Women's Sports Health
At CK Physiotherapy, we're committed to staying at the forefront of evidence-based practice. Understanding these female-specific factors isn't just academically interesting—it's essential for developing effective, personalised treatment plans that address the unique physiological needs of women in sport.
What the Latest 2025 Evidence Means for Your Training and Recovery
Female athletes face 2-8 times higher ACL injury risk than their male counterparts, with injury burden concentrated in the late luteal phase of the menstrual cycle. This updated evidence review consolidates the latest UK and international research on women's sports injuries, physiological risk factors, and evidence-based physiotherapy interventions—essential knowledge as women's professional sport enters its fastest growth period in history.
The research landscape for women's sports medicine has transformed dramatically since 2020. The establishment of the UK's first Centre of Excellence for Women in Sport at Manchester Metropolitan University in 2024, combined with landmark consensus statements from the International Olympic Committee (IOC) on injury prevention and Relative Energy Deficiency in Sport (REDs), now provides clinicians and athletes with robust, sex-specific guidance where previously only male-derived protocols existed.
UK Women's Football Injury Data Reveals ACL Crisis
The FA Injury and Illness Surveillance Study, published in the Scandinavian Journal of Medicine & Science in Sports in 2025, analysed 2,167 injuries across 93 team-seasons in the Women's Super League and Championship from 2018-2023. The findings are striking: while hamstring injuries were most frequent (11.7% of all injuries), ACL ruptures carried the greatest burden—accounting for 13.3% of all days lost with a median absence of 338 days.
Match injury incidence reached 20.5 injuries per 1,000 hours, with training injuries occurring at 2.9 per 1,000 hours. The UEFA Women's Elite Club Injury Study confirmed similar patterns, reporting that ACL injuries caused the highest burden at 38.0 days lost per 1,000 hours, with 64% occurring through non-contact mechanisms.
Key UK Women's Football Injury Statistics
- •Match injury rate: 20.5 injuries per 1,000 hours
- •ACL median absence: 338 days (nearly a full year)
- •Non-contact ACL injuries: 64% of all ACL ruptures
- •WSL ACL frequency: At least one ACL injury per week during 2024-25 season opening
Importantly, a 2024 meta-analysis from Harvard's GenderSci Lab challenged traditional explanations for the sex disparity. Published in the British Journal of Sports Medicine, it argued that social factors—including team size differences, training-to-competition ratios, and historic underinvestment—contribute significantly to the injury gap beyond purely anatomical explanations.
This holistic understanding is central to how we approach sports injury treatment at CK Physio. We consider not just the biomechanical factors but the full context of each athlete's training environment, schedule, and support systems.
Menstrual Cycle Timing Strongly Influences Injury Risk
Research tracking 26 WSL footballers across 13,390 days and 593 cycles found athletes were six times more likely to sustain injuries during the late luteal phase (the days before menstruation) compared to menstruation itself. This 2024 study in Medicine & Science in Sports & Exercise aligns with mechanistic evidence on hormone-ligament interactions.
Female ACL tissue contains receptors for oestrogen, progesterone, testosterone, and crucially relaxin—a hormone that male ligaments lack receptors for. Peak relaxin concentrations on cycle days 21-24 activate matrix metalloproteinases that degrade type I collagen while suppressing new collagen synthesis. Athletes with serum relaxin above 6.0 pg/mL face 4.4 times increased ACL tear risk, according to a 2024 review in the Iowa Orthopaedic Journal.
| Injury Factor | Key Statistic | Source |
|---|---|---|
| Late luteal phase injury risk | 6x higher | Barlow et al., MSSE 2024 |
| High relaxin ACL risk | 4.4x increase | Iowa Orthopaedic Journal 2024 |
| OCP protection (teens) | 63% risk reduction | DeFroda et al. 2019 |
| Non-contact ACL percentage | 64% | UEFA WECIS 2024 |
There is also protective evidence regarding oral contraceptives. A study of 165,748 females found OCP use was associated with 63% reduction in ACL reconstruction risk among 15-19 year olds, while Danish registry data of 13,355 women showed an 18-20% risk reduction with OCP use overall.
For athletes working with our physiotherapy team at CK Physio, we can help integrate menstrual cycle awareness into your training and recovery planning, particularly during higher-risk phases.
Pelvic Floor Dysfunction Affects Nearly Half of Female Athletes
Urinary incontinence in female athletes ranges from 10.9% in cyclists to 80% in trampolinists, with an average prevalence of approximately 45% across sports. A 2024 World Athletics U20 Championships study of 325 athletes found 53.7% of females reported pelvic floor dysfunction symptoms—yet fewer than 30% were aware of pelvic floor health and 88% had never undergone screening.
The clinical implications are significant: stress urinary incontinence affects concentration and performance, yet 87% of adolescent athletes stated they would not mention symptoms to their coach. This speaks to the critical need for normalising conversations about pelvic floor health in women's sport.
