Female Athlete

14 Lessons

Since the first FIFA Women’s World Cup was held in 1991 there has been a significant increase in the number of women playing football and women’s football is currently one of the fastest growing sports in the world. In 2007, according the Big Count survey, there were 26 million girls and women playing football in more than 180 countries.

There are a number of medical and musculoskeletal issues that are more commonly seen in, or experienced differently by, female players. For example, they seem to be more likely to develop relative energy deficit, which can lead to a variety of significant complications. In addition, they are also up to nine times more likely to injure their anterior cruciate ligament. An awareness of these issues is essential for clinicians who care for female football players and athletes in general.

This module will also discuss some of the issues relating to exercise and physical activity during pregnancy and in the post-partum period.

Presented by

Learning outcomes

By the end of this course you should:

  • have an understanding of the pathophysiology of relative energy deficiency in sport (RED-S);
  • be able to assess and manage an athlete with RED-S;
  • have an understanding of the differences between injuries sustained by men and women;
  • demonstrate an understanding of the effects of pregnancy on a woman’s ability to remain active and an ability to prescribe physical activity in these patients.


  • Watch/listen to the 11-slide talk and review the provided text.
  • Read the IOC consensus statement regarding RED-S as well as the other suggested articles.
  • Review the FIFA guide for coaches and players entitled “Health and Fitness for the Female Football Player”.
  • Complete the case-based assessment task.

Required reading

F-MARC Football Medicine Manual 2nd Edition:

Health and Fitness for the Female Football Player. A guide for players and coaches.

Chapter 2.4.1 (pages 109-112)

Suggested Reading

Brukner & Khan’s

Clinical Sports Medicine – 4th Edition

Chapter 43 (pages 910-935)


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  2. Sundgot-Borgen J, Torstveit MK. The female football player, disordered eating, menstrual function and bone health. Br J Sports Med. 2007;41(Suppl 1):i68-72.
  3. Loucks AB. Energy balance and body composition in sports and exercise. J Sports Sci. 2004;22(1):1-14.
  4. Sundgot-Borgen J. Nutrient intake of female elite athletes suffering from eating disorders. Int J Sport Nutr. 1993;3(4):431-442.
  5. Ackerman KE, Misra M. Bone health in adolescent athletes with a focus on female athlete triad. Phys Sportsmed. 2011;39(1):131-141.
  6. Martinsen M, Holme I, Pensgaard AM, Torstveit MK, Sundgot-Borgen J. The development of the brief eating disorder in athletes questionnaire. Med Sci Sports Exerc. 2014;46(8):1666-1675.
  7. Liu SL, Lebrun CM. Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: A systematic review. Br J Sports Med. 2006;40(1):11-24.
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  9. Christenson ES, Jiang X, Kagan R, Schnatz P. Osteoporosis management in post-menopausal women. Minerva Ginecol. 2012;64(3):181-194.
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  14. Olson D, Sikka RS, Hayman J, Novak M, Stavig C. Exercise in pregnancy. Curr Sports Med Rep. 2009;8(3):147-153.
  15. Little BB, Ghali FE, Snell LM, Knoll KA, Johnston W, Gilstrap LC,3rd. Is hyperthermia teratogenic in the human? Am J Perinatol. 1991;8(3):185-189.
  16. Uhari M, Mustonen A, Kouvalainen K. Sauna habits of Finnish women during pregnancy. Br Med J. 1979;1(6172):1216.
  17. Roquer JM, Figueras J, Botet F, Jimenez R. Influence on fetal growth of exposure to tobacco smoke during pregnancy. Acta Paediatr. 1995;84(2):118-121.
  18. Evenson KR, Barakat R, Brown WJ, et al. Guidelines for physical activity during pregnancy: Comparisons from around the world. Am J Lifestyle Med. 2014;8(2):102-121.
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  20. Evenson KR, Mottola MF, Owe KM, Rousham EK, Brown WJ. Summary of international guidelines for physical activity following pregnancy. Obstet Gynecol Surv. 2014;69(7):407-414.