INJURY

PREVENTION

OVERVIEW

Injuries hurt. Recurrent injuries can keep hurting for a long time. Dealing with nagging issues can cause long-term repercussions ranging from chronic pain, physical limitations, financial drain, and decline in mental health (1).

One of the biggest risk factors for pretty much any major injury is hurting that area a first time (1,2,3). Previous injuries can cause permanent changes to those hurt areas and can indicate underlying issues that need to be addressed.

Other issues that could increase future injuries include skipping rehab, getting back in the game too soon, not fixing techniques, or working to fix the wrong diagnosis.

Because of this, there has been plenty of research into injury prevention. While most of the studies done on this topic involve teens or young adults, it doesn’t mean it can’t be applied to you at any age!

Ultimately, to do everything you can to prevent injuries you need to take a full-body approach, integrating how you move (biomechanics), what you eat (nutrition), who you talk to (your healthcare team), and how you think (mental health).

Even if you think everything is working smoothly, it might be a good idea to undergo a Functional Movement Screen (FMS). This simple and fast screening test can help identify movement imbalances, weaknesses, and has been shown to correlate with injury risk (4,5). If you can find your weakness now before they hurt, you can save yourself a lot of pain later. 

Here, you will find information on major joints and areas that are known to be at risk or cause problems. We did not create any of the programs posted here but the links and PDFs are great resources for you to pick and choose the program that fits you.

PREHAB: HEAD & NECK

HOW & WHY
Females have a higher risk of concussions. In addition, younger, female concussed athletes take longer to recover (3). Not to mention the effect a head injury would have on the rest of your life, so it’s important to do what you can to prevent head injuries. Some of your risk will be based on things you can’t control like your sport and blind luck, but strengthing can be helpful. Neck exercises can increase neck muscle strength, which may decrease both concussion and neck injury risk (3,6). The evidence for this helping in adults is decently established and there may be an increase in head and neck injury as athletes become tired (3). 

The basic principles of this are:

  • Training program for 8 weeks or more is needed

  • Isometric may be enough, but adding dynamic is also helpful. 

  • Compliance is key
     

PREHAB LINKS
Troubleshoot Aging doesn’t promote one program over the other. Find one that works for you!

BokSmart Safe Six (PDF)

World Rugby Video Progression (Note: There are 3 levels to progress through)


SHOUT OUT TO TACKLES
In rugby union, tackles cause the most head injuries, with the tackler being more likely to get hurt. Front-on, active shoulder tackles with changes in acceleration (by either tackler or ball carrier) are more likely to cause injury. Head-on-head, head-on-elbow, higher number of tacklers in one tackle, and upright body position will also increase risk of head injury (7). 

To help prevent these injuries, get the technique right! Bend at the waist and get low. Don’t wait for the ball carrier to come to you, meet them at speed.

PREHAB: THE SHOULDER

HOW & WHY
Much of the studies regarding shoulder injury prevention focus on overhead athletes (sports that bring your arm above your head). These sports can cause injuries in 18–61% of participating athletes (8). However, other sports can cause injuries, particularly contact sports. 

Expert consensus states that risk factors for injury include decreased ROM, strength imbalances, weakness, changes in load/force on the shoulder and even different positions within a sport (9).

The evidence that is available regarding prevention of injury has mixed results with unclear benefit (10). However, the missing piece may be in compliance. The positive effects are seen in groups that stick to the program (8).

Aim for performing prevention exercises a minimum of twice a week (9).

PREHAB LINKS
Troubleshoot Aging doesn’t promote one program over the other. Find one that works for you!

FIFA 11+Shoulder (JPEG)

Throwers 10 (PDF)
Throwers 10 Infographic

NSCA Rotator Cuff Injury Primer (PDF)

PREHAB: CORE & PELVIC FLOOR

HOW & WHY
Your core is not just the abdominal muscles that sit under your shirt. They also include your glutes, the muscles running along your spine, hip muscles, and your pelvic floor. All work in concert to keep you upright and moving.

As a female athlete, you are at risk of having pelvic floor dysfunction no matter what sort of six-pack you have. This can include urinary and fecal incontinence, as well as pelvic organ prolapse. It is certainly an issue later in life, with 20% of women needing surgery for this issue by age 80 (11). 

It has been shown that regular walking for exercise can cut the odds of having stress urinary incontinence by half. For women between the ages of 37 and 54, moderate activity helped lower risk (11). However, middle-aged women that had more strenuous activity over their life, may have slightly increased stress urinary incontinence. 

