Identification of risk factors for lower limb injuries in female athletes

  • Sania Almousa

    Student thesis: Doctoral Thesis


    Sports-related injuries are commonly seen in the lower extremities and sometimes may affect an athlete's career in sports. Evidence suggests that the prevalence of certain injuries can be linked to sex. Specifically, female athletes have more acute ligament injuries, such as ACL injuries, while male athletes are more prone to muscle strain injuries. An improved understanding of sport-related injuries through identification of risk factors for lower limb injuries in female athletes could help advance the development of prevention strategies.

    The aim of study 1 of this thesis was to systematically review studies investigating the risk factors associated with ACL injuries in female athletes. Electronic databases MEDLINE, EMBASE, CINAHL, and Cochrane Library were systematically searched to identify eligible studies. Findings suggest that small intercondylar notch width, and prior history of ACL injury feature as the main risk factors associated with ACL injury in female athletes. Limited and conflicted evidence was found for: knee hyperextension; family history; Body Mass Index; playing surface; tibial slope; muscular strength, flexibility and coordination; psychological factors; and sex hormones.

    Chapter 2, novel normative data for female athletes obtained from field-based testing is presented. The measures include: eccentric knee flexor and isometric hip adduction and abduction muscle strength. In addition, the relationship between muscle strength measurements and anthropometrical data is also presented.

    Chapter 3 investigated risk factors for lower limb injuries, evaluating muscle strength, life events, family history, menstrual cycle and oral contraception in female athletes. For this purpose, one hundred and thirty-five female athletes age 14-31 years completed a battery of pre-season questionnaires and assessments. The pre-season data were analysed and then all athletes were followed for prospective injury. Findings indicate athletes who reported a high number of negative life events of the last 12 months, and displayed weak hip adductor strength, and between-limb adductor, and abductor strength imbalances at pre-season were associated with subsequent lower limb injury during the season.

    Finally, in chapter 4, the effect of menstrual cycle phases on distress and muscle strength is presented in female soccer players. Specifically, menstrual distress and hip adductor strength were found to peak during the follicular phase.

    Overall, it is anticipated that the findings by highlight potential avenues of research and development of more effective injury risk management practices while also taking into account the psychological risk factors in female athletes.
    Date of Award2022
    Original languageEnglish
    SupervisorMorgan Williams (Supervisor) & Richard Mullen (Supervisor)

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