Making football safer for women: a systematic review and meta-analysis of injury prevention programmes in 11 773 female football (soccer) players

Abstract

Objective: To evaluate the effects of injury prevention programmes on injury incidence in any women's football code; explore relationships between training components and injury risk; and report injury incidence for women's football.

Design: Systematic review and meta-analysis.

Data sources: Nine databases searched in August 2019.

Eligibility criteria: Randomised controlled trials evaluating any injury prevention programme (eg, exercise, education, braces) were included. Study inclusion criteria were: ≥20 female football players in each study arm (any age, football code or participation level) and injury incidence reporting.

Results: Twelve studies, all in soccer, met inclusion criteria, with nine involving adolescent teams (aged <18 years). All studies (except one) had a high risk of bias. Eleven studies examined exercise-based programmes, with most (9/11) including multiple (≥2) training components (eg, strength, plyometric, balance exercises). Multicomponent exercise programmes reduced overall (any reported) injuries (incidence rate ratio (IRR) 0.73, 95% CI 0.59 to 0.91) and ACL injuries (IRR 0.55, 95% CI 0.32 to 0.92). For exercise-based strategies (single-component and multicomponent), hamstring injuries were also reduced (IRR 0.40, 95% CI 0.17 to 0.95). While exercise-based strategies resulted in less knee, ankle and hip/groin injuries, and the use of multiple training components was associated with greater reductions in overall and knee injuries, further studies would be required to increase the precision of these results. The incidence of overall injuries in women's football was 3.4 per 1000 exposure hours; with ankle injuries most common.

Conclusion: In women's football, there is low-level evidence that multicomponent, exercise-based programmes reduce overall and ACL injuries by 27% and 45%, respectively.

Prospero registration number: CRD42018093527.

Keywords: anterior cruciate ligament; injury prevention; injury risk reduction; sporting injuries; women in sport.

Figure 1

Flow chart of study selection.

Figure 2

Meta-analysis examining the effectiveness of reducing overall injury for the exercise-based intervention groups compared with control groups. Note: the size of the boxes around each diamond are proportional to the weight of each study, and the horizontal lines represent the 95% CI. The open diamond represents the pooled overall injury incidence rate ratio (IRR) and its width represents its 95% CI. The studies by Espinosa et al and Söderman et al were separated due to only including one exercise-based training component. Studies by Gilchrist et al and Waldén et al only reported knee injuries, and thus the values for overall injuries are taken from knee injuries.

Figure 3

Meta-analysis examining the effectiveness of reducing ACL, knee, ankle, hip/groin and hamstring injuries for the exercise-based intervention groups compared with control groups. Note: the size of the boxes around each diamond are proportional to the weight of each study, and the horizontal lines represent the 95% CI. The open diamond represents the pooled overall injury incidence rate ratio (IRR) and its width represents its 95% CI. For ACL injuries, the studies by Barber Foss et al and Rössler et al were unable to be included in the meta-analysis as both the intervention and control groups reported no ACL injuries. For all meta-analyses, studies reporting no injuries in one group (either intervention or control) had a fixed correction applied to both groups of 0.5 as suggested by the Cochrane Handbook for Systematic Reviews of Interventions.