Older women 62–87 showed an increased in the odds of fecal incontinence with lower activity levels. However, women 18–40 that were more active were found to have more anal incontinence than less active counterparts (11). 

This can affect female athletes that haven’t given birth. The prevalence of stress urinary incontinence in female athletes that have not given birth ranged from 10.3% to 61.1%, with higher incidences seen in high-impact sports and sports that involved jumping (12, 13).

Why is that? One small study showed that female athletes had weaker pelvic floor muscle strength than their opposites (11). A leading theory as to why is due to the musculature being chronically stretched and weakened from overload and increased intraabdominal pressures (13). Which will be different for everyone and may be based on genetics, the makeup of your muscles (i.e., how much collagen is there), type of activity, and personal fatigue threshold (12).

NOW WHAT
Know about it. Urinary incontinence and pelvic floor dysfunction are common problems, but most women aren’t talking about it. You can’t fix a problem if you don’t know it’s an issue. 

Talk about it. Talk to your teammates. Bring it up to your healthcare team. There are specialist pelvic floor physical therapists.

Train it. Like any muscles, the pelvic floor can be trained and has shown to improve urinary incontinence (13).

Eight weeks of training intervention can produce lasting changes. First, become aware of your pelvic floor contractions. Then work on holding contractions for variable times and intervals (e.g., 2–3 seconds, building up to 10 seconds. Finally, progress to holding contractions during high-impact activities (13).


PREHAB LINKS
Troubleshoot Aging doesn’t promote one program over the other. Find one that works for you!

World Rugby Pelvic Floor Infographic (PDF)

PREHAB: THE KNEE

HOW & WHY
Women are more susceptible to knee pain, no matter the age. This includes a 3–8 times increased likelihood of tearing their ACL (2). This is likely from a variety of factors including skeletal alignment causing faulty mechanics, hormonal changes causing fluctuating joint stiffness or laxity, occupational choices, inactivity due to psychosocial factors, and overuse (2,14). After tearing an ACL, up to 33% of people sustain a second tear (2). 

There are multiple exercise programs available, and none have strong evidence to suggest one over the other (15). They all have a combination of agility, body weight strength exercise, balance, and plyometrics (2). 

ACL prevention exercises work best when done at least 2 times a week for 20 minutes (2). Many have found success in incorporating them into their warmups. 

Your best bet is to pick a program that works for you and stick to it.


PREHAB LINKS
Troubleshoot Aging doesn’t promote one program over the other. Find one that works for you!

FIFA 11+ Infographic

Prep to Play

PEP Program

Perform+

PREHAB: THE ANKLE

HOW & WHY
Women get more ankle sprains than men (16). And those who have already had one ankle sprain are more likely to get a second (16, 17). Neuromuscular training programs are likely helpful to prevent ankle sprains in women, and proprioceptive training has been shown to prevent both first and second ankle sprains (16,17).

More good news is that the proprioceptive exercises seem to be effective at a wide range of ages, including up to 70 years old (17).

Prevention programs will vary, but the most effective ones engage in a progression from light jogging to agility work including multi-directional plyometrics as well as strengthening and mobility work. Programs seem to be most effective when done for 15–20 minutes before activity approximately 3 times a week for at least 6 weeks (16). 

Side note: Bracing and taping can be helpful but may decrease performance, and both have to be applied correctly, which is not always guaranteed (17).


PREHAB LINKS
Troubleshoot Aging doesn’t promote one program over the other. Find one that works for you!

UCSF Protocol (PDF)

In general, these can be added into your normal warm up with proprioception and balance work can be done on a wobble disc, BOSU ball, foam pad, etc. Plyometrics can include your favorite variations of single leg hops as long as they are multidirectional and done with good form.

REFERENCES

  1. Forelli, F., Moiroux-Sahraoui, A., Nielsen-Le Roux, M., Miraglia, N., Gaspar, M., Stergiou, M., Bjerregaard, A., Mazeas, J., & Douryang, M. (2024). Stay in the Game: Comprehensive Approaches to Decrease the Risk of Sports Injuries. Cureus. https://doi.org/10.7759/cureus.76461

  2. Collings, T. J., Diamond, L. E., Barrett, R. S., Saxby, D. J., Lloyd, D. G., Whiteley, R., Patterson, B. E., Crossley, K. M., & Bourne, M. N. (2026). An Evidence-Based and Mechanistic Approach to Reducing the Risk of Anterior Cruciate Ligament Injury: An Exercise and Sport Science Australia Position Statement. Sports Medicine. https://doi.org/10.1007/s40279-026-02450-3

