The third Women in Sport Congress (WISC), a biennial conference presented by the Australian Sports Commission and the Australian Institute of Sport, brought together more than 400 sports scientists, physiotherapists and other clinicians, athletes, coaches and representatives from national and international sporting bodies. 

Recurring themes included an amplified athlete voice in decisions about health, training and performance and a call for more male coaches, leaders, researchers and practitioners to accrue the knowledge and skills needed to create environments where female athletes can thrive. 

The congress also provided an opportunity to capture insights from 11 women working in sport. Watch the full series of interviews to hear directly from those shaping best practice in female athlete health and performance.

Adolescent athletes 

It became clear during the session on female adolescent athletes that social and psychological considerations are just as important as biological ones in keeping girls actively playing sport. 

Opening the session, sports scientist Dr Karlee Quinn talked about the environment surrounding teenage athletes and the effect it can have on girls as well as ways to design a sporting environment to support adolescent female athletes. 

As the University of Queensland’s Associate Professor Michelle Smith MACP noted in the following presentation, less than 20 per cent of girls aged 15 to 17 meet Australia’s physical activity guidelines and about 75 per cent of girls aged 10 to 19 drop out of team sports, with more adolescent girls dropping out overall than boys. 

Associate Professor Michelle Smith presented a paper about adolescent girls in sport. Image by Samuel Tremayne for the Australian Sports Commission.

In a study led by Michelle, which analysed the responses from a series of interviews with girls aged 12–18, several themes emerged about why girls play sport, why they drop out and the barriers and facilitators of keeping them in sport. 

A key theme was the social side of sport: friendship, camaraderie, teamwork and community were all important. 

Michelle said that when this broke down, many girls would drop out. 

Another factor affecting participation was the level of competition and the challenge of finding a social competition where they could play for fun. 

Many girls said their enjoyment in playing sport was linked to success and achievement, not just winning but also learning new skills. 

Pressure to perform well, more internal than external, was also a factor. 

Finally, there were logistical barriers including clashes between sports, travel and training time and balancing sport with school in the later years. 

Michelle said that sports organisations need to facilitate friendships and camaraderie and address poor behaviour and that social and competitive sport opportunities need to be offered at all ages and skill levels. 

She noted that sport and exercise professionals, including physiotherapists, could provide support for girls at all levels, not just at the elite level. 

‘Health, sport and exercise professionals should talk to girls about pressure, anxiety and self-doubt and help them develop management strategies. 

‘While this happens well in elite sport, I don’t know that it happens at a lower community level or at the sub-elite level.’ 

Following Michelle, a series of three-minute presentations highlighted recent research in a variety of areas, including the impact of menstrual cycles and hormonal contraception on strength and bone health, mental health, confidence and identity, concussion presentation and recovery in girls, and building supports around elite teenage athletes. 

Of particular relevance to physiotherapists was Anna O’Loughlin APAM’s talk about how adolescent girls present to her concussion clinic compared to adolescent boys and the importance of recognising concussion in girls early. 

‘Concussion is one of the fastest growing areas of research in sport science; however, female athletes still only represent about 20 per cent of that research, despite sustaining concussions at a rate about 1.5 to 1.7 times that of their male counterparts. 

‘Most clinical guidelines are derived from male cohorts, as outlined in the AIS position statement, and consequently current management may not fully account for female-specific factors such as hormonal influences, migraine prevalence, neck strength and academic stress during adolescence,’ Anna said. 

Anna presented details of seven case studies from her clinic. 

Most of the girls reported headaches, dizziness and visual impacts and they typically took longer to return to sport than boys – around eight weeks versus two to three weeks. 

In addition, they were all significantly affected by academic decline in the weeks after the concussion, requiring a longer return to both learning and sport. 

‘A faster recovery was linked to an earlier referral and fewer comorbidities. 

‘One of the major barriers here, however, is that when female athletes present to the emergency department, they are often discharged with a rest advice sheet and with no follow-up… many will not receive referrals for rehab,’ she said. 

Stella Veith has set up a program to support the junior Matildas outside training camps. Image by Samuel Tremayne for the Australian Sports Commission.

Wrapping up the session, physiotherapist Dr Stella Veith APAM talked about a program she was involved in setting up for the junior Matildas, describing it as nurturing the athletes like plants in a greenhouse. 

Performance support staff work with the athletes both at training camps and externally, filling in the gaps to manage injury, load, nutrition and training schedules during periods of academic stress. 

The program helps to bridge the gap as players move from the junior (under 17) squad to the older squads. 

‘Twenty per cent of our players are impacted by injury or illness a week. 

‘As some of our extended 94-player squad do not have a physiotherapist at their games, let alone at their training sessions, junior Matildas performance support staff support the individual [players] remotely,’ Stella said. 

‘We focus on the individual, contextual factors of our junior Matildas.’ 

Rounding out the adolescent theme was a poster by Specialist Sports and Exercise Physiotherapist (as awarded by the Australian College of Physiotherapists in 2007) Dr Loretta O’Sullivan-Pippia FACP, who developed the Empowerful Girls model for injury management to help adolescent girls manage their first sporting injury. 

