Health Science Reviews

By Enya Steyn

In 1895, women in England played their first official football match. This turned into a series of successful games across the United Kingdom until 1921, when the Football Association banned women from using League and Association grounds , deeming the sport “unsuitable” for women. That ban was not fully lifted until 1989.

Today, women’s football is thriving on the world stage. However, female players still face  unseen disadvantages, particularly when it comes to injury.

Studies show that women in professional football are 2 to 8 times more likely to suffer an anterior cruciate ligament (ACL) injury compared to their male counterparts. It has also been shown that frequent injuries in females increases the risk of osteoarthritis. Injury Prevention Programs (IPPs) have been developed to reduce this risk, but many still use a one-size-fits-all approach that overlooks critical factors such as the athlete’s sex. Research has shown that men and women respond differently to IPPs , highlighting the need for tailored strategies.

What can be done?

Recently, a study by John et al. reviewed over three decades of research to explore why female footballers are more prone to injuries and to assess the suitability and effectiveness of IPPs. The study identified several contributing factors such as hormonal fluctuations, anatomical differences, muscle imbalances, and even genetic predispositions that affect tissue strength and neuromuscular control. The authors suggest that genetic testing shows promise as it can help identify high-risk individuals, but more research needs to be done on its widespread use.

Another key factor is core stability. About 70% of ACL injuries are caused by non-contact mechanism suggesting that musculoskeletal factors such as muscle strength and endurance, greatly influence injury risk. Women tend to have less stable cores than men, and research shows that core stability and strength is crucial  to athletic performance and injury prevention. Tailored core stabilisation programs focussed on women could be a game changer.

Figure 1. Risk and protective factors for injuries in female footballers. Adapted from John et al.(2025).

Importantly, the study also highlighted mental health as a critical piece of the injury puzzle. Female footballers report higher rates of depression, anxiety, and sport-related distress, often linked to injuries, hormonal cycles, and lack of support. Most IPPs fail to address these psychological factors. A more comprehensive approach is urgently needed and should integrate mental wellness alongside physical training.

Programs like FIFA 11+ and PEP have shown promise as ACL injury rates in women were reduced by up to 45%. However, poor implementation and lack of adaptation to female specific needs weakens their impact.

Take-home message

With the rapid growth of women’s  football, injury prevention strategies must evolve. That means tailoring programs to female athletes which includes both physical and mental well-being. By increasing research and developing effective strategies, we can protect female footballers from unnecessary injuries and let their talent, not biology, shape their careers.

References

John, G., AlNadwi, A., Georges Abi Antoun, T., and Ahmetov, I.I. (2025). Injury Prevention Strategies in Female Football Players: Addressing Sex-Specific Risks. Sports,13(2), p.39. doi:https://doi.org/10.3390/sports13020039.