Exploring a systems-based, multifactorial framework for load tolerance and injury risk in women's soccer: A...

To compare season-average cumulative multifactorial injury risk index scores between injured and uninjured women soccer players, describe the relationship between the weekly injury risk index and subsequent soreness and assess whether strength deficits and sleep disturbances influence the relationships among high load, soreness, and injury.

Prospective cohort study.

Twenty-five National Collegiate Athletic Association Division I women's soccer players were monitored over a 15-week season. External load was tracked using Global Positioning System accelerometers and weekly injury risk index scores were derived from weekly load, preseason strength testing, weekly sleep quality, sleep duration and mood. Lower extremity time-loss injuries were recorded by athletic trainers; weekly soreness was self-reported on a Likert-type scale. Differences between groups were explored descriptively, including relationships between high load, strength deficits, sleep, and injury/soreness.

Fifteen players (60%) sustained at least one injury (23 total; 0.92 injuries/player-season). Injured players had a higher mean risk index (33.8%, confidence interval: 22.1-45.5) than uninjured players (24.1%, confidence interval: 17.3-30.9). Under high load, all players with strength deficits were injured, compared with fewer injuries among those without deficits. Suboptimal sleep quality slightly increased soreness risk, whereas suboptimal sleep duration had no influence. The weekly injury risk index correlated moderately with soreness prevalence (r = 0.51).

This exploratory study suggests that a multifactorial injury risk index integrating modifiable factors and load exposure may provide a useful framework for understanding injury vulnerability in athletic populations. This approach demands further validation using larger samples and robust longitudinal methods.