Prevention strategies and modifiable risk factors for spine, chest, abdominal and/or pelvic injury and pain: a systematic review and meta-analysis for the Female, woman and/or girl Athlete Injury pRevention (FAIR) consensus

Objective: Investigate prevention interventions and potential modifiable risk factors (MRFs) for female/woman/girl athletes’ spine, chest, abdominal or pelvic injury and/or pain. Design: Systematic review with meta-analyses, semiquantitative analyses and Grading of Recommendations Assessment, Development and Evaluation. Data sources: MEDLINE, CINAHL, APA PsycINFO, CDSR, CENTRAL, SPORTDiscus, EMBASE, ERIC. Eligibility: Primary data studies with comparison group(s) assessing the association of prevention interventions and/or MRFs for spine, chest, abdominal and/or pelvic injury/pain with ≥1 female/woman/girl athlete in each study group. Results: Across 105 studies (n=11 interventions, n=92 MRFs, n=2 both, n=35 female/woman/girl-specific estimates) including 59 833 participants (23.7% females/women/girls) 9 injury/pain outcomes were assessed (n=74 low-back, n=14 back, n=13 neck, n=5 pelvis, n=3 thoracic, n=3 abdominal, n=3 trunk, n=2 rib, n=1 breast). Three prevention strategies (exercise, equipment, rule-change) and 22 MRFs were identified. High risk of confounding bias (Downs and Black quality assessment tool) was present in 92% and 63% of intervention and MRF studies, respectively. Considering female/woman/girl estimates, we performed meta-analyses (standardised mean-difference) on 4 MRFs (body mass, body mass index (BMI), weekly training hours, spinal flexion) for low-back pain (LBP) and semiquantitative analyses for one intervention (exercise), and 3 MRFs (yearly training load, hip motion, hip strength) for LBP. Very low-certainty evidence suggests no difference in body mass (g=0.28, 95% CI −0.06 to 0.62; I2=67.7%), BMI (g=0.22, 95% CI −0.25 to 0.69; I2=68.2%), weekly training hours (g=0.15, 95% CI −0.29 to 0.58; I2=45.6%) or spinal flexion (g=0.27, 95% CI −0.23 to 0.76; I2=40.4%) between female/women/girls athletes with and without LBP. Conclusions: There is limited knowledge about prevention interventions or MRFs for female/women/girl athletes’ spine, chest, abdominal and/or pelvic injury/pain. PROSPERO registration number: CRD42024479654.