Epidemic of ACL injuries in women’s soccer brings a mental-health reckoning

Marlee Nicholls thought it was almost a foregone conclusion that she would someday tear her ACL. It seemed that it happens to everyone and one day it will happen to him too.

When the Santa Clara women’s soccer goalkeeper suffered a knee injury at the end of her freshman season, the blow didn’t go away. Then, when he tore it again in September 2021, it looked brutal.

“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 went through this.”

Although studies have shown how prevalent these injuries are among athletes, numbering in the tens of thousands annually, and especially among female soccer players, who are four to six times more likely to tear an ACL than their male counterparts, researchers and medical Huh. Professionals are just beginning to understand its mental toll.

Getting hurt while playing sports is lonely in itself; A player not only loses her ability to participate in something she is really good at, but also loses her sense of community. Sure, she may spend time with teammates and attend games, but that’s not the case when she’s a contributor.

That’s why 40% of athletes who tear their ACL deal with anxiety and depression afterward, according to the Stone Clinic.

The sporting world is facing a mental health reckoning. This story is part of a series exploring the challenges and ways to overcome them at all levels of competition.


Stanford forward Emily Chiao’s history of knee trauma hasn’t prepared her for the mental rigors of a nine-month rehab season after tearing her ACL moments in the first game of the 2021 season.

“It really hurt, like I completely pushed (the play) out of my mind,” Chiao said. “Then sometimes I would lie in bed wondering what had happened at that moment. I never wanted to watch the video and still don’t. I can play through it in my head.

“An ACL is really challenging in general,” she said. “You have to handle the fact that you wake up in bed and can’t lift your leg. It feels like you’re hitting a milestone every day.

About 34% of football players who tear their ACL do it a second time. A study in the Journal of Athletic Training states that any primary ACL injury causes alterations in neuromuscular control that affect the risk of a second injury.

Nichols was not deterred by changes that were out of his control at other times—the fact that his feet were different sizes because he had lost muscle mass, for example—and focused on the grueling process of rebuilding leg strength. tried to concentrate.

Between her past experience and the growing list of soccer players in her life who could offer qualified advice, it felt like another rite of passage.

Nichols said, “It was a little comforting that I knew what to expect.” “It’s sad but it’s a part of women’s football. I have a lot of friends who have done it.

Above: Santa Clara goalie Marlee Nicholls has torn her ACL twice. Left: USF freshman midfielder Cade Mendoza (17) suffered an ACL injury when he was in high school.

Scott Strazante, Staff Photographer / The Chronicle

Nichols, a communications major who would have two more seasons with Santa Clara, made a film about ACL recovery after a second injury for one of his classes.

“Once it’s with you, it’s close to your heart,” she said.

For some, like Jordan Angeli, it happens three times or more.

“Everyone always called me mentally strong,” said the former Santa Clara player (2004–06) who now serves as an analyst on Columbus MLS broadcasts. “And then I was struggling mentally, and I thought wow, if I am, this must be tough for everyone. No amount of mental toughness is going to get you through that. You have to learn that out of those thoughts How to set something aside.”

The Journal of the American Academy of Orthopedic Surgeons cited a study that noted that “ACL-injured patients demonstrated seven times more depression than their baseline and experienced mood disturbances and reduced self-esteem.” had got.”

Angeli had her first two surgeries within a year, as her graft surgery was not performed correctly the first time. He tore it again on a non-contact play when going up for a header, and the third time he faced it in his first professional season.

“I knew it shouldn’t feel like that,” she said.

In his isolation, Angeli found community in the physical and mental trauma of ACL recovery. She founded the ACL Club in 2015, a podcast that highlights athletes going through the injury.

“I felt like people were craving a community,” she said. “It’s painful when you feel it. Your knee is essentially dislocated, and then the ACL is torn. It’s a feeling you never want to feel again. It’s such an unnatural feeling.

Nirav Pandya, associate professor of UCSF orthopedic surgery, said while ACL recovery times are faster and surgeries less invasive than in past decades, the rise in prominence among elite female athletes can be attributed to playing the same sport year-round. Could

Pandya said, ‘It is difficult at the lower level. “I’ve seen girls who need surgery and I’m like, God, you’re 10 years old and you tore your ACL.”

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

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

Scott Strazante, Staff Photographer / The Chronicle

Year-round female athletes who play soccer or basketball have a 5% chance of tearing their ACL each year they participate in their sport. This represents a 20% chance of tearing the ACL while playing high school football.

The collegiate careers of USF freshmen Hannah Burns and Cade Mendoza would all be post-ACL recoveries. Both of them were already committed to play for the Dons when they suffered the injury.

Some committed athletes worry about losing their scholarship if they get injured as a high school senior. Mendoza said USF assured him he was not at risk, but worries were still on his mind.

“There was nothing you could do, you couldn’t reverse it,” she said. “I definitely cried here and there.”

Mendoza and Burns attended to their injuries at various points in recovery. The two also consulted senior Mary Marlowe, who tore her ACL last season.

Mendoza said, “We consoled each other because football is our life and now you are suddenly out of it.” “It’s a glass box, you can look into it, but you can’t go into it.”

Burns’ process has been particularly challenging; She did not have surgery until three months after the initial injury. He has started practicing on his own, but watching the Dons from the sidelines has been both a blessing and a curse for his mental recovery.

“At first it was hard,” she said. “We have home games that you go into and it makes you want to play. The first few months were the hardest, trying to wrap your head around how that happened.

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