Creating prep to play PRO for women playing elite Australian football: a how-to guide for developing injury-prevention programs

Key points

1. 01Women in the elite AFLW have a 6 times greater risk of ACL injury than men in the men's AFL, the highest sex difference across team sports worldwide.
2. 02The authors used a 7-step development process guided by the RE-AIM Sports Setting Matrix, partnering with the league and engaging coaches, staff, players, and end-users.
3. 03The program was built into normal training as a flexible strategy rather than a stand-alone warm-up, and included football-specific skills, strength training, and athlete education.
4. 04In its first season, 9 of 10 AFLW clubs used some or all of the program; the tenth believed it already covered the components.
5. 05This is a process and feasibility description, so it does not measure whether the program actually lowered injury rates.

How it was conducted

Design

Description of a collaborative, evidence-informed program-development process (7 steps), guided by the RE-AIM Sports Setting Matrix

Setting

Elite Australian Football League for Women (AFLW), developed in partnership with the AFL governing organization

Inputs

Literature review, concept mapping with 27 content and context experts, interviews and focus groups with implementers and end-users

Experts engaged

14 injury-prevention experts (10 medical or rehabilitation, 4 high-performance coaches) plus 3 national focus groups totaling 34 experts

Stakeholders interviewed

19 players and 13 staff from 9 of 10 AFLW clubs after the 2019 season

Primary aim

Describe the process used to co-create a context-specific knee-injury-prevention program (Prep to Play PRO)

What they found

• In the 2017 AFLW season, 17 players sustained an ACL injury during preseason or in-season, and 13 (76%) of these occurred during games.
• Video analysis of 10 ACL injuries showed single-leg landing in 2 (20%), single-leg deceleration in 3 (30%), and side-step in 5 (50%); 7 were indirect contact and 3 were noncontact.
• In the first (2019) season after rollout, 9 of 10 AFLW clubs used some or all parts of Prep to Play PRO; 1 club did not, believing it already included all components.
• Recommended program dosage exceeded existing guidelines: warm-up 45 to 90 min/week, strength 30 to 90 min/week, and injury prevention 30 to 60 min/week.
• No changes to the 5 core program concepts were suggested by early implementers, and the education manuals were reported as clear and helpful.

Limitations

• The program was developed rapidly, leaving implementers little time to incorporate it into their season.
• Head coaches were not involved in co-creating the program, and off-season access to teams was limited.
• This is a development and early-uptake report, so it does not test whether Prep to Play PRO actually reduces ACL or other injuries.
• Findings reflect a single league and a small number of clubs, limiting how widely the specific program generalizes.

Why it matters

For patients

If you play in a women's football or similar high-risk sport, ask whether your team uses a structured, evidence-based injury-prevention program built into regular training.

For clinicians

The 7-step, stakeholder-engaged process offers a practical template for co-creating and rolling out a context-specific injury-prevention program that teams will adopt.

For readers

It shows that getting an injury-prevention program adopted depends as much on partnering with the organization and tailoring to the sport as on the exercises themselves.