Injuries in Female American Football Players from 2015 to 2024: An Age-stratified Epidemiological Analysis

BACKGROUND: American football has seen growing participation by women. In 2023, 474,000 females aged 6–17 participated in flag football, and the number of high school-aged females registering for tackle football rose by 5.6% compared to 2022. Unfortunately, female football players remain understudied in the injury prevention literature, limiting our understanding of the potentially unique risks that they may face. This study sought to describe injury patterns among female football players, with a particular emphasis on characterizing the relationship between player age and injury. METHODS: The National Electronic Injury Surveillance System database was queried for football-associated injuries in female patients from 2015 to 2024. Patients were stratified into three groups—those aged 6–13 (“youth”), 14–18 (“high school”), and 19+ (“adult”). National estimates were calculated for injuries by location and by diagnosis for each age group. Chi-square tests assessed for differences in injury location and diagnosis between groups. RESULTS: Between 2015 and 2024, an estimated 176,831 football-related injuries were treated in U.S. emergency departments. The hand was the most common site of injury, comprising 48.2% of injuries in youth, 35.8% in high school, and 31.6% in adult athletes. Sprains/strains were the most common injury diagnosis across all age groups, accounting for 30.3%, 33.5%, and 29.6% of injuries in youth, high school, and adult female football players, respectively. Fractures and injuries to the hand, elbow, and upper extremity made up a greater proportion of injuries in youth athletes compared to high school and adult athletes. However, injuries to the knee and lower extremity were proportionally less common in youths. Concussions and strains/sprains were proportionally most common in high school athletes. Dislocations, shoulder injuries, and trunk injuries were most common in adults. CONCLUSION: : Female football players experience differing injury patterns by age group. Notably, these patterns frequently differed in direction and/or magnitude from those reported in mixed-sex populations, where risk profiles specific to female football players may have been obscured by the larger number of males. Future studies should utilize these results to inform the development of age- and sex- specific injury prevention protocols and clinical guidelines.