Sport-related concussion knowledge and attitudes of staff working in English elite women's football: a survey-based study.

BACKGROUND: Sport-related concussion (SRC) remains an injury of concern in sport, including football(soccer). There has been little investigation into SRC knowledge and attitudes of support staff working in the professional setting. METHODS: An amended version of the Rosenbaum Concussion Knowledge and Attitudes Survey(RoCKAS) was distributed online to coaching staff, and medical and performance staff, working at clubs in the English Football Association Women's SuperLeague (WSL) and Championship. Completion of the survey generated two scores: concussion knowledge index (CKI) and concussion attitudes index (CAI). RESULTS: Sixty-three completed surveys were returned. Eighteen respondents were coaching staff, and 45 were medical and performance staff. The median CKI in medical and performance staff was significantly greater than in coaching staff. There was no significant difference in CAIbetween coaching staff and medical and performance staff. There was no correlation between CKI and CAI across all staff. CONCLUSION: Medical and performance staff working in elite women's football have greater knowledge of SRC than coaching staff. However, this does not always translate into safe behaviours on the field. Education should continue to be mandated across the professional game amongst support staff in order to maximise player welfare and enhance injury outcomes, whilst also reinforcing present SRC guidance.

Psychology research in women's soccer: a scoping review.

Previous research suggests that psychological factors play an important role in trying to explain and predict the participation, performance, and health of player and practitioners in soccer. However, most previous works have focused on specific research questions and included samples from male populations. As part of a larger Fédération Internationale de Football Association (FIFA) project aiming to steer women's soccer research, our purpose with this scoping review was to give an overview of the current state of psychology-related research within women's soccer. We searched five electronic databases up to April 2023, from which 280 original peer-reviewed articles met the inclusion criteria. Included records were inductively coded into 75 specific research topics and nine broader research categories. Population characteristics within each topic and category, and overall publication trends, were identified. The results revealed a growth in research attention, with notable increases in publication rates around the international competitions years, over the last two decades. While a notable number of abstracts did not report sufficient details about population age and/or playing levels, senior elite players were identified as the most common population studied. Most studies examined several topics from different research categories, with research focusing on emotions, moods and/or environmental factors, and the specific the topics of anxiety, stress, and coach behavior, receiving most research attention. Our study provides an informative mapping of all psychology-related research activity within women's soccer, which will enhance researchers' understanding of the current quantity of literature within this complex, heterogeneous, and growing area of research.

Research on women's football: a scoping review.

AIM: This study aims to scope available peer-reviewed literature published in a FIFA language to understand the current quantity of research on women's football. METHODS: Five databases were searched on the 15/12/2019. Studies were included when containing original research published in a peer-reviewed journal around female competitive football of any level, any age and on any subject. Author, journal, title and abstract of all included studies were scoped. Population assessed number of participants, level of play, age level of football and publication theme(s) were extracted. RESULTS: A total of 1,634 articles were scoped. The oldest publication dated back to 1939, whilst a total of 202 studies were gathered from 2019. The publication theme most frequently researched was sports medicine (N = 521) followed by strength and conditioning (N = 331) and sociology (N = 299). The majority of studies has focussed on elite (N = 442), senior (N = 977) players. CONCLUSION: A continuous growth in research attention has been seen. However, the numbers are not comparable to current research output levels in men's football. This study represents an essential first step in a larger 'research agenda-setting' project to determine research priorities for women's football during the next 10 years.

Elite female football players' perception of the impact of their menstrual cycle stages on their football performance. A semi-structured interview-based study.

