Prevention strategies for lower extremity injury: A systematic review and meta-analyses for the Female, woman and girl Athlete Injury pRevention (FAIR) Consensus
Author Identifier (ORCID)
Myles Calder Murphy: https://orcid.org/0000-0001-6068-1096
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.
Document Type
Journal Article
Date of Publication
1-1-2025
Publisher
BMJ Publishing Group
School
School of Medical and Health Sciences
Funders
The International Olympic Committee
Copyright
subscription content
Comments
Bullock, G. S., Räisänen, A. M., Martin, C., Martin, M., Galarneau, J., Whittaker, J. L., Losciale, J. M., Bizzini, M., Bourne, M. N., Dijkstra, H. P., Dubé, M., Hayden, A., Girdwood, M., Hägglund, M., McLeod, S., Mkumbuzi, N. S., Mosler, A. B., Murphy, M. C., Myklebust, G., . . . Emery, C. (2025). Prevention strategies for lower extremity injury: A systematic review and meta-analyses for the Female, woman and girl Athlete Injury pRevention (FAIR) Consensus. British Journal of Sports Medicine. Advance online publication. https://doi.org/10.1136/bjsports-2025-109910