Female participation in sport has increased dramatically in recent decades. From youth sport to elite competition, more women and girls are training, competing, and pursuing high performance pathways than ever before. However, research has shown that female athletes have unique physiological, hormonal, and injury risk considerations that require targeted training and support strategies (Elliott-Sale et al., 2021).
Historically, much of sports science research has been conducted on male participants and then applied broadly to female athletes. More recent research emphasises the importance of tailoring training, recovery, nutrition, and injury prevention strategies specifically to the female athlete population (McNulty et al., 2020).
For athletes, coaches, and clinicians, understanding these considerations is essential for maximising performance, reducing injury risk, and supporting long-term health.
Unique Physiological Characteristics of Female Athletes
Female athletes differ from male athletes in several key physiological areas that influence training responses and injury risk.
Hormonal Influences
The menstrual cycle produces fluctuations in oestrogen and progesterone across roughly a 28-day cycle. These hormones influence:
- Ligament laxity
- Neuromuscular control
- Recovery capacity
- Substrate utilisation during exercise
Oestrogen, for example, has been shown to influence collagen metabolism and ligament properties, which may affect injury risk in certain phases of the menstrual cycle (Herzberg et al., 2017).
Although research remains mixed regarding injury risk at different cycle phases, there is increasing evidence that tracking menstrual cycles can help guide training adjustments, recovery strategies, and symptom management (Elliott-Sale et al., 2021).
For many athletes, symptoms such as fatigue, cramps, headaches, and reduced concentration may affect training quality. Monitoring these patterns can allow for more individualised programming.
Strength Training for Female Athletes
One of the most important considerations for female athletes is the inclusion of structured resistance training.
Historically, myths suggested that strength training would lead to excessive muscle mass or negatively impact female performance. Research consistently disproves this. In fact, resistance training is one of the most effective strategies for improving performance and reducing injury risk in female athletes (Suchomel et al., 2018).
Key benefits include:
- Improved strength and power
- Enhanced sprint performance
- Improved jumping and landing mechanics
- Increased bone density
- Reduced injury risk
Strength training also plays an important role in reducing anterior cruciate ligament (ACL) injuries, which occur significantly more frequently in female athletes than male athletes in comparable sports (Arendt & Dick, 1995).
Neuromuscular training programs focusing on strength, landing mechanics, and change-of-direction control have been shown to reduce ACL injury risk by up to 50% in female athletes (Sugimoto et al., 2015).
Common strength priorities for female athletes include:
- Posterior chain development
- Hip and glute strength
- Hamstring strength
- Core stability
- Landing and deceleration mechanics
These qualities help improve force absorption and joint control during sport-specific movements.
ACL Injury Risk in Female Athletes
One of the most well-known injury trends in female sport is the increased incidence of ACL injuries.
Female athletes have been reported to be 2–8 times more likely to sustain an ACL rupture than male athletes participating in the same sports, particularly in soccer, basketball, and netball (Hewett et al., 2006).
Several factors contribute to this increased risk:
Anatomical Factors
Female athletes often have:
- Greater Q-angle at the knee
- Wider pelvis
- Different femoral notch geometry
These anatomical features may influence knee biomechanics.
Neuromuscular Factors
Research shows female athletes may demonstrate:
- Increased knee valgus during landing
- Reduced hip and hamstring strength
- Less trunk stability
These patterns increase stress on the ACL during cutting and landing tasks.
Hormonal Influences
Some research suggests hormonal fluctuations may influence ligament laxity and neuromuscular control, although findings remain inconclusive (Herzberg et al., 2017).
The most effective injury prevention strategy is neuromuscular training focusing on:
- Strength development
- Landing technique
- Deceleration control
- Agility mechanics
These programs are particularly effective when implemented in youth athletes.
Energy Availability and RED-S
Another critical issue in female athlete health is Relative Energy Deficiency in Sport (RED-S).
RED-S occurs when athletes consume insufficient energy to support both exercise demands and normal physiological functioning (Mountjoy et al., 2018).
Low energy availability can negatively affect:
- Hormonal function
- Bone density
- Menstrual function
- Immune health
- Recovery
- Performance
Common signs include:
- Irregular or absent menstrual cycles
- Frequent fatigue
- Stress fractures
- Reduced training capacity
- Recurrent illness
In adolescent female athletes particularly, RED-S can have long-term consequences for bone health and development.
Working with qualified dietitians and allied health professionals can help ensure appropriate energy intake to support training and recovery.
Bone Health and Stress Fracture Risk
Female athletes have a higher incidence of certain bone stress injuries, particularly when energy availability is low.
Low bone mineral density is often associated with:
- Low energy intake
- Menstrual dysfunction
- High training loads
This combination was historically described as the Female Athlete Triad, consisting of:
- Low energy availability
- Menstrual dysfunction
- Low bone density
This concept has since evolved into the broader RED-S model (Mountjoy et al., 2018).
Resistance training plays a critical role in improving bone density and reducing stress fracture risk. Weight-bearing and high-impact activities stimulate bone adaptation and help maintain skeletal health.
Recovery Considerations for Female Athletes
Recovery strategies should also consider the unique physiological demands placed on female athletes.
Sleep
Sleep is essential for:
- Hormonal regulation
- Muscle recovery
- Cognitive performance
- Injury prevention
Athletes who obtain less than 8 hours of sleep per night have been shown to have a significantly higher injury risk (Milewski et al., 2014).
Nutrition
Adequate carbohydrate and protein intake supports:
- Glycogen replenishment
- Muscle repair
- Hormonal balance
- Immune function
Protein intake of approximately 1.6–2.2 g/kg/day is often recommended for athletes involved in strength and endurance training (Morton et al., 2018).
Hydration
Hydration status also influences endurance capacity, recovery, and thermoregulation during training.
Training Considerations for Adolescent Female Athletes
Adolescence is a critical period for athletic development.
During growth spurts, rapid increases in limb length can temporarily reduce coordination and strength relative to body size. This can increase injury risk if training loads are not managed appropriately (DiFiori et al., 2014).
Key considerations for youth female athletes include:
- Gradual increases in training load
- Supervised resistance training
- Movement skill development
- Monitoring growth and maturation
- Ensuring adequate nutrition
Early strength training and movement education help build a foundation for long-term athletic development.
The Importance of Individualised Programming
While general training principles exist, female athletes benefit most from individualised training programs that consider:
- Training history
- Injury history
- Menstrual cycle patterns
- Sport demands
- Age and development stage
Monitoring training loads and recovery markers can help reduce injury risk and optimise performance.
How Allied Health Support Improves Female Athlete Outcomes
Managing the unique needs of female athletes often requires a multidisciplinary approach.
At Changez Health and Fitness Daisy Hill, athletes have access to a comprehensive allied health team that works collaboratively to optimise performance and reduce injury risk.
Physiotherapy
Physiotherapists can assist with:
- Injury diagnosis and management
- ACL injury prevention programs
- Return-to-sport planning
- Movement assessment and correction
Exercise Physiology
Exercise physiologists provide:
- Individualised strength and conditioning programs
- Injury prevention training
- Load management strategies
- Rehabilitation programs following injury
Dietetics
Dietitians support athletes with:
- Performance nutrition
- Energy availability management
- RED-S prevention and management
- Fueling strategies for training and competition
Strength and Personal Training
Our fully equipped gym environment allows athletes to safely perform structured resistance training under professional supervision.
This integrated approach ensures athletes receive coordinated care across all aspects of health, performance, and recovery.
Supporting Female Athletes at Every Stage
Whether an athlete is returning from injury, aiming to improve performance, or simply looking to train safely and effectively, understanding the unique needs of female athletes is essential.
Evidence-based strength training, proper nutrition, injury prevention strategies, and coordinated allied health support all play key roles in improving outcomes.
At Changez Health and Fitness Daisy Hill, our team is committed to helping female athletes train smarter, stay healthy, and perform at their best.
If you are a female athlete looking to improve performance, reduce injury risk, or return safely to sport, our physiotherapists, exercise physiologists, dietitians, and trainers can help guide you through a personalised program.
Book an appointment with the Changez team today and take the next step toward stronger, healthier performance.
References
Arendt, E., & Dick, R. (1995). Knee injury patterns among men and women in collegiate basketball and soccer. American Journal of Sports Medicine, 23(6), 694–701. https://doi.org/10.1177/036354659502300611
DiFiori, J. P., Benjamin, H. J., Brenner, J. S., Gregory, A., Jayanthi, N., Landry, G. L., & Luke, A. (2014). Overuse injuries and burnout in youth sports. Pediatrics, 133(3), e602–e614. https://doi.org/10.1542/peds.2013-3067
Elliott-Sale, K. J., Minahan, C. L., De Jonge, X. A. K. J., Ackerman, K. E., Sipilä, S., Constantini, N. W., Lebrun, C. M., Hackney, A. C., & McNulty, K. L. (2021). Methodological considerations for studies in sport and exercise science with women as participants. Sports Medicine, 51(5), 843–861. https://doi.org/10.1007/s40279-020-01387-6
Herzberg, S. D., Motu’apuaka, M. L., Lambert, W., Fu, R., Brady, J., Guise, J. M., & Sutton, K. M. (2017). The effect of menstrual cycle and contraceptives on ACL injuries and laxity. Sports Medicine, 47(11), 2397–2412. https://doi.org/10.1007/s40279-017-0737-1
Hewett, T. E., Myer, G. D., & Ford, K. R. (2006). Anterior cruciate ligament injuries in female athletes. American Journal of Sports Medicine, 34(2), 299–311. https://doi.org/10.1177/0363546505284184
McNulty, K. L., Elliott-Sale, K. J., Dolan, E., Swinton, P. A., Ansdell, P., Goodall, S., Thomas, K., & Hicks, K. M. (2020). The effects of menstrual cycle phase on exercise performance in women. Sports Medicine, 50(10), 1813–1827. https://doi.org/10.1007/s40279-020-01319-4
Milewski, M. D., Skaggs, D. L., Bishop, G. A., Pace, J. L., Ibrahim, D. A., Wren, T. A. L., & Barzdukas, A. (2014). Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. Journal of Pediatric Orthopaedics, 34(2), 129–133. https://doi.org/10.1097/BPO.0000000000000151
Morton, R. W., Murphy, K. T., McKellar, S. R., Schoenfeld, B. J., Henselmans, M., Helms, E., Aragon, A. A., Devries, M. C., Banfield, L., Krieger, J. W., & Phillips, S. M. (2018). Protein supplementation to support resistance training. British Journal of Sports Medicine, 52(6), 376–384. https://doi.org/10.1136/bjsports-2017-097608
Mountjoy, M., Sundgot-Borgen, J., Burke, L., Ackerman, K. E., Blauwet, C., Constantini, N., Lebrun, C., Lundy, B., Melin, A., Meyer, N., Sherman, R., Tenforde, A., Klungland Torstveit, M., & Budgett, R. (2018). IOC consensus statement on Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine, 52(11), 687–697. https://doi.org/10.1136/bjsports-2018-099193
Sugimoto, D., Myer, G. D., McKeon, J. M., & Hewett, T. E. (2015). Evaluation of the effectiveness of neuromuscular training to reduce ACL injury in female athletes. American Journal of Sports Medicine, 43(7), 1708–1719. https://doi.org/10.1177/0363546515588313
Suchomel, T. J., Nimphius, S., & Stone, M. H. (2018). The importance of muscular strength in athletic performance. Sports Medicine, 46(10), 1419–1449. https://doi.org/10.1007/s40279-016-0486-0
