THE (MORE) BEAUTIFUL GAME
In this special edition of the Aspetar Sports Medicine Journal, we are celebrating the “Beautiful Game” – not only football, but specifically, Women’s Football.
The term ‘The Beautiful Game’ was popularised by the famous Brazilian player, Pele – even though the exact origin of it is disputed. Some attribute it to the Brazilian footballer ‘Didi’ Pereira, whilst Stuart Hall, an English football commentator, claimed to have coined it in 1958. The English football author T.E Bates had already used it in 1952 in a newspaper article describing the game. What is certain however, is that the term was coined at a time when the ‘Beautiful Game’ was essentially the ‘Men’s Game’.
This was not always the case. Some historical records suggest that women may have been playing football for as long as the game (or something resembling it) has existed. ‘Cuju’ was a game most likely played by men and women, possibly professionally, as far back as the Han dynasty in China - more than 2000 years ago. Annual women’s football matches were also played in Scotland and England during the 18th and 19th Centuries and the game increased in popularity during the early 20th Century. The pinnacle of women’s football popularity was reached on Boxing Day 1920, when a women’s football match in Liverpool drew a crowd of 53,000 spectators – more than the men’s FA Cup final played the same year. This record stood for 98 years.
One year later, the English Football Association (FA) banned women from playing on medical grounds – stating: "the game of football is quite unsuitable for females and should not be encouraged".
Several countries followed suit, and in some (such as Brazil), it was downright illegal for women to play football – a move supported by the President of FIFA at the time. The impact of this ban cannot be overstated, and, in many countries, it effectively destroyed the Women’s Game for many decades. It was only in 1971 that the FA finally lifted the ban on Women’s football – but by then the damage had been done and the Women’s Game was essentially 50 years behind that of men. It took another 20 years before FIFA held the first ever Women’s World Cup - in China (1991) - by which time there had been 14 editions of the men’s tournament.
Since then, women have been playing catch-up, and what a remarkable journey it has been! We believe it is important to acknowledge the past and learn from it – but not to dwell on it too much. Much has been written about the financial, coaching, technical, scientific and medical gaps between the Women’s and the Men’s Games. In this edition of our journal, we want to move on and start filling in these gaps.
We kick off with a section focusing on a group of people who have been instrumental in pushing the Women’s Game forward in the past few years and passionately advocates for the future of women’s football. The United States women’s national soccer team (USNWT) is the most successful in international football, having won four FIFA Women’s World Cups and four Olympic gold medals. We hear from the team behind the team (the United States Soccer Federation) pushing for a change in women’s soccer, by implementing multiple new initiatives across the organisation – not only medically, but also financially, scientifically and socially. Jill Ellis was the USNWT coach from 2014 until 2019, the most successful coach in the history of the women’s game and a true superstar. She shares her thoughts about important topics that affect women’s football today, including coaching, youth development and the role of the medical team. We complete this section with a piece on Sandra Doreleijers, a former Dutch National Team player and current Head of Women’s football at PSV Eindhoven, focusing on her thoughts about the future of the Women’s Game.
In the next section we cover Sports Medicine topics. Dr. Jane Thornton eloquently highlights the importance of female athlete health across the lifespan and the importance of the athlete’s voice, not only in decision-making, but also in bridging the existing data gap. In a very interesting article on cardiovascular adaptations in football, Drs. Carmen Adamuz, Silvia Castelletti and Guido Pieles reveal some fascinating insights into the uncharted territory of the ‘female football player heart’ and how small-sided football matches can improve health even in those groups not traditionally associated with football: middle-aged postmenopausal women. In the final article in this section Dr. Suzanne Huurman, team doctor at Real Madrid and guest editor of this Special Edition, discusses her experiences of working with both men’s and women’s professional football teams and how they differ.
The Sports Injuries section deals with some of the ‘hot topics’ in women’s football injuries. Orthopaedic surgeons Drs. Bert Mandelbaum and Pieter D’Hooghe discuss a variety of issues, including physiological demands of the game, the menstrual cycle and injury risk, contraception, pregnancy and anterior cruciate ligament (ACL) rupture. This is followed by an insightful article by physiotherapists Roula Kotsifaki and Holly Silvers-Granelli about the latest concepts in ACL rehabilitation and how it differs between men and women. Dr. Milena Tomovic concludes this section with a pragmatic article on groin pain in the female footballer, including clinical and radiological features to look out for.
Katrine Kryger and Athol Thompson have been doing some groundbreaking work on the women’s football boot and they share their experience and latest developments with us.
Finally, Dr. Omar Al Sayrafi, a sports physician from Qatar, entertains and inspires us by sharing his story of his dreams as a young footballer and how anything is possible – if people are given a chance.
We hope that you will enjoy this Special Edition of the Aspetar Sports Medicine Journal. We would like to thank the Editor-in-Chief, Prof Nebojsa Popovic, for inviting us to promote the Women’s Game, which we hope you agree, is fast becoming the (more) Beautiful Game…
Celeste Geertsema MD
Suzanne Huurman MD
Pieter D’Hooghe MD, PhD