Review of Musculoskeletal Injury Prevention in Female Soccer Athletes
Purpose of Review
This paper aims to review the recent literature regarding the prevention of musculoskeletal injuries in female soccer athletes.
Female soccer players are at risk for many musculoskeletal injuries, mostly involving the lower extremities, due to anatomic, hormonal, and biomechanical factors. Various programs are available that target overall injury prevention, as well as specifically the prevention of anterior cruciate ligament (ACL), ankle, and overuse injuries. The Fédération Internationale de Football Association (FIFA) 11+ is the most well-studied program for overall injury prevention and has been shown to have modest but significant effects in injury incidence. Prevention of ACL injuries is also well studied, and multiple programs have been shown to significantly reduce incidence, especially in youth athletes. Fewer current studies are available regarding ankle and overuse injuries.
Musculoskeletal injury prevention programs are available for female soccer players and may be effective in decreasing the incidence of certain injuries. There are clear differences in injury patterns in females compared to males, and further research is needed to specifically look at injury prevention in this population.
KeywordsSoccer Injury prevention Female athletes Anterior cruciate ligament Overuse injuries Ankle injuries
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Donaldson A, Callaghan A, Bizzini M, Jowett A, Keyzer P, Nicholson M. A concept mapping approach to identifying the barriers to implementing an evidence-based sports injury prevention programme. Inj Prev 2018 Jan 20;injuryprev-2017-042639.Google Scholar
- 3.Mufty S, Bollars P, Vanlommel L, Van Crombrugge K, Corten K, Bellemans J. Injuries in male versus female soccer players: epidemiology of a nationwide study. Acta Orthop Belg. 2015;81(2):289–95.Google Scholar
- 4.Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lázaro-Haro C, et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc. 2009;17(7):705–29.Google Scholar
- 6.Roos KG, Wasserman EB, Dalton SL, Gray A, Djoko A, Dompier TP, et al. Epidemiology of 3825 injuries sustained in six seasons of National Collegiate Athletic Association men’s and women’s soccer (2009/2010-2014/2015). Br J Sports Med. 2017;51(13):1029–34.Google Scholar
- 8.Dick R, Putukian M, Agel J, Evans TA, Marshall SW. Descriptive epidemiology of collegiate women’s soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 through 2002–2003. J Athl Train. 2007;42(2):278–85.Google Scholar
- 10.Yoo JH, Lim BO, Ha M, Lee SW, Oh SJ, Lee YS, et al. A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes. Knee Surg Sports Traumatol Arthrosc. 2010;18(6):824–30.Google Scholar
- 18.• O’Kane JW, Neradilek M, Polissar N, Sabado L, Tencer A, Schiff MA. Risk factors for lower extremity overuse injuries in female youth soccer players. Orthop J Sports Med [Internet]. 2017 Oct 23 [cited 2019 Jan 13];5(10). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656111/. This case control study of 351 female youth soccer players found that overuse injuries were associated with lower knee separation distance, decreased lower extremity strength, and playing on more than 1 soccer team.
- 20.Brenner JS, And the Council on sports Medicine and Fitness. Overuse injuries, overtraining, and burnout in child and adolescent athletes. PEDIATRICS 2007;119(6):1242–1245.Google Scholar
- 22.Jacobson I, Tegner Y. Injuries among Swedish female elite football players: a prospective population study. Scand J Med Sci Sports. 2007;17(1):84–91.Google Scholar
- 24.Hoang QB, Mortazavi M. Pediatric overuse injuries in sports. Adv Pediatr Infect Dis. 2012;59(1):359–83.Google Scholar
- 26.Chorba RS, Chorba DJ, Bouillon LE, Overmyer CA, Landis JA. Use of a functional movement screening tool to determine injury risk in female collegiate athletes. North Am J Sports Phys Ther NAJSPT. 2010;5(2):47–54.Google Scholar
- 27.Garrison M, Westrick R, Johnson MR, Benenson J. Association between the functional movement screen and injury development in college athletes. Int J Sports Phys Ther. 2015;10(1):21–8.Google Scholar
- 28.McCall A, Carling C, Davison M, Nedelec M, Le Gall F, Berthoin S, et al. Injury risk factors, screening tests and preventative strategies: a systematic review of the evidence that underpins the perceptions and practices of 44 football (soccer) teams from various premier leagues. Br J Sports Med. 2015;49(9):583–9.CrossRefGoogle Scholar
- 30.• Al Attar WSA, Soomro N, Pappas E, Sinclair PJ, Sanders RH. How effective are F-MARC injury prevention programs for soccer players? A systematic review and meta-analysis. Sports Med. 2016;46(2):205–17. Systematic review and meta-analysis of 9 studies found that FIFA injury prevention programs, particularly the FIFA 11+, had a statistically significant reduction in overall injury risk among soccer players.CrossRefGoogle Scholar
