When Erin Phillips went down in the third quarter of the 2019 AFLW grand final there was a collective gasp in the stadium. An uneasy silence settled over the crowd as she clutched her knee. It was an unfortunately familiar sight. One we’ve seen repeated across all four seasons of the fledgling competition, including as recently as round two this year when Melbourne’s Ainslie Kemp hobbled off the ground after tearing her ACL for the second time.

The number of ACL injuries sustained by players has been a much-discussed topic since the inaugural season. The AFL has previously partnered with La Trobe University to develop a risk-reduction program for the AFLW with a focus on prevention via strengthening exercise, weights and altered running programs. But the partnership will soon grow to include investigating a potential link between menstrual cycles and ACL injuries.

There has been plenty of discussion around physiological and biological factors that can mean women are anywhere from two to 10 times more likely to sustain the season-ending injury. Of course, with the AFLW season starting in February, hard grounds are also factor. As is pre-season fatigue. Both have been linked with ACL injuries. Less exposure to the kind of training that can prevent such injuries or access to appropriate support staff (the AFL has set a $450,000 soft cap on women’s football departments) and the part-time nature of the competition are other, influential factors. So too is the simple fact the competition is not yet four seasons old.

Menstrual cycles, however, and their possible impact on player performance as well as susceptibility to injury, have not been raised until recently. It reflects a cultural perception of periods and menstrual cycles as being taboo topics, things we just shouldn’t discuss. But that perception is changing. And not just on home soil.

In recent weeks, several high-profile teams and clubs revealed they are using information about athletes’ menstrual cycles to tailor training programs, enhance performance and endeavour to avoid injury. Among them, reigning world champions the US women’s football team, who tracked their periods in a bid to improve performance.

Chelsea FC, the home of Sam Kerr, revealed last week they had designed training plans for their players around the phases of their menstrual cycle. Manager Emma Hayes said it was important women had a better understanding of their menstrual cycle. “It comes from a place of wanting to know more about ourselves and understanding how we can improve our performance,” she said.

“I am a female coach in an industry where women have always been treated like small men,” Hayes said. “The application of anything from rehab to strength and condition to tactical all come from the basis of what men do.”

Hayes is right. An analysis from 2014 revealed that of all the sports performance studies conducted between 2011 and 2013, only 3% involved women. This is hardly surprising. The absence of women in clinical trials and the assumption that what works for men will work for women has long persisted, and to the detriment of women.

For Brisbane Lions, tracking periods to boost performance and help avoid injury is nothing new. The club has been doing so since the beginning of the AFLW. The Lions use an app where players record how they’re feeling in the different stages of their cycle.

Coach Matt Green said the information helps the club more accurately assess the impact of the menstrual cycle on players. “When are the right times to be pushing recovery? When are the right times to be eating certain foods that will aid with limiting bloating and aiding in fatigue and all those different types of things?”

Professor Kay Crossley, Director of the La Trobe Sport and Exercise Medicine Research Centre, which is working with the AFL, said there was currently limited knowledge about how the menstrual cycle related to injury and performance. “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 said.

While it’s far too early to make any sweeping claims about any links between menstrual cycles and ACLs, it’s encouraging the AFL is committed to exploring the topic. However, it cannot do so in isolation. Exploring any link between menstrual cycles and ACL injuries, or any injury, must be done alongside a plan to address the other factors that contribute to the rate of ACLs in the league: the part-time nature of the competition, the desire to play the game in the warmest part of the year when grounds are at their hardest and the limits on what clubs can spend on support staff. These factors must also be addressed.

It’s unlikely the risk of tearing an ACL will ever be completely neutralised for women, or for anyone for that matter. But a proactive and holistic approach to reducing risk factors could mean a reduction in the number of incidences. And if that keeps the likes of Erin Phillips, Katherine Smith and Chelsea Randall on the track, that will be a good thing.