‘It puts the athlete at the centre of their own care, rather than decisions being made for and around them,’ Loretta said. 

Pregnancy and the postpartum period in elite sport 

A major focus at WISC was the pregnant and postpartum athlete, particularly at the elite level. 

The key message was that sports organisations, including the women’s National Rugby League and Australian Athletics (formerly Athletics Australia), are beginning to develop frameworks and guidelines for elite athletes to support them through pregnancy and postpartum return to sport. 

Victoria Kahn showcased Australian Athletics' program for pregnant and postpartum athletes. Image by Samuel Tremayne for the Australian Sports Commission.

At Australian Athletics, physiotherapist Victoria Kahn MACP oversees a program that supports track and field athletes to continue competing after becoming mothers. 

‘Since 2020, 12 athlete mothers have competed at the highest level on the global track and field stage,’ Victoria said. 

Australian Athletics identified five main barriers – financial and organisational support; pelvic health; return to running, jumping and throwing; nutrition, physiology and bone health; and identity, matrescence and mental health. 

The resulting model is integrated into the organisation’s national policy and focuses on an athlete’s needs as she moves through pregnancy and beyond. 

Athlete mothers come back to competition at equivalent or higher levels postpartum. 

In a similar vein, physiotherapist Siobhan Shirlaw APAM outlined the program developed by the Queensland Rugby League for postpartum return to play. 

The framework is based on the ‘6 Rs framework’ developed by Irish physiotherapists led by Gráinne Donnelly (), moving from Ready (postpartum) through Review (return to gym and assessment of movement needs), Restore (return to run/ general strength), Recondition (return to training), Return (return to play) and Refine (optimising performance). 

Canadian sports scientist Professor Margie Davenport provided an overview of the unique factors facing pregnant and postpartum athletes at elite levels. 

Margie noted that for the average, non-elite athlete, the recommended guidelines are for 150 minutes of moderate to vigorous physical activity across the week, which has been shown to reduce complications including pre-eclampsia and gestational diabetes by 40 per cent, followed by a gradual and symptoms-based increase in physical activity postpartum. 

But for elite athletes, this is not enough to maintain condition and return to play. 

‘Pregnancy and postpartum are unique and we need to prove safety before we can recommend it. 

‘But the problem we have had for many years is that the restrictions we have placed on it are based on opinion – sometimes expert, sometimes not – and not on empirical evidence,’ Margie said. 

Her team is looking at the limits of prenatal exercise across the spectrum of training types – for example, lifting heavy weights, high-intensity training and training for longer durations (more than 60 minutes at a time) than non-athletes. 

Across the board, she said, women who stop training have more complications than women who keep training. 

And continued participation is linked to better mental health and lower stress. 

‘There’s a need to balance the potential risks with the known harms of unnecessarily restricting physical activity in pregnancy,’ Margie said. 

‘I would argue that injury prevention actually starts well before the postpartum period. 

‘Athletes who reduced their training load by 50 per cent or more during the first and second trimesters had nearly double the risk of having an injury in the postpartum period.’ 

Margie and her team have developed some evidence-based decision aids and frameworks to support athletes to stay in play during pregnancy and return to sport postpartum for the international football body FIFA as well as a seven-stage return-to-sport training framework, which they plan to adapt to other sports. 

The need for frameworks and models for return to sport was underscored by Jacinta Carroll MACP, a physiotherapist and world champion waterski jumper who unexpectedly fell pregnant right after winning a major competition while ranked first in the world in her sport. 

‘I wanted to retire on my own terms, not because I was pregnant,’ Jacinta said during her talk, which focused on the lack of knowledge regarding exercise and pushback from doctors, midwives and even her own colleagues when she decided to continue training through her pregnancy. 

Jacinta developed her own pregnancy and training plan based on the limited amount of evidence she could find and won her final World Cup 100 days postpartum. 

A consistent thread throughout the pregnancy and postpartum theme was pelvic health. 

Jodie Dakic outlined the work she has done towards a pelvic floor screening tool for athletes. Image by Samuel Tremayne for the Australian Sports Commission.

Melbourne-based researcher Dr Jodie Dakic APAM presented her work on pelvic health screening in athletes. 

‘Pelvic floor symptoms such as urinary incontinence and pelvic pain affect the performance and wellbeing of female elite athletes, with up to 80 per cent reporting at least one symptom. 

‘Despite this high prevalence, fewer than 10 per cent discuss this with someone in their support team, limiting their access to timely management,’ Jodie said. 

Her research has shown that while screening is not commonly offered, both athletes and support staff are open to it but there is uncertainty about what questions to ask. 

‘Professionals need a sports-specific, concise and validated screening tool.’

Jodie has recently completed a scoping review to identify potential questions for screening tools. 

A Delphi consensus process will be used to select questions for a screening tool for athletes. 

FAIR consensus 

A special symposium session was held at WISC to discuss the Female, woman and/or girl Athlete Injury pRevention (FAIR) consensus, a global project led by La Trobe University’s Professor Kay Crossley FACP, an Honoured Member of the APA, and Professor Carolyn Emery from the University of Calgary in Canada. 