OBJECTIVES: This study assesses how female footballers perceive how their menstrual cycle impacts their physical and psychological performance, informing future research and intervention. METHODS: Semi-structured interviews, developed using piloting and peer review took place with fifteen elite female footballers from two English WSL clubs (age: 25.2 [18-33]). Data was audio recorded, transcribed verbatim, and analysed thematically using NVivo. RESULTS: All players (100%) perceive their menstrual cycle to negatively impact performance. Analysing 27,438 words of data revealed five themes: A) symptoms, B) preparation, C) performance, D) recovery, and E) management. Over half (53%) of players experienced decreased appetite and sleep quality prior to performance during menstruation. Competitive performance was perceived to be most negatively impacted during menses (54 references) following by the pre-menstrual stage (23 references). During menstruation, the most impacted physical performance indicators were power (93%) and fatigue (87%). Psychologically, confidence, focus, and reaction to criticism were commonly affected (66.7%). Players reported missing training (13.3%) and matches (13.3%) due to severity of impact. Recovery was affected during the pre-menstrual (26.7%) and menstrual (66.7) stages. Players self-manage symptoms using over the counter (66.7%) and prescription (26.7%) medication, some prophylactically prior to competition (46.7%). CONCLUSIONS: This first attempt to ascertain player perception in football exposes a clear negative impact on performance. The complex interplay of biopsychosocial and logistical factors, lack of awareness and education highlight the need for further research. Intervention is necessary and immediate initiation would be prudent, starting with simple measures such as basic self-management advice, education, and provision of sanitary products.

Sport-related concussion attitudes and knowledge in elite English female footballers.

BACKGROUND: Sport-related concussions (SRC) are more common and more severe in women's football than men's yet the knowledge and attitudes of SRC in the women's game are not well understood. The objective of this study was to assess the SRC knowledge and attitude in elite female footballers. METHODS: An online questionnaire was sent to all registered players in the English Football Association Women's Super League (WSL) and Championship. Respondents completed an amended version of the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS). Concussion Knowledge Index (CKI) and Concussion Attitudes Index (CAI) scores were derived for all respondents. RESULTS: One hundred and twenty-three players completed the survey with 111 fitting the inclusion criteria. The mean CKI score was 20.5 ± 2.3 and the mean CAI score was 63.3 ± 6.3. A weak positive correlation was shown between the CKI and CAI (r = 0.20; p = 0.03). Previous concussion education had a significant impact on increased knowledge (U = 1198; p = 0.04). There was no significant difference in concussion attitudes and knowledge between the WSL and Championship or in those with a previous concussion history and no previous concussion (p > 0.05). CONCLUSION: Previous SRC education demonstrated an increased knowledge around concussion but a limited impact towards concussion attitudes. It is suggested that concussion education should be mandated across the professional game to enhance player welfare.

Non-steroidal anti-inflammatory drugs in football - a "Keeping SCORE" approach to judicious use.

Non-steroidal anti-inflammatory drug (NSAID) use in elite sport is high, with football being no exception. Increased awareness of significant adverse drug reactions from published research and retired players commentary in the media have made the topic mainstream. Despite this increased awareness, usage rates show no sign of significantly reducing. Footballers, like all elite athletes are focused on maximising their performance and potential - even at the expense of their long-term health. An educational intervention prior to the 2010 FIFA Men's World Cup aimed at reducing rates was ineffective, suggesting that education alone is not the answer. Our author group propose a 'safer use' rather than 'no use' of NSAIDs in football. A 'Keeping SCORE' approach is suggested, designed as a prescribing aid. The approach guides medical staff towards focusing on Safety checks, Clinical indication/judgement, Open dialogue, Recording, and Evaluation.

The impact and experienced barriers menstruation present to football participation in amateur female footballers.

This study (1) assessed the impact different stages of the menstrual cycle has on experienced football performance and exercise ability (2) identified the experienced barriers to football participation menstruation presents in amateur women footballers. An online survey was used. The inclusion criteria were non-professional, women currently experiencing regular menstrual cycles, ≥18 years, ≥60 min football/week in the UK. Descriptive statistics were performed on quantitative data and thematic analysis of the open-ended questions. 127 responses were included. Most of the respondents were aged between 18-25 (89%), Caucasian (83%) and competing in Universities Leagues (69%). Menstruation was reported to "never" limit football playing in 17%, "sometimes" in 47%, "rarely" in 25% and "always" in 10% of respondents. The majority (73%) reported one or more barriers menstruation present to football participation. Following thematic analysis, 165 meaning units, 23 themes and seven categories were identified. Confidence and aerobic capacity/endurance were identified to be the aspects most negatively impacted during the pre-menstrual and menstrual stages. Confidence is likely to be negatively impacted due to the barriers identified. Thus, recommendations on how to reduce these through education of players and involved staff, at the club and the FA level have been made.

