Perinatal physical activity has been shown to have numerous benefits. Pregnancy leads to physiologic changes in nearly every organ system to support the uterus and fetus. There is strong evidence to support the safety of low, moderate, and intense exercise in pregnancy for people with all physical activity backgrounds. More sedentary populations are encouraged to start a low-intensity exercise regimen with a gradual progression. Evidence supports that postpartum physical activity has significant health advantages even as the physiologic changes of the body are resetting. Various return to activity guidelines exist to guide a safe return to exercise.

Stress fractures are fatigue fractures of bone that result from an overuse mechanism. These injuries present most commonly in the legs and feet of distance runners and military personnel but can also occur in the upper extremity and the spine depending on the causative activity. Nutritional, hormonal, and biomechanical factors influence the development of bone stress injuries, and no two bone stress injuries behave identically. A thorough history, detailed physical examination, and proper imaging are required to diagnose and classify these injuries. Management of stress injuries requires nutritional and emotional support, rest from the causative activity, and occasionally surgical intervention.

Relative energy deficiency in sport, previously known as the female athlete triad, is under-recognized by coaches, physicians, and the medical team. It is a multifactorial clinical syndrome driven by problematic low energy availability (LEA) in the athlete. LEA is the underlying etiology that results in body system dysfunction including physical and psycholgical function as well as an increase in injuries and decline in performance. There are risk assessment tools that can be used to triage and manage the female athlete, and treatment often requires a multidisciplinary approach.

Artistic gymnastics is a demanding sport that puts unique stressors on the female athlete's body, predisposing them to certain acute and chronic conditions. Intense and repetitive upper extremity weight-bearing, particularly in skeletally immature gymnasts, can contribute to capitellar osteochondritis dissecans and distal radial physeal injuries. Repetitive lumbar hyperextension and rotation can contribute to spondylolysis. Physicians treating adolescent idiopathic scoliosis in gymnasts may consider additional counseling or modified treatment to maximize outcomes while aligning with athletic goals. Physicians treating elite-level gymnasts should be aware of training demands and the history of pervasive mistreatment within the sport.

Volleyball is a highly popular women's sport played recreationally and competitively by a wide variety of ages. Game play requires agility, power, flexibility, and stamina to succeed. Although injury rate is lower compared to other team sports, athletes are still predisposed to acute injuries of the ankle and overuse injuries of the shoulder and knee. Injury patterns differ based on player subspecialty and playing surface. Most injuries are amenable to nonoperative treatment and require little time removed from play.

Softball continues to grow in popularity within the United States. With the growth of the sport and specific movements required for sport, there are most common injury patterns seen among these athletes. The windmill pitching motion is specifically associated with a certain subset of injuries. The goal is to better understand these injury patterns so that we can better manage these athletes and allow for safe and effective return to competitive levels of sport.

Swimming is a popular sport at both domestic and international levels. Over the last 40 to 50 years, there has been an increased focus on swimming injuries and the risk factors associated with them. While the bulk of the work has been done identifying and classifying injuries of the shoulder, given the whole-body nature of the sport, numerous other sites have been reported. Fortunately, the majority of these are overuse in nature, and the need for surgical management remains relatively low.

Psychological readiness in return to sport has been recently identified as an important factor in addition to physical function. A number of psychological factors have been identified; however, fear of reinjury (ie, kinesiophobia) has been identified as an important risk factor associated with worse outcomes related to return to sport. Several validated questionnaires and surveys are available to evaluate psychological factors. Return to sport following shoulder instability and anterior cruciate ligament reconstruction is an important area of study. There are many factors, including gender, that affect an athlete's ability to return to sport following surgical intervention.

Injury prevention is an important aspect of female sports and requires a multi-disciplinary approach. This article provides a general overview of extrinsic and intrinsic risk factors for injury, focusing on female sex-specific risk factors that should be acknowledged in young athletes. We also discuss the importance of pre-participation physical examinations, injury prevention programs, and promoting well-balanced diets and training schedules in athletes to maximize performance while minimizing injury risk.

Female athletes are susceptible to traumatic anterior shoulder instability, possibly due to higher levels of ligamentous laxity leading to soft tissue capaciousness. Rates of shoulder instability are near equal between male and female athletes. Rehabilitation is the initial treatment to improve scapular stabilization and rotator cuff strengthening. If conservative treatment fails, surgical treatment includes arthroscopic versus open Bankart repair for anterior shoulder instability. Surgical intervention for multidirectional instability may include open inferior capsular shift or arthroscopic capsular plication. Postoperative rehabilitation focuses on regaining the full range of motion and strength to pre-injury values before returning to performance.

Ankle sprains are a very common injury in the athletic population, with up to 30% of acute ankle sprains progressing to chronic ankle instability. Female athletes are at greater risk of developing chronic lateral ankle instability, likely secondary to hormonal fluctuations. Despite this, further work is needed to investigate the relationship between gender and chronic lateral ankle instability. When conservative management fails, surgical reconstruction of the lateral ligaments, typically in the form of an open modified Brostrom-Gould procedure, is required to restore stability. Recent evidence suggests arthroscopic Brostrom-Gould procedure may be the new gold standard.

The spectrum of hip pathology treated by hip preservation surgery ranges from femoroacetabular impingement to hip dysplasia. Borderline hip dysplasia (BHD) represents a challenging diagnosis where the surgical indication is not always clear. BHD is a complex pathology which presents challenges in surgical decision-making between hip arthroscopy and open surgery, specifically periacetabular osteotomy. Research has shown efficacy for both isolated hip arthroscopy and/or periacetabular osteotomy as a treatment option in the appropriately selected patients.

Patellofemoral pain and instability are debilitating conditions, most commonly presenting in a young, predominantly female patient cohort. Assessment of underlying pathophysiology requires a detailed history, focused physical examination, and proper assessment of advanced imaging. Treatment, both operative and nonoperative, is focused on reducing the risk of recurrent instability and chondral damage, to provide a patient with a pain-free, stable knee. It is essential to have a comprehensive understanding of the patient's demographic and anatomic risk profile to best determine the most appropriate and effective treatment course and mitigate their risk of recurrence.