  3. Elliott, J., Heron, N., Versteegh, T., Gilchrist, I. A., Webb, M., Archbold, P., Hart, N. D., & Peek, K. (2021). Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review. Sports Medicine, 51(11), 2373-2388. https://doi.org/10.1007/s40279-021-01501-1

  4. Jofré-Saldía, E., Villalobos-Gorigoitía, Á., & Gea-García, G. (2022). Methodological Proposal for Strength and Power Training in Older Athletes: A Narrative Review. Current Aging Science, 15, 135-146. https://doi.org/10.2174/1874609815666220228153646 

  5. Perry, F. T., & Koehle, M. S. (2013). Normative Data For the Functional Movement Screen in Middle Aged Adults.  The Journal of Strength and Conditioning Research, 27(2), 458-462. https://doi.org/10.1519/JSC.0b013e3182576fa6 

  6. Hrysomallis, C. (2016). Neck Muscular Strength, Training, Performance and Sport Injury Risk: A Review. Sports Medicine, 46(8), 1111-1124. https://doi.org/10.1007/s40279-016-0490-4 

  7. Tucker, R., Raftery, M., Kemp, S., Brown, J., Fuller, G., Hester, B., Cross, M., & Quarrie, K. (2017). Risk factors for head injury events in professional rugby union: a video analysis of 464 head injury events to inform proposed injury prevention strategies. British Journal of Sports Medicine, 51, 1152–1157. https://doi.org/10.1136/bjsports-2017-097895 

  8. Cools, A. M., Maenhout, A. G., Vanderstukken, F., Decle`ve, P., Johansson, F. R., & Borms, D. (2021). The challenge of the sporting shoulder: From injury prevention through sport-specific rehabilitation toward return to play. Annals of Physical and Rehabilitation Medicine, 64. https://doi.org/10.1016/j.rehab.2020.03.009

  9. Schwank, A., Blazey, P., Asker, M., Møller, M., Hägglund, M., Gard, S., Skazalski, C., Haugsbø Andersson, S., Horsley, I., Whiteley, R., Cools, A. M., Bizzini, M., & Ardern, C. L. (2022). 2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels. Journal of Orthopaedic & Sports Physical Therapy, 52(1), 11-28. https://doi.org/10.2519/jospt.2022.10952 

  10. Wright, A. A., Ness, B. M., Donaldson, M., Hegedus, E. J., Salamh, P., & Cleland, J. A. (2021). Effectiveness of shoulder injury prevention programs in an overhead athletic population: A systematic review. Physical Therapy in Sport, 52, 189-193. https://doi.org/10.1016/j.ptsp.2021.09.004 

  11. Nygaard, I. E., & Shaw, J. M. (2016). PHYSICAL ACTIVITY AND THE PELVIC FLOOR. American Journal of Obstetrics and Gynecology, 214(2), 164-171. https://doi.org/10.1016/j.ajog.2015.08.067. 

  12. Almousa, S., & Loon, A. B. V. (2019). The prevalence of urinary incontinence in nulliparous female sportswomen: A systematic review. Journal of Sports Sciences, 37(14), 1663-1672. https://doi.org/10.1080/02640414.2019.1585312 

  13. Rodríguez-Longobardo, C., López-Torres, O., Guadalupe-Grau, A., & Gómez-Ruano, M. Á. (2024). Pelvic Floor Muscle Training Interventions in Female Athletes: A Systematic Review and Meta-analysis. Sports Health, 16(5), 766 - 775. https://doi.org/10.1177/19417381231195305 

  14. Ahmad, Z. (2026). The Escalating Prevalence of Knee Pain in Females: A Systematic Review of Multifactorial Contributors. Pakistan Journal of Medical and Cardiological Review, 5(2). https://doi.org/10.5281/zenodo.20733552 

  15. Clar, C., Fischerauer, S. F., Leithner, A., Rasic, L., Ruckenstuhl, P., & Sadoghi, P. (2025). Reducing ACL injury risk: A meta‐analysis of prevention programme effectiveness. Knee Surgery, Sports Traumatology, Arthroscopy, 33(8), 2815-2824. https://doi.org/10.1002/ksa.12542 

  16. Caldemeyer, L. E., Brown, S. M., & Mulcahey, M. K. (2020). Neuromuscular training for the prevention of ankle sprains in female athletes: a systematic review. The Physician and Sportsmedicine, 48(4), 363-369. https://doi.org/10.1080/00913847.2020.1732246 

  17. Schiftan, G. S., Ross, L. A., & Hahne, A. J. (2015). The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis. Journal of Science and Medicine in Sport, 18, 238–244. https://doi.org/10.1016/j.jsams.2014.04.005