Sport-related concussion return-to-play practices of medical team staff in elite football in the United Kingdom.

INTRODUCTION: This study explored sport-related concussion (SRC) return-to-play (RTP) behaviours and attitudes of medical team staff working in elite football in the United Kingdom. Usage and awareness of The Football Association (FA) guidelines, concussion education rates of players and coaching staff, and collection of baseline concussion assessments. Additionally, confidence in managing RTP post-SRC, perceived player under-reporting of symptoms, use of enhanced RTP pathways, and coaching pressure on RTP were investigated. METHODS: A cross-sectional questionnaire study was distributed online by organisations including or representing medical staff working in elite football in the United Kingdom. RESULTS: A total of 112 responses were gathered. High awareness rates of the FA guidelines were found (96%) with variable rates of player and coaching staff concussion education. Baseline concussion assessments were collected by 80% of respondents with 93% feeling very confident or confident in managing the RTP of a player with a SRC. 60% rarely or never experienced coaching pressure around player RTP, and 24% felt players always or very often under-reported symptoms to expedite their return. 90% had a moderate to high confidence in the Sport Concussion Assessment Tool-5 (SCAT-5) as a RTP decision tool, and 66% always or very often used an enhanced RTP pathway. CONCLUSION: Confidence in managing player RTP post SRC and use of enhanced RTP pathways were high, as was confidence in the SCAT-5 as a RTP decision tool. Respondents raised concerns around player under-reporting of symptoms to accelerate RTP post-SRC, and perceived coaching pressure around decision making.

Sport-related concussion practices of medical team staff in elite football in the United Kingdom, a pilot study.

OBJECTIVES: To explore sport-related concussion (SRC) awareness, behaviours, and attitudes of medical team staff working in elite football in the United Kingdom. Including usage and awareness of the FA concussion guidelines, concussion education rates of players and coaching staff, and collection of baseline concussion assessments. METHODS: Cross-sectional questionnaire study distributed online by organisations including or representing medical staff working in elite football in the United Kingdom. RESULTS: 120 responses were gathered. High awareness rates of the FA guidelines were found (97%) with variable rates of player and coaching staff concussion education. Baseline concussion assessments were collected by 78%. Of those, 99% collected SCAT5 with low rates of other neuro-psychometric testing (17%). Confidence of pitch-side SRC recognition was high (93% feeling very confident or confident). Introduction of a 'concussion' substitute was seen as strongly positive for player welfare (85% strongly agreeing or agreeing). CONCLUSIONS: Awareness of FA concussion guidelines, and collection of SCAT5 baseline testing was high. Player and coaching staff concussion education rates were low, as was the use of neuro-psychometric testing beyond the use of the SCAT5. There was strong support the introduction of a 'concussion' substitute being a positive thing for player welfare.

An Updated Systematic Review of Turnout Position Assessment Protocols Used in Dance Medicine and Science Research.

Turnout, or external rotation of the lower limbs, is an integral part of classical ballet technique. Contributions of lower limb structures to turnout can be separated into HER (hip external rotation) and NHCTO (non-hip contributions to turnout). This study aimed to review systematically methods used to measure turnout in dance medicine and science research, thereby updating the literature since the Champion and Chatfield review of 2008. CINAHL, EMBASE, PubMed, and Web of Science were searched in January 2018 by two independent reviewers. Peer-reviewed studies measuring turnout in dance were included, except those published prior to March 23, 2006, as that was the last date of publication included in the previous review. Abstracts, theses, and editorials were excluded. From each study, study design, population (sample size, sex, age, genre of dance, and level of training), details of the protocol used, and result of turnout measurement were extracted, as well as reliability data. All included studies were assessed for risk of bias, using either Newcastle-Ottawa scale, AXIS tool, or PEDro scale as appropriate for each study design. A total of 41 studies met the inclusion criteria. Twenty-eight studies measured HER, nine measured NCHTO, and 22 measured total turnout (TTO). An increased number of studies investigated TTO (N = 22; N = 4 passive TTO) and NHCTO (N = 9) since 2006. All studies scored above half the points attainable from their respective tools. Results suggest HER remains the most common protocol for measuring turnout (N = 28), despite the fact it disregards input from structures below the hip. It is concluded that researchers should focus on quality of reporting of protocols to ensure repeatability and facilitate comparison of results. Future studies should include absolute reliability and validity testing of all currently used protocols so that standardization can be fully achieved.