Kay and Emily Heming, a Canadian researcher and member of the FAIR consensus team, opened the session with an introduction to the consensus statement, the methodology used to develop it and the 56 recommendations it makes, spanning policy, personal protective equipment, training and management. 

Emily walked the delegates through the systematic reviews looking at injuries in the lower and upper limb extremities, concussion and spine, chest, abdomen and pelvis injuries and the resulting recommendations, which cover policy, rules and laws for play, personal protective equipment, training and exercises for specific sports and management of injuries as well as recurrent injury prevention. 

‘The key takeaway is that the FAIR recommendations help guide evidence-based decisions, even when the female-specific research in a particular sport is limited,’ Emily said. 

Kay focused on the recommendations for implementation and education, including planning injury prevention strategies from an early stage in an athlete’s life and co-creating implementation plans with athletes, coaches and others to ensure that recommended, evidencebased strategies are adapted to specific groups and environments in a usable form. 

‘We need to use these recommended strategies that we spent so much time trawling through the evidence to find but we need to tailor them to our individuals, prioritising our female/woman/girl evidence where we have it,’ Kay said. 

This included making sure that sport partners such as coaching staff and organisations developed the motivation and capacity for implementing injury prevention programs for female/woman/girl athletes, established policies on implementation and education, evaluated the outcomes and prioritised mechanisms for gender- and sex-specific injury surveillance. 

Kay wrapped up her presentation by calling for the creation of supportive and safe environments for female/ woman/girl athletes, for adapting a whole-of-system approach from the individual athlete to elite athletes and from community level to international sports, and finally for developing expertise at all levels, from teaching coaches and support staff to sports organisations, to implement female/woman/girl injury prevention programs. 

‘We’re really excited to have these 56 recommendations that can be adapted for female/woman/girl athletes globally,’ she said. 

Kay was followed by physiotherapist Dr Brooke Patterson APAM, who led the FAIR consensus scoping review on dissemination and implementation (D and I) of injury prevention strategies – essentially the information gap between the research and practice. 

Brooke Patterson talked about the importance of actively planning dissemination and implementation strategies for research. Image by Samuel Tremayne for the Australian Sports Commission.

The group analysed 220 papers, looking at a variety of outcomes, factors and strategies used for D and I. 

The review showed that a variety of D and I strategies could be used to ensure injury prevention strategies were adopted, including workshops and online modules to upskill and build capacity in athletes, coaches and other support personnel. 

‘We can confidently say that it is no longer best practice to purely create an intervention, put it out there and have passive D and I strategies,’ Brooke said. 

‘We need to raise awareness of these evidence-based injury prevention strategies and build capacity to use them.’ 

Another member of the FAIR team, physiotherapist Melissa Haberfield APAM, provided a summary of the concept-mapping exercise she led to identify genderand/ or sex-specific factors relevant to injury risk in female/ woman/girl athletes. 

Melissa Haberfield used concept mapping to identify gender and/.or sex-specific factors relevant to injury risk in female/woman/girl athletes. Image by Samuel Tremayne for the Australian Sports Commission.

Involving more than 60 expert participants from around the world, including athletes and coaches, the study generated 101 statements, which were sorted into 10 clusters of concepts across five domains – funding and resources, expertise and knowledge, sex-related factors, the gendered environment and gendered communication. 

This led to the development of a number of recommendations for creating supportive, equitably funded environments with access to appropriate knowledge and expertise. 

‘We all have a role in redefining injury prevention in female, women’s and girls’ sport, through our various roles in sport, from research to policy and leadership,’ Melissa said. 

Sports physician Dr Siobhan Brodrick closed out the session with an examination of the epidemiology of sports injuries – an analysis of 288 papers on female athletes aged 11 years and up, participating in competitive sport from amateur to elite level – that looked at the types of sports studied, the kinds of injuries received and at what age specific injuries occurred.

Acknowledging that the vast majority of the research was conducted in soccer and basketball and that lower limb extremity injuries were the most prevalent, Siobhan noted that future research needs to standardise definitions of injury and reporting of statistics as well as identify the effects of other relevant factors like season timing and competition level. 

‘The data we gather on female athlete injury should help to inform prevention and treatment guidelines, with a flow-on effect of hopefully reducing injury rates and potentially enhancing female athlete participation, longevity and performance outcomes in sport.’ 

And finally 

A poster presented by sports scientist Dr Ella Smith, who works with cyclists and other athletes at the South Australian Sports Institute, provides a clear framework for classifying ovarian hormone status (including menstrual cycle stage and contraceptive status) in studies involving female athletes. 

Ella said the framework makes it easier to control for the complexity of ovarian hormone status and help researchers adopt appropriate, high-quality approaches to studying female athletes, facilitating the correction of the sex bias in sports and exercise research, which has often led to women being left out of studies altogether. 

WISC2026 Youtube Video Series

Watch the full series of short interviews with physiotherapists who presented at WISC.