Abstract
Objective: Examine the effectiveness and unintended consequences of prevention strategies for reducing female/woman/girl athletes’ lower extremity (LE) injuries.
Design: Systematic review with meta-analyses and Grading of Recommendations, Assessment, Development and Evaluation. Data sources: Systematic search of eight data sources.
Eligibility: Primary data studies with a comparison group(s) investigating injury prevention strategies for sport-related LE injuries with ≥1 female/woman/girl in each study group.
Results: Across 82 studies—including 48 randomised controlled trials (59%), 16 quasiexperimental studies (20%), 16 cohort studies (20%) and 1 cross-sectional study (1%)—a total of 154 561 participants were included, of whom 84 915 (55%) were females/women/girls. Neuromuscular training (NMT)-based programmes (n=60, 73%) were the most frequently studied intervention, followed by personal protective equipment (PPE) (n=9, 11%), policy/rule change (n=4, 5%) and education (n=6, 7%). The median Downs and Black score for all studies was 17 (range: 5–24). Point estimate from pooled results from nine studies revealed that NMT programmes, which include LE balance, strength, agility and change of direction exercises, with a minimum dose of 10 min two times per week, reduced female/woman/girl athletes’ LE injuries by 19% (0.81, 95% CI 0.61% to 1.08%; low certainty evidence). Point estimate of pooled results from six studies uncovered that NMT reduced ankle sprains by 39% (0.61, 95% CI 0.36% to 1.03%; moderate certainty evidence). NMT significantly reduced anterior cruciate ligament (ACL) injuries by 61% (0.39, 95% CI 0.25% to 0.60%; high certainty evidence).
Conclusion: NMT programmes can reduce female/woman/girl athletes’ ACL injuries by up to 61% and ankle sprains by 39%, highlighting the need for widespread implementation of NMT programmes. Evidence informing PPE, policy/rule changes and education to prevent female/woman/girl athletes’ LE injuries is needed.
PROSPERO registration number: CRD42024486715.
Design: Systematic review with meta-analyses and Grading of Recommendations, Assessment, Development and Evaluation. Data sources: Systematic search of eight data sources.
Eligibility: Primary data studies with a comparison group(s) investigating injury prevention strategies for sport-related LE injuries with ≥1 female/woman/girl in each study group.
Results: Across 82 studies—including 48 randomised controlled trials (59%), 16 quasiexperimental studies (20%), 16 cohort studies (20%) and 1 cross-sectional study (1%)—a total of 154 561 participants were included, of whom 84 915 (55%) were females/women/girls. Neuromuscular training (NMT)-based programmes (n=60, 73%) were the most frequently studied intervention, followed by personal protective equipment (PPE) (n=9, 11%), policy/rule change (n=4, 5%) and education (n=6, 7%). The median Downs and Black score for all studies was 17 (range: 5–24). Point estimate from pooled results from nine studies revealed that NMT programmes, which include LE balance, strength, agility and change of direction exercises, with a minimum dose of 10 min two times per week, reduced female/woman/girl athletes’ LE injuries by 19% (0.81, 95% CI 0.61% to 1.08%; low certainty evidence). Point estimate of pooled results from six studies uncovered that NMT reduced ankle sprains by 39% (0.61, 95% CI 0.36% to 1.03%; moderate certainty evidence). NMT significantly reduced anterior cruciate ligament (ACL) injuries by 61% (0.39, 95% CI 0.25% to 0.60%; high certainty evidence).
Conclusion: NMT programmes can reduce female/woman/girl athletes’ ACL injuries by up to 61% and ankle sprains by 39%, highlighting the need for widespread implementation of NMT programmes. Evidence informing PPE, policy/rule changes and education to prevent female/woman/girl athletes’ LE injuries is needed.
PROSPERO registration number: CRD42024486715.
| Original language | English |
|---|---|
| Pages (from-to) | 1575-1586 |
| Number of pages | 12 |
| Journal | British Journal of Sports Medicine |
| Volume | 59 |
| Issue number | 22 |
| Early online date | 11 Jul 2025 |
| DOIs | |
| Publication status | Published - 1 Nov 2025 |
Keywords
- Exercise
- Education