- 31.Soligard T, Myklebust G, Steffen K, Holme I, Silvers H, Bizzini M, et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ. 2008;337(dec09 2:a2469–9.Google Scholar
- 32.• Steffen K, Emery CA, Romiti M, Kang J, Bizzini M, Dvorak J, et al. High adherence to a neuromuscular injury prevention programme (FIFA 11+) improves functional balance and reduces injury risk in Canadian youth female football players: a cluster randomised trial. Br J Sports Med. 2013;47(12):794–802. FIFA 11+ was introduced in 31 youth teams in Canadian female soccer league. Results indicated that high player adherence resulted in significant improvements in functional balance and reduced injury risk.Google Scholar
- 36.Sadigursky D, Braid JA, De Lira DNL, Machado BAB, Carneiro RJF, Colavolpe PO. The FIFA 11+ injury prevention program for soccer players: a systematic review. BMC Sports Sci Med Rehabil [Internet]. 2017 Nov 28 [cited 2019 Jan 13];9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704377/Google Scholar
- 37.Thorborg K, Krommes KK, Esteve E, Clausen MB, Bartels EM, Rathleff MS. Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. Br J Sports Med. 2017;51(7):562–71.CrossRefGoogle Scholar
- 39.Steffen K, Meeuwisse WH, Romiti M, Kang J, McKay C, Bizzini M, et al. Evaluation of how different implementation strategies of an injury prevention programme (FIFA 11+) impact team adherence and injury risk in Canadian female youth football players: a cluster-randomised trial. Br J Sports Med. 2013;47(8):480–7.Google Scholar
- 47.• Walden M, Atroshi I, Magnusson H, Wagner P, Hagglund M. Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial. BMJ 2012;344(may03 1):e3042–e3042. 230 Swedish adolescent female soccer teams were followed over 1 season during which a 15-minute neuromuscular warm up program was implemented. The rate of ACL injuries was significantly reduced from this program. Google Scholar
- 48.van Beijsterveldt AM, van de Port IG, Krist MR, Schmikli SL, Stubbe JH, Frederiks JE, et al. Effectiveness of an injury prevention programme for adult male amateur soccer players: a cluster-randomised controlled trial. Br J Sports Med. 2012;46(16):1114–8.Google Scholar
- 49.Rodríguez C, Echegoyen S, Aoyama T. The effects of “prevent injury and enhance performance program” in a female soccer team. J Sports Med Phys Fitness. 2018;58(5):659–63.Google Scholar
- 50.• Åman M, Larsén K, Forssblad M, Näsmark A, Waldén M, Hägglund M. A Nationwide follow-up survey on the effectiveness of an implemented neuromuscular training program to reduce acute knee injuries in soccer players. Orthop J Sports Med [Internet]. 2018 Dec 21 [cited 2019 Jan 27];6(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304704/. Follow up survey looking at the implementation of a neuromuscular training program in Swedish male and female soccer players. In female soccer players, the incidence of cruciate ligament injuries decreased from 4.9 to 3.9 per 1000 player-years.
- 51.Mandelbaum BR, Silvers HJ, Watanabe DS, Knarr JF, Thomas SD, Griffin LY, et al. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. Am J Sports Med. 2005;33(7):1003–10.Google Scholar
- 52.Gilchrist J, Mandelbaum BR, Melancon H, Ryan GW, Silvers HJ, Griffin LY, et al. A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. Am J Sports Med. 2008;36(8):1476–83.Google Scholar
- 55.• Petushek EJ, Sugimoto D, Stoolmiller M, Smith G, Myer GD. Evidence-based best-practice guidelines for preventing anterior cruciate ligament injuries in young female athletes: a systematic review and meta-analysis. Am J Sports Med 2018 12;036354651878246. Meta-analysis of 18 studies looking at ACL injury risk reduction in female athletes. Based on these data, ACL programs should target younger athletes and use trained implementers who incorporate lower body strength exercises (ie, Nordic hamstrings, lunges, and calf raises) and focus specifically on landing stabilization exercises. Google Scholar
- 57.Zebis MK, Andersen LL, Brandt M, Myklebust G, Bencke J, Lauridsen HB, et al. Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes: a randomised controlled trial. Br J Sports Med Lond. 2016;50(9):552–7.Google Scholar
- 64.• Grimm NL, Jacobs JC, Kim J, Amendola A, Shea KG. Ankle injury prevention programs for soccer athletes are protective: a level-i meta-analysis. J Bone Jt Surg. 2016;98(17):1436–43. Meta-analysis of 10 studies looking at male and female soccer players found that ankle injury prevention programs reduce the risk of ankle injury in the intervention group ( p < 0.002). No sex differences were analyzed in this study. CrossRefGoogle Scholar
- 69.Thijs K, Huisstede B, Goedhart E, Backx F. The preventive effect of a soccer-specific ankle brace on acute lateral ankle sprains in girls amateur soccer players: study protocol of a cluster-randomised controlled trial. Inj Prev 2017 Jul 27;injuryprev-2017-042465.Google Scholar
- 75.Brenner JS. COUNCIL ON SPORTS MEDICINE AND FITNESS. Sports specialization and intensive training in young athletes. Pediatrics. 2016;138(3):e20162148–8.Google Scholar