santa Clara’s Sally Menti (right), who is recovering from an ACL injury, stands on the sidelines with teammate Lucy Mitchell, who is recovering from an ankle injury.

Scott Strazzante, staff photographer / The Chronicle

Female athletes who play soccer or basketball all year have a 5% chance of tearing their ACL each year they play their sport. That’s a 20% chance of tearing your ACL while playing high school football.

The college careers of USF freshmen Hannah Burns and Cade Mendoza will all be post-ACL recovery. They had both already signed up to play for the Dons when they suffered their injuries.
Some committed athletes fear losing their scholarship if they are injured as a high school student. Mendoza said USF assured her she was not at risk, but anxiety still gripped her mind.
“There was nothing you could do, you can’t go back,” she said. “I really cried here and there.”
Mendoza and Burns bonded from their injuries at different times during recovery. They have also both received advice from senior Marie Marlow, who tore her anterior cruciate ligament last season.
“We consoled ourselves because football is our life, and now you’ve come out of it so abruptly,” Mendoza said. “It’s a glass box, you can see it, but you can’t get into it.”
Burns’ process was particularly difficult; she was not operated on until three months after the initial injury. She started training on her own, but watching the Dons from the sidelines has been both a blessing and a curse to her mental recovery.
“At first it was difficult,” she says. “We have home games that you go to and it makes you want to play. The first few months were the hardest, trying to figure out how it happened.

Epidemic of ACL injuries in women’s football brings mental health toll

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