For female/woman/girl athletes social, cultural and environment factors, alongside biological factors, may shape how injuries happen. This blog summarises a recent study that asked experts what could influence injury risk [1]. The study informed part of the  International Olympic Committee Female, woman, and girl Athlete Injury pRrevention (FAIR) Consensus recommendationsm [2] on changes that could reduce injury risk and create safer, more equitable sporting environments. 

Why is this study important?

Female/woman/girl athletes are playing more sport than ever before, but with rising injury rates. We don’t fully understand why injuries are happening, because most studies don’t include enough female/woman/girl athletes or adequately report sex and gender differences [3]. There are also too few studies that include the expert voices of those within the female/woman/girl sporting environment, such as athletes, coaches, support staff, practitioners, administrators and researchers [4]. 

Injury risk is complex and can be shaped by biology (e.g. hormones and anatomy) and gendered factors (like social expectations, access to good coaching, and the quality of training environments). These factors interact in real life, but research has rarely explored them together. This study is important because it aimed to bring together the expert voices of those actively involved in female/woman/girl sport and to explore the key sex-and gender-related factors that they believe affect injury risk. By understanding these factors, we can design injury prevention interventions and implementation strategies that are relevant, fairer, and more effective for female/woman/girl athletes. 

How did the study go about this?

This study used a mixed-methods concept-mapping approach — a structured process combining participants ideas and perspectives with sorting and rating activities, to visually organise and prioritise concepts related to female/woman/girl injury risk. A panel of 66 experts – including athletes, coaches, carers, clinicians, sports-science and high-performance professionals, administrators and researchers – were asked to respond to the prompt: ‘What gender- and/or sex-specific factors do you think contribute to injury risk among female, woman and girl athletes?’.

What did the study find?

Participants were mostly cisgender females (85%) and white (74%), from six continents, with 23% from low- or middle-income countries. 8% identified as living with a disability. 

Participants brainstormed, sorted and rated 101 statements about gender- and sex-specific factors contributing to injury risk. The ideas were grouped into 10 clusters spanning biological, social and organisational themes including: 

1. Lack of organisational funding and support 
2. Limited resources for athletes 
3. Insufficient knowledge and expertise among support staff
4. Poor implementation or evidence for sex/gender appropriate injury prevention
5. Biological/sex-related factors (e.g. anatomy, hormones) 
6. Gendered health issues 
7. Pressure to meet athletic ideals shaped by gender norms 
8. Exposure to harassment, bias, or unequal treatment 
9. Sports environments structured in ways that disadvantage women and girls 
10. Gendered communication around injury and health 

‘Insufficient knowledge among support staff’ was seen as the most important and modifiable cluster. 

Take home messages

Preventing injuries in female/woman/girl athletes requires a major shift in focus — it is not enough to look at biological factors alone. This study highlights that female/woman/girl athlete injury risk is also shaped by social, cultural, and structural factors. Reducing injury risk for female/woman/girl athletes requires a collaborative and multi-level approach involving the prioritisation of research, leadership, funding and policy from sporting organisations across all sport levels including: 

• Targeted research on factors such as equitable access to athlete, coach and clinician education and resources 
• Specific implementation strategies designed to address the gendered sports environment
• Consideration and targeted research of gendered barriers to injury prevention 
• Equitable funding and access to resources for athletes, coaches and support staff
• Eliminating gendered harassment and interpersonal violence 

Authors:

Melissa Haberfield (1, 2)

Brooke Patterson (1, 2)

Libby Gracias (1, 2)

Kay Crossley (1, 2)

Affiliations: 

1. La Trobe University Sports and Exercise Medicine Research Centre
2. Australian IOC Research Centre

References

1. Crossley, K.M., et al., Gender- and/or sex-specific considerations for sport-related injury: a concept mapping approach for the Female, woman and/or girl Athlete Injury pRevention (FAIR) consensus. British Journal of Sports Medicine, 2025: p. bjsports-2025-109946.
2. Crossley, K.M., 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): p. 1546.
3. Cowan, S.M., et al., Sport and exercise medicine/physiotherapy publishing has a gender/sex equity problem: we need action now! British Journal of Sports Medicine, 2023.
4. Haberfield, M.J., et al., What Do Women (With Serious Knee Injury) Want to Know about Knee Health? Identifying Research Priorities With a Consumer Advisory Group. J Orthop Sports Phys Ther, 2025. 55(2): p. 1-33.