Baroness Sue Campbell, Sir Gareth Southgate, & Yorkshire Knee Clinic: Teaming Up To Tackle ACL Injuries in the Young

The Lionesses’ incredible success at the Euros came despite half the team having recently recovered from, or still being sidelined by, knee injuries.
Reducing the incidence of knee injuries in women and young people has been the aim of the START project initiated by Yorkshire Knee Clinic’s Nick London, led by Tom Hughes, and supported by Baroness Sue Campbell, Sir Gareth Southgate, The Women’s FA and Carnegie School of Sport (Leeds Beckett University).

Now, as the programme receives formal backing from the FA, Nick shares the programme’s journey from inception to rollout.

The Lionesses’ recent Euros success was genuinely historic. First English national football team to win a tournament on foreign soil. First English national football team to win back-to-back titles (having won the last Euros tournament in 2022).

It’s all the more impressive when you consider how many of the squad have been battling with knee injuries. Georgia Stanway, Lauren Hemp and Alex Greenwood all recovered from serious injuries to be part of the trophy-lifting team. Ella Morris, Millie Bright and others didn’t recover in time to join the party.

You probably don’t need me to tell you that we’re facing a global epidemic of knee injuries in young people, and especially among young women and girls. Google ‘The Lionesses’, and the dispiriting fact, despite their astonishing success, is that you’ll find almost as many references to ACL injuries as you do tournament wins. There is an obvious physical toll of such injuries. But there can be a brutal mental toll too, something we have explored previously but which is often overlooked.

The evidence tells us that it is possible to reduce the number of injuries by up to 50 percent in school-aged females and 30 percent in school-aged males. But it hasn’t happened. Whatever programme is launched in schools falters. Why is that?

To find out, I initiated a research project through The Yorkshire Knee Clinic and in my capacity as Visiting Professor of Sports Medicine to the Leeds Beckett University Carnegie School of Sport. We appointed a research student, Tom Hughes, to explore the issue and I attracted start-up funds in early 2020 (which were more than matched by Leeds Beckett University). Expertly guided by his supervisors, Professor John O’Hara and Dr Stacey Emmonds, Tom set about planning the project. You can read more about Tom’s research journey and the development of the START programme here.

Engineering a positive start for START

Tom will now widen the net, incorporating a range of schools into the design process, and upskilling teachers to deliver the programme.

Yet taking any research project into the real world takes funding, and funding is rarely easy to find. It also requires opportunity. If START were to make an impact at the required national level, it needed government backing. I was most grateful, therefore, for the guidance of then England manager, Sir Gareth Southgate.

The FA factor

I first met Sir Gareth at the Football Association. I’d just delivered a sports meeting lecture on knee injury prevention. After the session we spoke more about the subject – it was a topic clearly close to his heart. He asked me to keep him posted, so early in summer 2024, as Tom was completing his PhD, I did just that.

I mentioned the challenges that lay ahead of us in terms of getting START into the school curriculum. Gareth wisely put me in touch with Baroness Sue Campbell, Chair of UK Sport and the outgoing director of women’s football at the FA (she’s now Chair of England Netball).

Baroness Campbell is one of the most remarkable people I’ve ever met. Tom, Professor John O’Hara and I returned to St George’s Park to meet her in summer 2024. She was fascinated by START, took copious notes, and was extremely generous with her time. At the end of our presentation, she asked: “Well, what’s the bottom line?”

I spoke about the need to leverage contacts so that we could speak to ministers and try and get the programme into schools. We were also keen on taking our studies forward to provide more evidence to support the schools programme. Finally, and of at least equal importance, we wanted to study the psychological impacts of these injuries on schoolchildren and develop strategies to assist them, their parents and schools.

“Yes,” she said, “but you also need the money to take it forward. What will it cost?”

We gave her a ‘ball-park’ figure with some trepidation.

“Oh, I’m sure I can find that,” she said!

A green light for START

Thanks to Sue Campbell, Gareth Southgate and their incredibly supportive colleagues at the Women’s FA, I’m delighted to say that the FA has given its agreement to support the rollout of the START programme in schools, in partnership with Leeds Beckett University. They have backed Tom Hughes to help deliver the programme whilst simultaneously funding two additional PhD students at Leeds Beckett University to study both the injury prevention (reduction) programme and the psychological aspects of the injuries themselves.

The FA has a longstanding commitment to bringing more girls into football, and the START programme will effectively ‘piggyback’ on this.

Momentum for change

It’s an important moment in the fight against ACL injuries in young people, and especially among girls. All the surgeons at Yorkshire Knee Clinic have dealt with young patients who have damaged their ACLs. We’ve seen the mental anguish this causes alongside the physical damage. We understand the worry of placing sporting dreams on hold, not knowing whether they will ever be revisited.

The legacy of the 2022 Euro-winning side was to increase the participation of girls in sport. The Lionesses’ latest win will no doubt do the same. That has enormous benefits but it places on us (schools, sports authorities, medical community) a responsibility to maintain safety and minimise the risks of injury.

Through START, and with the support of the FA, we hope many more young people will be spared injury through a programme that schools and pupils find easy to use and apply, and which helps build momentum for change over the long term.

I personally am immensely grateful to Leeds Beckett University for their continuing support of this programme; to Sir Gareth Southgate and Baroness Sue Campbell for their vision; to the Women’s FA for their backing and their recognition of their responsibility to grow the game as safely as possible; and to Tom Hughes for continuing to drive the process forward.

> Discover more about Nick London
> Discover more about the START programme