Do injury prevention programs work for women?

2017 – Olympique Lyonnais goalkeeper Sarah Bouhaddi celebrates with her team mates after beating Paris St Germain Action Images via REUTERS/Carl Recine

More women are playing soccer than ever before. In fact, the rate of females joining soccer teams is outpacing the growth of all other sports(1). Injuries from playing soccer are on the rise as well.

According to the NCAA, injuries occurred in collegiate female soccer players between 2004 and 2009, at a rate of 7.3 per 1000 athlete exposure hours(2). Elite international soccer players studied in 2007 demonstrated a higher injury rate of 67.4 injuries per 1000 athlete exposure hours(3). A much smaller South African high school sample found that injuries occurred at a rate of 90 per 1000 athlete exposure hours(4).

Injuries in female soccer players are typically more severe than men(5). Women are more susceptible to serious knee injuries, concussion, and ankle injuries than men(1). There are several injury prevention programs specifically for soccer players. However, none consider the different injury profile in females. Therefore, researchers from La Trobe University sought to determine the effectiveness of these programs on reducing injury among female players. In this systemic review, they also looked at the specific effects on the incidence of particular injuries and the types of strategies they employ. Further, they conducted a meta-analysis of the data when appropriate to determine injury rates.

The final evaluation included 12 studies of injury prevention in female soccer players. The majority of the subjects were less than 18 years old, and all studies but one demonstrated a high risk of bias. Most of the programs (9/12) emphasized multiple neuromuscular strengthening exercises executed with control and attention to the quality of movement. One study focused solely on balance training while another on eccentric hamstring strengthening only.

The studies that looked at prevention programs that used multiple exercise components compared to controls showed low-level evidence of a significant (27%) decrease in overall injuries in the test subjects. The athletes in these programs also demonstrated a significant 45% drop in ACL injuries versus control players. The injury prevention programs did not show a significant influence on the rate of general knee or ankle injuries. However, hamstring injuries were lowered significantly (by 60%) when all studies were pooled together, and there was a reduction, although not significant, in hip and groin injuries.

Choosing the best program

While acknowledging the low level of evidence and the high chance of bias, this study shows that programs with multiple neuromuscular-based components had the highest impact on injury rates in women. Many of the multi-component studies included in this review lacked data on hamstring injuries. However, the eccentric exercise and balance training programs both significantly influenced the rates of these injuries. The investigators acknowledge that confounders include factors affecting external and internal training loads. While more research is needed, implementing a neuromuscular-based exercise program appears to lower rates of overall injuries, ACL, and hamstring injuries in female soccer players. The challenge continues to be designing a program that fits into training schedules and earns support and adherence from coaches and athletes.


  1. Br J Sports Med. 2020;0:1-12.
  3. Br J Sports Med. 2007 Aug; 41(Suppl 1): i3–i7.
  4. Afr Health Sci. 2016 Mar; 16(1): 298–305.
  5. Acta Orthop. Belg., 2015, 81, 289­295
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