A 2024 meta-analysis in Sports Health confirmed that pelvic floor muscle training (PFMT) significantly increases maximal voluntary contraction and reduces urinary leakage, establishing PFMT as first-line treatment. Contrary to previous recommendations, a 2025 study in female rugby players found that parallel squats, planks, and quadruped positions produced the highest pelvic floor muscle activation without significant negative effects on intra-abdominal pressure, making these exercises suitable for pelvic floor dysfunction management programmes.
Did you know? At CK Physio, we understand that discussing pelvic floor concerns can feel uncomfortable. Our physiotherapists create a supportive, private environment where you can address these issues confidentially as part of your overall sports rehabilitation or prevention programme.
IOC REDs Consensus Introduces Traffic Light System
The 2023 IOC Consensus Statement on Relative Energy Deficiency in Sport (REDs) represents the most significant update since 2018, incorporating over 170 new research publications. REDs affects 15-80% of elite athletes depending on sport, with low energy availability existing on a spectrum from adaptable to problematic.
The updated framework introduces a four-colour traffic light risk stratification (green, yellow, orange, red) through the IOC REDs CAT2 clinical assessment tool. New symptoms have been added including sleep disturbances, growth impairment, and urinary incontinence. The low energy availability threshold remains at less than 30 kcal/kg fat-free mass per day.
This matters for physiotherapy practice because bone stress injuries—a common presentation we treat at our Hanwell clinic—cannot be managed adequately without addressing energy deficiency. History of bone stress injury is among the strongest predictors of future injury, according to the January 2025 BJSM International Bone Stress Injury Consensus Statement.
Neuromuscular Training Reduces ACL Injuries by Up to 67%
The evidence for injury prevention programmes has strengthened considerably. A 2024 JBJS Reviews analysis found neuromuscular training reduces overall ACL risk by 50% and non-contact ACL injuries by 67% in female athletes. The optimal protocol involves 2-3 sessions weekly of 10-15 minutes each, totalling 30-60 minutes per week, with maximum effectiveness in the 14-18 age group where programmes may prevent over 70% of knee injuries.
A 2024 network meta-analysis in the Journal of Science and Medicine in Sport ranked the Knäkontroll programme as most effective for ACL prevention in female players, with FIFA 11+, PEP, and CORE training all showing significant benefits. The FIFA 11+ specifically reduces ankle injuries by 94.6% and sprains by 93.4% after season-long implementation with high adherence.
Four Critical Components for Effective Prevention Programmes
BJSM meta-regression analysis identified these key factors:
- Younger participants — beginning before age 18
- Sufficient training duration — exceeding 20 minutes, frequency greater than twice weekly
- Exercise variety — multiple exercise variations within the programme
- Coaching feedback — consistent verbal feedback from coaches
Crucially, programmes must continue throughout the season—preseason-only implementation proves insufficient. This is why we work with athletes to build sustainable, year-round prevention strategies as part of our comprehensive treatment approach.
IOC FAIR Consensus Delivers 56 Evidence-Based Recommendations
The December 2025 IOC Consensus Statement on Female, woman and/or girl Athlete Injury pRevention (FAIR) provides the most comprehensive female-specific guidance to date, containing 56 evidence-based recommendations informed by five systematic reviews. The statement mandates neuromuscular warm-up exercises across all sports and age groups.
Key recommendations include warm-ups combining aerobic, balance, strength, and agility training performed twice weekly for at least 10 minutes, which can reduce injury rates by 60% in youth team sports. The consensus emphasises creating gender-specific supportive environments free of body shaming and applies a socio-ecological model involving athletes, coaches, support staff, and administrators.
For postpartum athletes, CSP-endorsed UK guidelines recommend return to running no sooner than 8 weeks postpartum, with an optimal window of 3-6 months depending on individual recovery. Athletes must be able to walk 30 minutes symptom-free and pass the Run Readiness Scale—which includes six tasks such as single-leg squats, step-ups, and plank holds, each for 60 seconds—before running commences.
UK Women's Sport Investment Reaches Unprecedented Levels
The UK's first Centre of Excellence for Women in Sport, launched in 2024 through partnership between Manchester Metropolitan University and UK Sports Institute, now supports 25+ women's sports with 35+ research staff. FIFA-funded research at Kingston University tracks hormone levels across menstrual cycle phases in elite and grassroots players from Chelsea and Fulham.
Government investment includes the £30 million Lionesses Future Fund, £12 million for women's rugby development, and the Women's Sport Investment Accelerator covering 20+ elite leagues across nine sports. The UK women's sport industry is expected to surpass £1 billion valuation by end of 2024, representing 300% growth since 2021. The UK will host the FIFA Women's World Cup in 2035, with 22 stadiums across 16 cities planned.
