Rapidly increasing sport participation among female, woman, and girl athletes is mirrored by concerning increases in injury burden. Evidence-based injury prevention interventions can reduce injury (1-4), but getting these into routine practice remains challenging. A recent scoping review (5) examined how well injury prevention interventions are used in female/woman/girls’ sport, and which dissemination and implementation (D&I) strategies best support their uptake and sustainment. The review informed part of the International Olympic Committee Female woman and girl Athlete Injury pRrevention (FAIR) Consensus (6). 

Why is this study important?

Despite strong evidence supporting various injury prevention interventions, many fail to translate into everyday practice. This is especially relevant for female/woman/girl athletes who often experience higher injury rates (7) and worse outcomes8, and participate in different sporting environments than male/men/boy athletes. Exercise-based interventions, for example, can reduce lower extremity injuries by 20–60% (2) and shoulder injuries by up to 50% (4), but coaches, athletes, and sport organisations still struggle to embed them consistently. Understanding how prevention strategies are used and what influences their adoption is critical for building safer sport systems. This scoping review helps identify what’s working, what isn’t, and where future focus is needed.

What did we do?

We searched nine major databases for studies reporting D&I outcomes for injury prevention interventions, such as attitudes, awareness, or adoption and sustainment. When available, factors that facilitated or hindered D&I were extracted, including intervention characteristics, competition level, coach or athlete attitudes, experience, and sex/gender. The review also catalogued D&I strategies used in experimental studies, such as who delivered interventions, when, and in what format.

What did we find?

Across 220 papers spanning 81 sports, more than 419,000 participants were included: 96,790 athletes (49% female/woman/girl), 277,923 coaches (59% working with female/woman/girl athletes), and 44,481 other (e.g. health professionals). Interventions were training/exercise programs (n=113), protective equipment (n=41), policies/rules (n=5), and multimodal approaches (n=61). Most research was conducted in Europe, Oceania, and North America, leaving substantial gaps in Asia, Africa, and South America — regions that may have unique sporting environments and implementation constraints (9). 

Moderate–high levels of adoption (60–80%) were reported across many studies, although far fewer examined how well interventions were delivered (e.g., correct dosage, frequency, or technique) or sustained over time. Protective equipment was adopted more consistently than training/exercise interventions. Common barriers to implementing exercise-based interventions included time pressures, poor suitability for specific sports or younger athletes, and low coach confidence. Conversely, positive attitudes, greater confidence, previous injury experience, and higher playing levels were associated with better uptake. Importantly, parents, health professionals, and sport administrators — all key influencers of athlete behaviour — remain understudied. The most common D&I strategy was pre-season education, often through online modules or in-person workshops delivered by researchers or health professionals. 

What are the key takeaways?

1. Implementation matters. Prevention interventions are effective, but improved implementation is essential to better protect female/woman/girl athletes.
2. Adoption is high, but fidelity/adaptation and sustainment is patchy. Many interventions are adopted initially, but few studies examined how well they were implemented (e.g. with the right frequency, duration) and sustained.
3. Identified barriers and facilitators provide cues to optimise future implementation efforts. Time constraints, poor fit with sport demands, and low coach confidence hinder implementation, while positive attitudes, experience, and confidence support it.
4. Effective D&I strategies exist and must be context-specific. Education and practical workshops can support adoption, but interventions and implementation strategies must be adaptable, engaging, sport-specific, and backed by organisational policy. In-season supervision may improve implementation, but more rigorous trials are needed.
5. Everyone has a role. Parents, teachers, health professionals, and administrators strongly influence implementation and must be included in future research and strategy development.

References

1. Shill IJ, Shepherd HA, Eliason PH, et al. Prevention strategies and modifiable risk factors for concussion: a systematic review and meta-analysis for the Female, woman and girl Athlete Injury pRevention (FAIR) consensus. Br J Sports Med 2025 Published Online First: 2025/09/20. doi: 10.1136/bjsports-2025-109915 doi: 10.1136/bjsports-2025-109915 [published Online First: 2025/09/20]
2. Bullock GS, Raisanen AM, Martin C, et al. Prevention strategies for lower extremity injury: a systematic review and meta-analyses for the Female, Woman and Girl Athlete Injury Prevention (FAIR) Consensus. Br J Sports Med 2025 Published Online First: 2025/07/12. doi: 10.1136/bjsports-2025-109910 doi: 10.1136/bjsports-2025-109910 [published Online First: 2025/07/12]
3. Whittaker JL, Schulz JM, Galarneau JM, et al. Prevention strategies and modifiable risk factors for spine, chest, abdominal and/or pelvic injury and pain: a systematic review and meta-analysis for the Female, woman and girl Athlete Injury pRevention (FAIR) consensus. Br J Sports Med 2025 Published Online First: 2025/09/02. doi: 10.1136/bjsports-2025-109900 doi: 10.1136/bjsports-2025-109900 [published Online First: 2025/09/02]
4. Heming EE, Gibson ES, Friesen KB, et al. Prevention strategies and modifiable risk factors for upper extremity injury: a systematic review and meta-analysis for the female, woman and girl Athlete Injury pRevention (FAIR) consensus. Br J Sports Med 2025 Published Online First: 2025/10/25. doi: 10.1136/bjsports-2025-109907 doi: 10.1136/bjsports-2025-109907 [published Online First: 2025/10/25]
5. Patterson BE, McKay CD, Critchley ML, et al. Dissemination and implementation of injury prevention interventions: a scoping review for the Female, woman and girl Athlete Injury pRevention (FAIR) consensus. British Journal of Sports Medicine 2025  doi: 10.1136/bjsports-2025-109904:bjsports-2025-109904. doi: 10.1136/bjsports-2025-109904
6. Crossley KM, Whittaker JL, Patterson B, et al. Female, woman and/or girl Athlete Injury pRevention (FAIR) practical recommendations: International Olympic Committee (IOC) consensus meeting held in Lausanne, Switzerland, 2025. British Journal of Sports Medicine 2025;59(22):1546. doi: 10.1136/bjsports-2025-110889
7. Hardaker NJ, Hume PA, Sims ST. Differences in Injury Profiles Between Female and Male Athletes Across the Participant Classification Framework: A Systematic Review and Meta-Analysis. Sports Medicine 2024;54(6):1595-665. doi: 10.1007/s40279-024-02010-7
8. Bruder AM, Culvenor AG, King MG, et al. Let’s talk about sex (and gender) after ACL injury: a systematic review and meta-analysis of self-reported activity and knee-related outcomes. Br J Sports Med 2023;57(10):602-10. doi: 10.1136/bjsports-2022-106099 [published Online First: 2023/03/09]
9. Patterson BE, Adom-Aboagye NAA, Constantini N, et al. Advancing global equity, diversity and inclusion in sport and exercise medicine consensus and research: deliberate, thoughtful steps from the FAIR consensus. British Journal of Sports Medicine 2025  doi: 10.1136/bjsports-2025-111063:bjsports-2025-111063. doi: 10.1136/bjsports-2025-111063

Authors:

Brooke Patterson [1]

Kay Crossley [1] 

Libby Gracias [1]

Olu Owoeye [2]

Carly McKay [3]

Affiliations:

1. La Trobe Sport and Exercise Medicine Research Centre, Australian IOC Research Centre, La Trobe University, Melbourne, Australia 

2. Translational Injury Prevention Lab, Department of Physical Therapy and Athletic Training, Saint Louis University, Saint Louis, Missouri, USA

3. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada