As women’s sport has become more visible at every level, the level of inequity both in the support for female, woman and girl athletes in participating in sport and physical activity and in the research underpinning it is also becoming more visible. 

Now a major international consensus statement—the Female, woman and/or girl Athlete Injury pRevention (FAIR) consensus—is highlighting the chronic under-representation of female/woman/ girl-specific data in injuries and injury prevention in female/woman/ girl athletes from grassroots to elite levels of sport. 

‘FAIR came about because we were starting to look at injuries in female, woman and girl athletes, in particular playing football, and it became clear that we didn’t know anywhere near enough about the injuries they sustain and how we might prevent them. 

‘We also did some work looking at the proportion of female, woman and girl athletes as participants in research and realised there really wasn’t a high proportion,’ says APA Honoured Member Professor Kay Crossley FACP (left), director of the La Trobe Sport and Exercise Medicine Research Centre at La Trobe University. 

To identify where the gaps in the evidence base were, Kay teamed up with Canadian physiotherapist and researcher Professor Carolyn Emery, who is chair of the International Olympic Committee’s Sport Injury Prevention Research Centre at the University of Calgary, to propose FAIR to the International Olympic Committee and they were awarded funding in 2023. 

Then came the process of deciding what needed to be done. 

‘We asked ourselves, “What are the questions we really need to ask and answer?” 

‘We needed to do some systematic reviews to gather the information on injury prevention in female, woman and girl athletes across lower extremity, upper extremity, concussion and—we call it spine plus, but basically everything down the middle, so ribs, pelvis, etc. 

‘What made our process unique is that we decided to also do a scoping review on implementation, looking at how we actually get injury prevention out there for female, woman and girl athletes, either to coaches, to the athletes directly or to administrators,’ Kay says. 

‘We also decided to look at people’s experiences. 

‘We conducted some original research, which was a concept mapping paper led by Melissa Haberfield, on people’s experiences and understanding of the gender- and sex-related factors that are important for injury prevention in female, woman and girl athletes—not just going to the numbers but actually getting people’s thoughts on what we should be doing rather than just what has been done in the past.’ 

Once the systematic reviews were completed and submitted for publication, the project’s steering committee met to develop recommendations, based on the papers as well as on input from external advisers, which included clinicians, coaches and athletes. 

In total, 109 authors from across six continents contributed to the work. 

Professor Kay Crossley was one of the leaders of the FAIR consensus project.

The final set of recommendations was published as a consensus statement in the British Journal of Sports Medicine in November 2025 (Crossley et al 2025a), along with the reviews, the concept mapping research and a series of editorials looking at different aspects of the consensus process and implications for future research. 

Out of the 56 FAIR recommendations, 16 address primary injury prevention, including policy, rules and laws, personal protective equipment and training; four cover secondary injury prevention; 12 are about modifiable risk factors; 14 involve approaches to diversity and inclusion; and 10 are about promoting gender- and sex-supportive environments. 

They cover female, woman and girl athletes across all competitive sports and physical activities, including performance-based activities like dance but excluding non-competitive physical activities like jogging or hiking as well as active transportation like cycling or walking. 

‘There are a few sports that are under-represented as physical activities. 

‘For example, even though people who run regularly probably consider that they are athletes, we only included studies that had looked at running competitions—it could be marathons, it could be five-kilometre races, but it had to be related to a competition. 

‘We needed to set some criteria for the studies,’ says Kay. 

Then, of course, there’s the ‘but’—there isn’t enough data on female, woman and girl athletes in a lot of areas to form conclusions. 

In some cases, they had to draw on research done in male, man and boy athletes or in other sports and extrapolate the data. 

‘For the FAIR recommendations, we use what we’re calling hedging words, so if there’s a lot of evidence we say “should” but then there are a number of recommendations using “could” or “may” or “might” because the evidence isn’t strong enough,’ Kay explains. 

‘This is where the evidence is in 2025–26. 

‘Now there’s going to be a new lot of research to build on that and we’ll be able to document those changes. 

‘Would it have been nice to have had more evidence? 

‘Yes, but maybe we wouldn’t have needed to do this if there were a lot more evidence. 

‘This is our line in the sand, where we are right now.’ 

The next step, which is underway, is to set research priorities, which again will be done via consensus. 

Some priorities are obvious, Kay says, while others will emerge through discussion. 

‘We need more research in women and girls, especially those who aren’t from North America, Australia and Europe. 

‘We need more research on para-sport; we need more research in Indigenous populations and other communities that are really under-represented.’ 

In the meantime, there are some well-supported practical recommendations that can be implemented right away. 

‘The strongest recommendations are about doing a structured warm-up exercise, not just going for a jog or doing some stretching but also some activities that are relevant to that sport—perhaps jumping and landing, perhaps change of direction, cutting or tackle practice—and it’s got to be at least twice a week for at least 10 minutes of time. 

‘We already know that; the evidence is clear and that’s what we as physios and as participants ourselves should be taking on board, recommending and trying to get out there at every opportunity,’ Kay says. 

Other strong recommendations are centred on wearing appropriate protective gear, like mouthguards or helmets, and concussion management. Kay and her team are no strangers to developing structured warmup programs like this, including their AFLW-based Prep-to-Play program. 

She notes, however, that it is important to know how to implement these warm-up programs and to do so from an early stage of participation. 

‘We need to upskill coaches, players and trainers who are going to actually deliver some of these warm-ups and we need to be starting this early, ideally as soon as someone begins playing sports so that they get in the habit of doing this as part of their warm-up.’ 

Furthermore, organisations should take responsibility for the implementation of injury prevention and creating safe spaces for female, woman and girl athletes to play sport—places with no harassment or abuse, no body-shaming or making athletes feel bad about injuries—and there should be equitable allocation of resources such as playing grounds, coaches and trainers. 

Mapping the factors involved 

Physiotherapist and PhD student Melissa Haberfield used concept mapping approaches to identify the factors involved in injury in female/woman and girl athletes.

The lack of equity in sport was highlighted in the concept mapping research led by Kay along with Melissa Haberfield APAM (left), a PhD student and physiotherapist in Kay’s team at La Trobe University, which was published as one part of the consensus statement (Crossley et al 2025b). 

The study gathered expert perspectives on the gender- and sex-specific factors that are relevant to injury risk and injury prevention in female, woman and girl athletes, analysing the main themes. 

The experts included athletes themselves, along with coaches, medical and exercise practitioners, administrators and researchers in that space. 

‘We took a broad scope of what an expert is to capture all those perspectives. 

‘Part of the beauty of this project is that it’s a global project. 

‘We used our global networks to recruit for this study and tried within the categories of expertise to get diverse voices from around the world in terms of geography and socio-economic and cultural backgrounds to really understand what contributes to that female, woman and girl injury risk,’ Melissa says. 

Participants in the concept mapping study were asked to brainstorm as many ideas as possible in response to a prompt and the ideas were sorted into groups of related concepts and rated for importance and modifiability. 

The group consisted of 66 participants, again from all six continents, and they sorted through 101 ideas, resulting in a visual map and framework for action. 

The map includes five overarching domains made up of 10 conceptual clusters illustrating the relevance of different gender and/ or sex-specific factors to injury risk for female, woman and girl athletes. 

The domains include funding and resources; expertise and knowledge, both among support staff and in research; sex—the differences in biology, anatomy and physiology; gendered environments in health, expectations, harassment and social biases as well as the gendered sport environment; and finally gendered communication, which links strongly to the other four domains. 

‘To me, the big stand-out is that gendered environment domain and I think that will help people to start thinking differently about female, woman and girl injury prevention. 

‘We already know that we need more funding and resources, and we know that people working with female, woman and girl athletes need to have better education and better support. 

‘A lot of the existing research is on the sex-related factors,’ Melissa says. 

Importantly, the study is the first to highlight all the relevant sex and gender factors for female, woman and girl injury risk and prevention as perceived by the experts who work in the space, creating a foundation in the literature for future progress. 

Some of the factors identified in the study may seem obvious but how they could influence somebody’s participation or their injury risk is rarely considered, she notes. 

It could be as simple as having uniforms that fit a teenage girl’s body or having a safer gym environment for training that is more accessible and less intimidating for female, woman and girl athletes or listening to what the female, woman and girl athletes want from their club or organisation. 

‘If the people in your environment are speaking up and saying this is an issue or a barrier, then believe them, listen to them and action those simple things that may not seem relevant to you but clearly are to the female, woman and girl athletes,’ Melissa says. 

Next steps 

In addition to setting research priorities, Kay and the FAIR team have started to look at implementing the recommendations into practice. 

The first step will be to disseminate the findings of FAIR as widely as possible—to physiotherapists and other sports medicine practitioners, sporting organisations, coaches, trainers, athletes and sports administrators. 

This may include adapting the recommendations to specific sports, such as soccer, or to specific arenas, such as para-sport, and working with organisations and groups to implement the recommendations for their environment. 

Comprehensive resources including infographics, videos and webinars are in the works, along with a website to house them. 

And the recommendations are likely to spur on the development of sports-specific, co-designed programs for female, woman and girl athlete injury prevention. 

‘Making the resources is one thing; getting them out there is another. 

‘It’s taken two and a half years to get to this point and it’s probably going to take us two and a half years to get to the next point,’ says Kay. 

>> Read more about the FAIR consensus project 

>> Kay and other members of the FAIR consensus team will present their findings at the Women in Sport Congress in Brisbane in March. 

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