Participation has responded accordingly: WSL and Women's Championship combined attendance exceeded one million for the first time in 2023-24, while 845,000 girls now play football regularly (up from 669,000 in 2018). Women's cricket has seen nearly 6,000 teams established, double the 2021 figure.
How This Applies to Your Training and Recovery
Whether you're a competitive athlete, weekend warrior, or returning to exercise after pregnancy, this evidence has practical implications for your approach to training and injury management:
- ✓ Consider menstrual cycle tracking — Understanding your cycle phases can inform training intensity and recovery, particularly during the late luteal phase when injury risk is elevated
- ✓ Don't ignore pelvic floor symptoms — Urinary leakage during exercise is common but not normal, and effective treatment is available
- ✓ Implement structured warm-ups — FIFA 11+ or similar neuromuscular programmes significantly reduce injury risk when performed consistently
- ✓ Be patient with postnatal return to running — Allow adequate recovery time and progress through criterion-based milestones
- ✓ Consider energy availability — Persistent fatigue, stress fractures, or menstrual irregularities may indicate REDs requiring comprehensive assessment
Frequently Asked Questions
Why are women more prone to ACL injuries than men?
Female athletes face 2-8 times higher ACL injury risk due to a combination of anatomical, hormonal, and neuromuscular factors. Research shows that female ACL tissue contains receptors for relaxin, a hormone that male ligaments lack receptors for, which can affect ligament integrity during certain phases of the menstrual cycle. However, 2024 research from Harvard's GenderSci Lab also highlights that social factors—including training-to-competition ratios and historic underinvestment in women's sport—contribute significantly to the injury gap.
How does the menstrual cycle affect injury risk in female athletes?
Research tracking WSL footballers found athletes were six times more likely to sustain injuries during the late luteal phase (the days before menstruation) compared to menstruation itself. Peak relaxin concentrations on cycle days 21-24 activate enzymes that degrade collagen while suppressing new collagen synthesis. This evidence suggests menstrual cycle tracking should be integrated into training and injury prevention programmes.
What is pelvic floor dysfunction and how common is it in female athletes?
Pelvic floor dysfunction, including urinary incontinence, affects approximately 45% of female athletes on average, ranging from 10.9% in cyclists to 80% in trampolinists. Despite high prevalence, fewer than 30% of young athletes are aware of pelvic floor health. Pelvic floor muscle training is an effective first-line treatment that significantly increases muscle strength and reduces urinary leakage.
What injury prevention exercises are most effective for female athletes?
The 2025 IOC FAIR consensus statement recommends neuromuscular warm-up exercises combining aerobic, balance, strength, and agility training performed at least twice weekly for 10+ minutes. The FIFA 11+ and Knäkontroll programmes are particularly effective, showing overall ACL risk reduction of 50% and non-contact ACL injury reduction of 67%.
When can I return to running after having a baby?
According to CSP-endorsed UK guidelines, return to running should occur no sooner than 8 weeks postpartum, with an optimal window of 3-6 months depending on individual recovery. Before running, you should be able to walk 30 minutes symptom-free and pass the Run Readiness Scale. At CK Physio, we provide personalised postnatal rehabilitation assessments to guide your safe return to exercise.
The Road Ahead for Women's Sports Physiotherapy
The research gap in female sports medicine is closing rapidly. The 2023-2025 period has delivered the IOC FAIR consensus providing 56 injury prevention recommendations, robust UK-specific epidemiological data from the FA surveillance study, and mechanistic clarity on menstrual cycle influences on injury risk.
The growth trajectory of women's professional sport in the UK, combined with confirmed hosting of the 2035 FIFA Women's World Cup, signals an expanding population of athletes with sophisticated demands. At CK Physiotherapy, we're committed to meeting this need through evidence-based, personalised care that acknowledges the unique physiological considerations of female athletes.
Whether you're dealing with a current sports injury, looking to implement effective prevention strategies, or navigating return to sport after pregnancy, our team of Chartered Physiotherapists in West London is here to help you achieve your goals safely and sustainably.
Ready to Optimise Your Training and Recovery?
Our experienced physiotherapists specialise in sports injury prevention, rehabilitation, and women's health. Book your assessment today.
Book Your AppointmentReferences & Further Reading
- Crossley KM, et al. Female, woman and/or girl Athlete Injury pRevention (FAIR) practical recommendations: International Olympic Committee (IOC) consensus meeting. British Journal of Sports Medicine. 2025;59:1546-1559. View on PubMed
- Mountjoy M, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine. 2023;57(17):1073-1097. View on PubMed
- International Olympic Committee. IOC REDs CAT2 Clinical Assessment Tool. IOC Documents
- Chartered Society of Physiotherapy. Returning to Running Postnatal Guidelines. CSP Website
- FIFA Medical Network. FIFA 11+ Injury Prevention Programme. FIFA Medical
- NICE Guideline NG211. Rehabilitation after traumatic injury. NICE Guidelines
- BASEM. Health4Performance Resources. Health4Performance
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