Women footballers need training and rehab programmes that are specifically designed for them, according to former elite player Steph Houghton (pictured).

Steph – who retired last year after a glittering career with clubs such as Manchester City and Arsenal – has collaborated with a high-profile counterpart from the men’s game – veteran midfielder James Milner (currently at Brighton and Hove Albion) – to write a reflective article that appears in the current issue of the British Journal of Sports Medicine.

Drawing on their shared experience of having played at the top level for more than two decades, Steph and James stress that the game has undergone a transformation since their fledgling days on the pitch and in the treatment room.

In her early playing days, Steph and her peers had to balance attending training sessions with holding down full-time jobs. They trained just twice a week, had ‘no gym access, hardly any staff and no physio’, Steph recalls.

‘It was definitely a “people first” approach without any numbers or statistics to aid decision-making and those decisions would be made by a small support team. There is still a disparity between clubs at the top of the WSL and those just transitioning to professionalism,’ she notes.

While the steady shift towards becoming full-time professionals has ‘elevated the standard of play’ it has also meant more fixtures and ‘introduced new layers of complexity to accelerated development and management of female players’, Steph suggests.

‘It is great that more research is being done into female footballers now; that is exactly what is needed. We (women) are different to men and need programmes that are designed specifically for us.’

Football is ‘not just a spectacle’

James and Steph write: ‘Every sprint, tackle, goal and decision is subject to intense analysis and scrutiny. Through our experiences from the men’s and women’s game, we share stories of resilience, adaptability and standards that are woven into the fabric of English football.

‘Our journeys remind us that football is not just a spectacle, it is a lived experience, shaped by real people confronting challenges every day.’

‘As football continues to evolve, it remains important that a platform is offered to the voices of players with first-hand experience, to ensure our insights and perspectives bring balance to any conversations occurring that may impact the game.’

When James’ career kicked off at Leeds United in 2002, players were supported by just two physiotherapists, a doctor and a masseur. Today, by contrast, ‘there might be nine or ten members of the medical team and five in the sports science team, alongside nutrition and psychological support’, he writes.

Promoting long careers

James, who went on to play for England and for clubs such as Manchester City and Liverpool, says that the days of ‘hoping for the best’ over an injury are long gone.

‘The changing rooms can be full of support staff and, as players, we need to learn to use it all in the right way. It is no longer necessary to just play through injuries and hope for the best. Today, even minor concerns are met with immediate assessments, diagnostic imaging and precise individualised management plans.’

Such changes reflect a ‘broader trend towards data-driven decision-making, where physiological metrics and imaging inform treatment plans, recovery and return-to-play timelines’, James notes.

‘While these advances are valuable, we can’t rely solely on technology. Sometimes it is just about knowing your own body. It is just as important that players are self-aware and their insights included in decisions related to balancing resilience and risk.

‘Blending scientific insight with intuitive self-management and high-quality professional support is key to career longevity.’

‘As football continues to evolve, it remains important that a platform is offered to the voices of players with first-hand experience, to ensure our insights and perspectives bring balance to any conversations occurring that may impact the game [James Milner and Steph Houghton] ‘

Players can offer ‘critical insights’

Steph and James suggest that their stories mirror broader trends in elite sport, ‘where the boundaries between science, strategy and personal agency are increasingly blurred and must be navigated with care’.

They note: ‘As football evolves, the perspectives of players will provide critical insights for other players, coaches, sports science and medicine staff and policymakers. The sport’s advancement will depend not only on technological progress but also on cultivating holistic, adaptable and resilient players who are empowered to share their views in the management of their own health.’

James and Steph conclude: ‘It is imperative that the voices of those with direct experience are included in decision-making to ensure a sustainable and balanced progression of the game.’

To read the full version of the article – titled Player reflections on change: 20 years of evolving demands and support in elite football – click

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