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Injury Prevention for Women
INTRODUCTION & PURPOSE
Women’s professional, semi-professional and community football is one of the fastest growing sports worldwide, at all leves. When accounting for football exposure, women have a different injury risk profile than men. In fact, women have a higher risk of concussion, knee and ankle injuries than men, with men at greater risk of hamstring and groin injuries. However, no studies have specifically synthesised the literature for female football players, to determine the efficacy of injury prevention programmes on all injuries, and other local injuries. Determining the sex-specific and sport-specific efficacy of injury prevention programmes will provide patients, clinicians and sporting organisations with context-specific evidence-based recommendations.
“Women have a higher risk of concussion, knee and ankle injuries than men, with men at greater risk of hamstring and groin injuries”
The aim was to systematically review the effect of any type of injury prevention programme on reducing overall injury incidence in women’s football. Secondary aims were to: (1) examine the effect on reducing the incidence of ACL, knee, ankle, hip/groin and hamstring injuries; (2) describe the exercise-based training components (eg, strength, balance) included in each exercise-based programme, and explore the relationship between the number of training components and injury incidence; and (3) report the injury incidence for lower-limb injuries for female football players using control group (ie, non-intervened) data.
Randomised controlled trials evaluating any injury prevention programme (eg, exercise, education, braces) were included. Specific selection criteria were (figure 1): i) randomised controlled trials including any type of injury prevention programme (eg, exercise, education, braces) and a control group that was not exposed to the intervention; ii) ≥20 female football players in each study arm (any age, any football code, any participation level); and iii) reported an outcome relating to injury incidence for any injury.
Figure 1. Flow chart of study selection.
- Twelve studies, all in soccer, met inclusion criteria, with nine involving adolescent teams (aged <18 years).
- All studies (except one) had a high risk of bias.
- Intervention components (table 1): Eleven studies examined exercise-based programmes, with most (9/11) including multiple (≥2) training components (eg, strength, plyometric, balance exercises). Regarding intervention components, the most common exercise-based training component was strength (10/11 studies), while agility and mobility exercises were used the least (5/11 studies).
- Multicomponent exercise programmes reduced overall (any reported) injuries (incidence rate ratio (IRR) 0.73, 95% CI 0.59 to 0.91) and ACL injuries (IRR 0.55, 95% CI 0.32 to 0.92).
- For exercise-based strategies (single-component and multicomponent), hamstring injuries were also reduced (IRR 0.40, 95% CI 0.17 to 0.95).
- While exercise-based strategies resulted in less knee, ankle and hip/groin injuries, and the use of multiple training components was associated with greater reductions in overall and knee injuries, further studies would be required to increase the precision of these results.
- The incidence of overall injuries in women’s football was 3.4 per 1000 exposure hours; with ankle injuries most common.
Table 1 (table 2 in full-text). Intervention components for exercise-based injury prevention programmes.
✓, included; X, did not include; *, articles that included strength and plyometric components were assessed to determine if they met training prescription guidelines for strength and power respectively39—small ✓ symbols in a green cell indicate the article met the muscular strength (included at least 2 sets, 8–15 repetitions or 20–30 s duration, AND one progression (ie, increased intensity/difficulty)) or power (included at least 1 set, 3–15 repetitions or 10–30 s duration, AND one progression (ie, increased intensity/difficulty)) guidelines, while small X symbols in an orange cell indicate they did not. CORE, exercises focused on the trunk and lower extremity; PEP, Prevent injury and Enhance Performance.
- Based on the new findings from this review, there appears to be greater reductions in overall injuries, and specifically in knee injuries, when a larger number of training components were included in the intervention. However, studies focused on precise / concrete training components would help to clarify results, and to manage each injury with individualized treatments.
- This research shows that multi-component, exercise-based injury prevention programs reduce overall injuries by 27%, and ACL injuries by 45%. Nonetheless, taking into account that ankle injuries are the most common ones in female football, new studies on these injuries are warranted in order to help the practitioners being able to respond to women’s football specific requirements.
- Despite exercise-based strategies (single-component and multicomponent) seem to reduce the number of many injuries (e.g., hamstrings, knees, overall), most studies have high risk of bias, so the results should be interpreted with caution.
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