TY - JOUR
T1 - Prevention strategies for lower extremity injury
T2 - a systematic review and meta-analyses for the Female, woman and/or girl Athlete Injury pRevention (FAIR) consensus
AU - Bullock, Garrett S.
AU - Räisänen, Anu M.
AU - Martin, Chelsea
AU - Martin, Maitland
AU - Galarneau, Jean-Michel
AU - Whittaker, Jackie L.
AU - Losciale, Justin M.
AU - Bizzini, Mario
AU - Bourne, Matthew N.
AU - Dijkstra, Hendrik Paul
AU - Dubé, Marc-Olivier
AU - Hayden, Alix
AU - Girdwood, Michael
AU - Hägglund, Martin
AU - McLeod, Shreya
AU - Mkumbuzi, Nonhlanhla Sharon
AU - Mosler, Andrea Britt
AU - Murphy, Myles Calder
AU - Myklebust, Grethe
AU - Møller, Merete
AU - Ocarino, Juliana M.
AU - Owoeye, Oluwatoyosi B.A.
AU - Palmer, Debbie
AU - Pasanen, Kati
AU - Rio, Ebonie Kendra
AU - Thorborg, Kristian
AU - van Middelkoop, Marienke
AU - Verhagen, Evert
AU - Warden, Stuart J.
AU - Whalan, Matthew
AU - Crossley, Kay M.
AU - Emery, Carolyn
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.
PY - 2025/12/3
Y1 - 2025/12/3
N2 - 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 154561 participants were included, of whom 84915 (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 10min 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.
AB - 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 154561 participants were included, of whom 84915 (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 10min 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.
KW - Education
KW - Exercise
KW - Athletic Injuries/prevention & control
KW - Humans
KW - Personal Protective Equipment
KW - Female
KW - Lower Extremity/injuries
KW - Leg Injuries/prevention & control
UR - http://www.scopus.com/inward/record.url?scp=105010923011&partnerID=8YFLogxK
U2 - 10.1136/bjsports-2025-109910
DO - 10.1136/bjsports-2025-109910
M3 - Review
C2 - 40645751
AN - SCOPUS:105010923011
SN - 0306-3674
VL - 59
SP - 1575
EP - 1586
JO - British Journal of Sports Medicine
JF - British Journal of Sports Medicine
IS - 22
ER -