TY - JOUR
T1 - Modifiable risk factors for lower-extremity injury
T2 - a systematic review and meta-analysis for the Female, Woman and Girl Athlete Injury Prevention (FAIR) consensus
AU - Whittaker, Jackie L.
AU - Räisänen, Anu M.
AU - Martin, Chelsea
AU - Galarneau, Jean Michel
AU - Martin, Maitland
AU - Losciale, Justin M.
AU - Bullock, Garrett S.
AU - Dubé, Marc Olivier
AU - Bizzini, Mario
AU - Bourne, Matthew N.
AU - Dijkstra, H. Paul
AU - Girdwood, Michael
AU - Hayden, K. Alix
AU - Hägglund, Martin
AU - Mcleod, Shreya
AU - Mkumbuzi, Nonhlanhla Sharon
AU - Mosler, Andrea Britt
AU - Murphy, Myles Calder
AU - Myklebust, Grethe
AU - Moller, Merete
AU - Ocarino, Juliana Melo
AU - Owoeye, Oluwatoyosi B.A.
AU - Palmer, Debbie
AU - Pasanen, Kati
AU - Rio, Ebonie Kendra
AU - Thorborg, Kristian
AU - Van Middelkoop, Marienke
AU - Verhagen, Evert
AU - Warden, Stuart J.
AU - Whalan, Matthew
AU - Crossley, Kay M.
AU - Emery, Carolyn A.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.
PY - 2025
Y1 - 2025
N2 - Objective: Examine potentially modifiable risk factors (MRFs) for female/woman/girl athletes' lower-extremity injuries. Design: Systematic review with meta- or semiquantitative analyses and Grading of Recommendations, Assessment, Development and Evaluation. Data sources: MEDLINE, CINAHL, APA PsycINFO, Cochrane Systematic Review Database, CENTRAL, SPORTDiscus, EMBASE, ERIC searched 30 October or 23 November 2023. Eligibility: Primary data studies with comparison group(s) assessing the association of MRFs for sport-related lower-extremity injury(s) with ≥1 female/woman/girl per study group. Results: Across 195 studies (n=115; 58.9% female/woman/girl-specific estimates) including 1 525 662 participants (2.4% females/women/girls), eight injury outcomes were assessed (n=75 general lower-extremity, n=3 groin, n=6 hip, n=17 thigh, n=88 knee, n=17 lower-leg, n=27 ankle, n=9 foot). Sixty-six MRF categories were identified. Substantial heterogeneity in MRFs and injury outcomes exists, with high risk of bias present in 37.4% of studies. Considering female/woman/girl specific estimates, we performed meta-analyses for 10 MRFs (body mass, x (BMI), weekly training distance, muscle strength, artificial turf, off-season plyometric training, readiness to return-to-sport, single-leg hop asymmetry, vertical drop jump peak knee flexion angle and ground reaction force) and semiquantitative analyses for 26 MRFs for a variety of injuries. Meta-analyses suggest no association between any lower-extremity strength outcome (g=0.01, 95% CI -0.11 to 0.14; I2=37.3%; very low certainty evidence) or artificial turf (Incidence Rate Ratio=0.97, 95% CI 0.88 to 1.07; I2=2.4%; low certainty evidence) and various lower-extremity injuries. Higher body mass (g=0.19, 95% CI 0.00 to 0.38; I2=71.7%) and/or BMI (g=0.22, 95% CI 0.09 to 0.36; I2=37.0%) are associated with several lower-extremity injuries (very low certainty evidence). Conclusion: This review synthesises a large body of exploratory research, exposes important knowledge gaps and provides a foundation for understanding MRFs for female/woman/girl athlete lower-extremity injuries.
AB - Objective: Examine potentially modifiable risk factors (MRFs) for female/woman/girl athletes' lower-extremity injuries. Design: Systematic review with meta- or semiquantitative analyses and Grading of Recommendations, Assessment, Development and Evaluation. Data sources: MEDLINE, CINAHL, APA PsycINFO, Cochrane Systematic Review Database, CENTRAL, SPORTDiscus, EMBASE, ERIC searched 30 October or 23 November 2023. Eligibility: Primary data studies with comparison group(s) assessing the association of MRFs for sport-related lower-extremity injury(s) with ≥1 female/woman/girl per study group. Results: Across 195 studies (n=115; 58.9% female/woman/girl-specific estimates) including 1 525 662 participants (2.4% females/women/girls), eight injury outcomes were assessed (n=75 general lower-extremity, n=3 groin, n=6 hip, n=17 thigh, n=88 knee, n=17 lower-leg, n=27 ankle, n=9 foot). Sixty-six MRF categories were identified. Substantial heterogeneity in MRFs and injury outcomes exists, with high risk of bias present in 37.4% of studies. Considering female/woman/girl specific estimates, we performed meta-analyses for 10 MRFs (body mass, x (BMI), weekly training distance, muscle strength, artificial turf, off-season plyometric training, readiness to return-to-sport, single-leg hop asymmetry, vertical drop jump peak knee flexion angle and ground reaction force) and semiquantitative analyses for 26 MRFs for a variety of injuries. Meta-analyses suggest no association between any lower-extremity strength outcome (g=0.01, 95% CI -0.11 to 0.14; I2=37.3%; very low certainty evidence) or artificial turf (Incidence Rate Ratio=0.97, 95% CI 0.88 to 1.07; I2=2.4%; low certainty evidence) and various lower-extremity injuries. Higher body mass (g=0.19, 95% CI 0.00 to 0.38; I2=71.7%) and/or BMI (g=0.22, 95% CI 0.09 to 0.36; I2=37.0%) are associated with several lower-extremity injuries (very low certainty evidence). Conclusion: This review synthesises a large body of exploratory research, exposes important knowledge gaps and provides a foundation for understanding MRFs for female/woman/girl athlete lower-extremity injuries.
KW - Achilles
KW - Ankle
KW - Foot
KW - Groin
KW - Hip
U2 - 10.1136/bjsports-2025-109902
DO - 10.1136/bjsports-2025-109902
M3 - Review
C2 - 40908104
AN - SCOPUS:105015054228
SN - 0306-3674
JO - British Journal of Sports Medicine
JF - British Journal of Sports Medicine
ER -