How Physios Can Close the Gap in Female Athlete Care

Historically, training and rehabilitation systems for female athletes have been based largely on research conducted in male populations.

Only 8–9% of sports medicine research is female-specific, despite a massive increase in female sports participation globally. As a result, care can miss the mark, leading to longer injury recovery times, higher dropout rates, and underrecognised health risks in women and girls across all levels of sport.

As physiotherapists, we are uniquely placed to change this.

We see female athletes through every chapter of life, from early development to peak performance and into peri- and post-menopause. Our scope extends beyond injury management to include menstrual health, mental wellbeing, and musculoskeletal optimisation.

This blog explores how you can be a proactive force in the injury prevention and development of female athletes throughout the lifespan, focusing on youth development and menopause transition.

If you want an in-depth understanding of managing female athletes like a pro, watch expert Dr Paulina Kloskowska’s full Masterclass HERE.

The role of the physio

Rehabilitation and return-to-play guidelines built on research dominated by male data can often result in female athletes following protocols that don’t account for their unique physiology, hormonal cycles, or psychosocial stressors. These oversights aren’t just academic, they may result in higher re-injury rates, prolonged time off sport, and reduced confidence in recovery.

Unfortunately, as Paulina points out, the fact of the matter is that the research is lacking, meaning an emphasis on evidence-based care for female athletes remains tricky.

As physios, we are in the ideal position to push for change. Female-specific assessments open the door for better communication, early referrals, and more successful outcomes. For example, around 1 in 3 elite female athletes report harassment or abuse, and disordered eating patterns are alarmingly common across all sports levels. These issues directly affect performance, recovery, and longevity in sport participation. Validating emotional stressors isn’t a “soft skill”, it’s clinical care, and when used in tandem with a sound understanding of the factors unique to female athletes, it can go a long way to reducing the gender gap in sport.

Treating young female athletes

Puberty is an important milestone to consider for female athletes. Hormonal shifts can alter knee mechanics, putting girls at higher risk of ACL injury. By focusing on progressive loading during these vulnerable years, we can help young female athletes build resilience.

Additionally, education regarding the importance of resistance and movement training is beneficial. Multidirectional agility, posterior chain strength, and trunk control are important factors for injury prevention. See Paulina explain this in the below video from her Masterclass:

It’s important for clinicians to invite a safe space for young females, as they may feel uncomfortable discussing periods, body image, or pain that doesn’t “show up” on imaging. Meet these conversations with compassion, use non-pathologising language. Encourage open dialogue. And where possible, include parents and coaches in consistent, supportive messaging.

Female athletes and menopause

Menopause can disrupt physical and mental performance. Yet it’s often overlooked in athlete care. Joint pain, hot flushes, mood changes, fatigue, and brain fog can derail training and reduce quality of life. A lack of support during menopause can lead previously active females to simply accept they can no longer do what they enjoy, but this doesn’t have to be the case!

Resistance training during menopause helps prevent osteoporosis, maintain muscle mass, and support mental health. Rather than backing off training, the focus should be on adapting by adjusting intensity, increasing recovery, and reinforcing load tolerance. See Paulina explain in this clip from her Masterclass:

One example of the lag in research and knowledge translation for menopause is the outdated belief about the association between hormone replacement therapy (HRT) and breast cancer, a fear that still lingers and prevents the initiation and/or long-term use of this treatment option. But modern research supports the safe use of HRT, especially for symptom relief and bone health in perimenopausal athletes, as Paulina explains in this short clip from her Masterclass:

While as physios we don’t prescribe, it’s important to advocate for our female patients, listen, and learn what’s important for them. Working with “menopause-literate” GPs and specialists to support your patients holistically is a great step in keeping your female athletes participating and performing.

Wrapping up

From early injury prevention in adolescence to advocacy through midlife and beyond, physiotherapists are uniquely positioned to support female athletes across every stage of life. While the research still has a way to go, the momentum is shifting – and so should our clinical approach.

Your clinic can be more than a place for treatment. It can be a space that educates and adapts to the needs of female athletes, rather than restricting them. It’s time to build systems that reflect the realities of the female athletic experience, not force women to fit male-centric models of care.

To really understand how you as a clinician can help to support females throughout their lifespan, watch Dr Paulina Kloskowska’s in-depth Masterclass HERE.