Female athletes: common injuries and prevention

Much of the research on sports injuries has been done on men. In a review of risk factors for lower extremity injuries, only 2.4 percent of the roughly 1.5 million participants were women, and four in ten studies did not report figures for women separately [4]. A corresponding review of injuries and pain in the spine, chest, abdomen and pelvis covered 105 studies, and women made up less than a quarter of the participants [5].

This means that much of what we know builds on findings transferred from male athletes. Researchers have therefore called for better injury surveillance and more studies designed for women and girls [5].

ACL injury is a common sports injury, and its incidence is clearly higher among female than male athletes in contact sports [2]. Girls and young women are affected somewhat more often than boys and men, and the age group 15 to 45 has the highest risk. About 70 percent of the injuries occur during sport [3]. In Norway, women who undergo surgery are most often between 10 and 19 years old [2].

The injury is usually noticed immediately. Many hear a snap, the pain comes at once, and the knee often swells within a few hours [3]. Rehabilitation after the injury usually takes six to twelve months [3]. Not everyone needs surgery, and the assessment depends first and foremost on the demands you place on the knee at work and in leisure time [3].

A review from 2025 gathered 82 studies with a total of over 150,000 participants, and slightly more than half were women and girls. Most studied was neuromuscular training, that is, programmes with balance, strength, agility and changes of direction. The studies that were included had at least ten minutes of such training twice a week [1].

Athletes who completed such programmes had fewer ACL injuries. The authors estimate a reduction of 61 percent and rate the certainty of the finding as high. For ankle sprains the reduction was 39 percent with moderate certainty, but the margin of uncertainty is wide, and the result is not clearly statistically certain. For all lower extremity injuries combined the figure was 19 percent with low certainty, and this was not clearly certain either [1].

NHI similarly describes that warm-up with balance, coordination and strength exercises can reduce knee injuries by about a quarter and ACL injuries by up to half, and that such programmes can be introduced at low cost [2][3].

For ankle sprains there is thus some support that neuromuscular training can reduce the incidence, but the certainty of the finding is not high [1].

For injuries and pain in the spine, chest, abdomen and pelvis the knowledge is very limited. The authors of a review from 2025 write that the evidence that exercise prevents low back pain in female athletes is of very low certainty, and that it is premature to give preventive recommendations for this group of injuries [5].

There is no settled explanation of why ACL injuries are more frequent in women. NHI writes that no conclusion has been drawn about anatomical or hormonal differences. Women often land with more inward rotation of the hip and with the knee collapsing inward (valgus), and this places higher load on the ligament [2].

The researchers behind the review of risk factors for lower extremity injuries found that the certainty of the findings for almost all factors is low or very low, and that the risk is multifactorial. They caution against explaining injuries by hormones, the menstrual cycle or anatomy without stronger evidence. Progressive strength training, adapted load and individual follow-up are still regarded as sensible measures [4].

With an acute knee injury with a snap, immediate pain and swelling, and where it is difficult to load or move the knee, the injury should be assessed by a healthcare professional [3]. X-ray and MRI are used in the diagnosis of knee injuries [3].

A physiotherapist can examine the injury, go through the load in your training and together with you plan rehabilitation or a preventive training programme. You can read more about physiotherapy at Dr.Dropin and about ankle sprains.

Do women get ACL injuries more often than men?

The incidence is clearly higher in female than male athletes in contact sports, and girls and young women are affected somewhat more often than boys and men [2][3].

What is neuromuscular training?

It is training programmes that combine balance, strength, agility and changes of direction. The studies that were summarised used at least ten minutes twice a week [1].

Can a warm-up prevent ACL injury?

According to NHI, warm-up with balance, coordination and strength exercises can reduce ACL injuries by up to half. Reviews of studies point in the same direction [1][3].

How long does rehabilitation after an ACL injury take?

Rehabilitation usually takes six to twelve months [3]. The course varies from person to person.

Do I need a referral to see a physiotherapist?

No, you can book directly without a referral from a doctor.

You can read more about Pain Reprocessing Therapy and long-lasting pain. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Bullock GS, Räisänen AM, Martin C, et al. Prevention strategies for lower extremity injury: a systematic review and meta-analyses for the Female, woman and/or girl Athlete Injury pRevention (FAIR) consensus. Br J Sports Med. 2025;59(22):1575-1586. doi:10.1136/bjsports-2025-109910. Link

2. Johannessen T. Fremre korsbåndskader hos kvinnelige idrettsutøvere (Anterior cruciate ligament injuries in female athletes). NHI.no (for healthcare professionals). Last updated 5 August 2024. Link

3. Korsbåndskade, fremre (Anterior cruciate ligament injury). NHI.no. Last updated 6 December 2024. Link

4. Female, Woman and Girl Athletes Lower Extremity Injury Risk: Separating Fact from Fiction. BJSM blog, discussing Whittaker JL, Räisänen AM, Martin C, et al. Br J Sports Med. 2025;59(21):1499-1513. doi:10.1136/bjsports-2025-109902. Link

5. Whittaker JL, Schulz JM, Galarneau J-M, et al. Prevention strategies and modifiable risk factors for spine, chest, abdominal and/or pelvic injury and pain: a systematic review and meta-analysis for the FAIR consensus. Br J Sports Med. 2025;59:1515-1528. doi:10.1136/bjsports-2025-109900. Link