Girls and women: prevention and training, what the science says

PHYSICAL PREPARATION Reading time : 10 min Updated October 1, 2026
Contents
Girls and women tear the knee's anterior cruciate ligament (ACL) more often, and a neuromuscular warm-up done regularly, all season, reduces that risk. For the rest (menstrual cycle, puberty, breast support, running after childbirth), here is what research establishes, what it does not, and what a club can simply do.

Fewer studies on women

Of 5,261 sport-science studies published from 2014 to 2020, only 6% were on women alone (Cowley 2021). Many recommendations therefore come from trials on men, or on mixed groups with no separate result for women. On this page, every figure says who it was measured on.

The knee and the ACL

Female athletes have about 1.7 times more ACL ruptures than male athletes across sports, and 2.2 times more in football (Montalvo 2019). Neuromuscular warm-ups reduce non-contact ACL injuries in women by 67% (Webster and Hewett 2018).

The relative risk compares the group doing the programme with the group that does not: 0.36 means about 64% fewer injuries. In brackets, the 95% confidence interval.

ProgrammeStudied inWhat the trial shows
Knäkontroll (Knee Control, Swedish Football Association), 15 min, twice a week4,564 female players aged 12 to 17ACL ruptures: 0.36 (0.15 to 0.85) (Waldén 2012)
FIFA 11+1,892 female players aged 13 to 17All injuries: 0.68; severe injuries: 0.55. The primary outcome, lower-limb injuries, was not significant: 0.71 (0.49 to 1.03) (Soligard 2008)
Knee Control, handball version627 players aged 15 to 19, 46% girlsKnee injuries: 0.69 (0.49 to 0.97), no separate result for girls (Asker 2022)

The handball result is for a mixed group: it does not say whether the effect is the same in girls and boys. It is a textbook case of the data gap described above.

Based on FIFA 11+ and FIFA 11+ Kids, developed by FIFA. Official material: FIFA injury prevention page. Paak is not affiliated with or endorsed by FIFA.
Based on Knäkontroll, developed by the Swedish Football Association (SvFF). Paak is not affiliated with or endorsed by the SvFF.

Regularity carries the effect

As with all prevention, regularity drives the result. In the Knäkontroll trial, the most compliant third of players had a relative risk of ACL rupture of 0.12 (Hägglund 2013). Among female players doing FIFA 11+, the most adherent had an injury rate ratio of 0.28 (Steffen 2013). Two sessions a week kept up from September to June beat a complete programme dropped after the holidays.

All the general rules on the Preventing injuries page apply to women's teams too. By sport: physical preparation in football, physical preparation in handball.

The menstrual cycle: what the science actually says

  • Performance: it may be very slightly lower at the very start of the cycle (early follicular phase), with a "trivial" effect (effect size −0.06) and low-quality evidence. The authors draw no general guideline and recommend a personalised approach (McNulty 2020).
  • Muscle injuries: a link with cycle phase is not shown (relative risk 1.18; 0.75 to 1.86), with very low certainty (Guthardt 2026).
  • The UEFA consensus (2025, 82 statements): the link between cycle phase and performance or injury is "inconclusive". Tracking one's cycle can help wellbeing and spot irregularities (Verhagen 2025).

For a club, this means: do not plan a team's training by cycle phase. Let each player say how she feels, and adapt case by case, as for any other discomfort.

Missed or irregular periods over several months are a reason to see a doctor. They can be a sign of relative energy deficiency in sport (REDs), which the IOC consensus describes in female and male athletes (Mountjoy 2023). The club's role is to talk about it and point to a doctor, not to diagnose.

Puberty: keeping girls in sport

In the UK, 43% of girls who saw themselves as sporty at primary school disengage from sport afterwards, against 24% of boys; 78% of teenage girls avoid sport during their period (Women in Sport 2022). A club can act with no budget:

  • Kit: offer the choice of dark shorts or leggings, especially during periods.
  • Toilets and period products: know where the toilets are at training and at away games, and keep a few period products in the team kit bag.
  • Changing rooms: make sure there is a private place to change, and breaks long enough to get there.
  • Talk about it plainly: say at the start of the season that periods are not a taboo subject, and that a player can tell the coach without having to explain.

Breast support

In a survey of 540 elite Australian female athletes, 44% reported breast pain during exercise, and this pain was reported to hurt performance (32%) (Brisbine 2020). A suitable sports bra is part of the kit, just like shoes. A club can say so in its kit list, without making it awkward.

Returning to running after childbirth

  • A pelvic-health assessment for everyone: it is the first recommended step before running again.
  • About 12 weeks: a guide for returning to running, not a fixed date. The return is gradual, according to the assessment and how it feels.

Both guides come from a professional guideline (Goom, Donnelly and Brockwell 2019), which was not published in a peer-reviewed journal. The IOC expert group published a series of papers on physical activity during pregnancy and after childbirth in athletes (Bø et al. 2016 to 2018).

Urinary leakage affects about 36% of female athletes (Teixeira 2018). A player who is affected can talk to a doctor.

In Paak

With Paak Pro, a club turns on the "Physical preparation & prevention" module for the teams it chooses. For a team the club has set as "Women" or "Mixed", the session builder then puts the knee and ACL warm-up first, marked "Recommended for this team" with the reason:

  • in football: FIFA 11+ Kids for under-9s, Knäkontroll for under-13s and under-17s, FIFA 11+ for seniors;
  • in handball: the knee prevention block, at the dose used in the Knee Control trial, from under-13s up.

Every graded prevention warm-up shows who it was studied on, for example "Studied in 4,564 female players aged 12 to 17 (Waldén 2012)". On the team page, a card shows how many sessions a week included a prevention block, against the programme's target. What counts is the team type the club chose, never data about a player. See how to turn the module on, or see Paak for a football club or a handball club.

Sources

Last updated: October 1, 2026
In Paak · Paak Pro

Tests and prevention, inside your team's sessions

Switch the module on for the teams you choose: a « Test day » session puts the tests in the published order and prints the field sheet, results are entered on a phone, and you follow each athlete against their own results. Prevention warm-ups show their evidence level and weekly dose.

An option, team by team: nothing changes for the others.

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