Effectiveness of injury prevention programmes in female team sports: a systematic review and meta-analysis of hierarchical injury outcomes, training dose-response relationships, and adherence.

OBJECTIVE

To quantify the effectiveness of exercise-based injury prevention programmes (IPPs) in female team sports across overall, lower-limb, and site-specific injury outcomes, and to examine training dose and adherence as potential effect modifiers.

METHODS

Randomised controlled trials evaluating exercise-based IPPs in female team-sport athletes were synthesised. Risk ratios (RRs) were pooled using random-effects models. Subgroup analyses examined training frequency, session duration, weekly training dose, and adherence, while meta-regression was used to examine study-level associations with training dose and adherence.

RESULTS

Thirteen unique trials involving 13,675 athletes were included. IPPs reduced overall injury risk by 35% (RR = 0.65, 95% CI: 0.53-0.79), with a similar reduction in lower-limb injuries (RR = 0.67, 95% CI: 0.53-0.86). Significant reductions were also observed for anterior cruciate ligament injuries (RR = 0.62, 95% CI: 0.43-0.89) and ankle injuries (RR = 0.59, 95% CI: 0.42-0.84). Exploratory subgroup analyses suggested larger effects at 4-5 sessions/week (RR = 0.47) and 21-30 min/session (RR = 0.42). Programmes providing 51-120 min/week were associated with greater risk reduction than those providing 1-50 min/week (RR = 0.48 vs. 0.80). Trials with adherence ≥75% showed a clear protective effect (RR = 0.55), whereas those with lower adherence showed little evidence of benefit (RR = 0.93). The certainty of evidence for the primary overall-injury outcome was low.

CONCLUSION

Exercise-based neuromuscular IPPs appear to reduce overall and lower-limb injury risk in female team sports, with protective effects observed for ACL and ankle injuries and the most consistent estimate for ACL injury. Greater weekly exposure was associated with larger risk reductions at the study level, whereas the continuous adherence meta-regression was not significant. These patterns should be interpreted as exploratory implementation signals rather than definitive thresholds.

SYSTEMATIC REVIEW REGISTRATION: The systematic review was prospectively registered in PROSPERO (CRD420251236606). URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251236606.