## 9 Multicomponent Injury Prevention Programs in Youth Female Soccer: A Key Strategy for Athletes
Notable examples include the FIFA 11+ [108], the Prevent Injury and Enhance Performance (PEP) program [107], Knakontroll [1], and Footy First [72], which, by targeting key movement patterns and incorporating sport-specific exercises, play a pivotal role in promoting safer, more effective athletic performance. While some studies report inconsistent outcomes due to small sample sizes and low compliance [109], most demonstrate significant benefits. For instance, [PERSON] et al. [110] observed reduced overall injuries (25 vs. 31) and knee injuries (11 vs. 15), and [PERSON] and [PERSON] [111] reported decreases in overall (27 vs. 61) and ankle injuries (8 vs. 23). Similarly, ACL-specific reductions were noted in studies by [PERSON] et al. [112] and [PERSON] et al. [73]. Programs specifically designed for younger players, such as FIFA 11+ and FIFA 11+ Kids, have shown remarkable outcomes, including no ACL injuries and a reduction in overall injuries (5 vs. 7) among U9 to U13 players [74] and fewer overall injuries (161 vs. 215) and knee injuries (35 vs. 58) in under-15 and under-16 teams [6]. For older youth players, [PERSON] et al. [1] found a 64% reduction in ACL injuries among adolescent female soccer players through a twice-weekly neuromuscular warm-up program targeting core strength, balance, landing technique, and proper knee alignment. Key improvements in knee valgus, hip abductor strength, and core stability contribute to better movement control, enhanced landing mechanics, and reduced injury risk [113]. These improvements likely contribute to better control during landing, allowing athletes to absorb ground reaction forces more effectively and reduce the risk of injury [114]. Early introduction of neuromuscular training mitigates growth and maturation risks, including knee valgus, and improves leg stiffness and stability through glyometric exercises [115]. Furthermore, the observed improvements in leg stiffness, which are enhanced through glyometric exercises, highlight how neuromuscular training contributes to the stretch-shortening cycle, increasing stability during landing and reinforcing the long-term injury prevention benefits for female youth athletes [116; 117]. However, these benefits are strongly tied to maintaining high compliance rates, as consistent adherence is critical to achieving these outcomes [118]. Finally, while neuromuscular programs are highly effective in reducing lower-limb musculoskeletal injuries, further specificity in training, such as progressive hip adductor strengthening, load management strategies, and soccer-specific skill development, may enhance their ability to address particular injury mechanisms, particularly for knee, ankle, and hip/groin injuries [119]. Finally, tailoring neuromuscular programs with increased specificity can significantly improve their efficacy in addressing particular injury mechanisms, particularly for high-risk female youth players. The study by [PERSON] et al. [113] highlights that multi-component training programs, incorporating strength, glyometrics, stabilization, and balance exercises, lead to significant improvements in key injury risk factors such as knee valgus, leg stiffness, and high knee abduction moment. Importantly, these benefits are more pronounced among high-risk athletes, classified by elevated knee valgus probabilities, compared to their low-risk counterparts. For instance, high-risk players experienced a 30.3% reduction in knee valgus compared to 12.2% in low-risk players, underscoring the greater responsiveness of those at higher risk to targeted interventions. These findings suggest that identifying and prioritizing high-risk individuals for tailored training can maximize the preventive potential of neuromuscular programs. Additionally, these findings emphasize the need to assess individual responses to such programs, even when a team approach to prevention is used, emphasizing the importance of individualization in injury prevention strategies.