Physical performance and perception of foot discomfort during a soccer-specific match simulation. A comparison of football boots.

Football boots are marketed with emphasis on a single key performance characteristic (e.g. speed). Little is known on how design parameters impact players' performance. This study investigated the impact of boot design on performance maintenance and perceived foot comfort during a 90-minute match simulation drill. Eleven male university football players tested two commercially available "sprint boots" known to generate significantly different plantar pressures (high=Boot H and low=Boot L) . Players completed a modified Soccer-specific Aerobic Field Test on a 3G pitch. Heart rate, rated perceived exertion and perceived foot discomfort were assessed for each 15-min interval. Power generation was assessed pre- and post-match simulation. A significantly higher mean heart rate was seen for Boot L in the 60th-75th and 75th-90th minute intervals (P = 0.017, P = 0.012 respectively). Perceived exertion did not differ between boots (P ≥ 0.302). Power generation significantly decreased in Boot H between pre- and post-match (P = 0.042). Both boots increased discomfort with significantly more plantar discomfort felt in the last 30 min in Boot H (75th min: P = 0.037; 90th min: P = 0.048). The results imply that a comfortable boot design may improve maintenance of performance during match-play.

A systematic review on methodological variation in acute:chronic workload research in elite male football players.

Objectives: To investigate and evaluate the methodological variation in research on acute:chronic workload ratio (ACWR) and injury in elite male football players.Methods: Relevant literature was electronically searched on PubMed, Web of Science, ScienceDirect, and Embase. Additional literature was obtained from studies' bibliographies and authors. Cohort studies investigating the effects of ACWR on male elite footballer injuries were included. Information regarding study population, time frame, protocol, injury classification, and statistical analysis were elucidated.Results: Database searches led to 2,689 articles. After full text screening, twelve articles remained. All studies were of poor quality. Five studies had GPS-derived workload measures with consideration of running intensity zones, though little consensus over zone thresholds were found. Nine studies incorporated rated perceived exertion data; heterogeneity in exposure type and data collection timing was observed. All studies applied rolling average ACWRs, exploring 1:2, 1:3, and 1:4-week load ratio windows. Differences in data grouping, inference or regression analysis, and other statistical methods were noted.Conclusion: Existing literature displayed methodological heterogeneity. Future studies should consider consulting guidelines for developing prognostic studies and further examine causal links between workload and injury. From that basis, decisions around ACWR definitions, workload measures, and statistical methods may be more appropriately made.

Can subjective comfort be used as a measure of plantar pressure in football boots?

Comfort has been shown to be the most desired football boot feature by players. Previous studies have shown discomfort to be related to increased plantar pressures for running shoes which, in some foot regions, has been suggested to be a causative factor in overuse injuries. This study examined the correlation between subjective comfort data and objective plantar pressure for football boots during football-specific drills. Eight male university football players were tested. Plantar pressure data were collected during four football-specific movements for each of three different football boots. The global and local peak pressures based on a nine-sectioned foot map were compared to subjective comfort measures recorded using a visual analogue scale for global discomfort and a discomfort foot map for local discomfort. A weak (rs = -0.126) yet significant (P < 0.05) correlation was shown between the peak plantar pressure experienced and the visual analogue scale rated comfort. The model only significantly predicted (P > 0.001) the outcome for two (medial and lateral forefoot) of the nine foot regions. Subjective comfort data is therefore not a reliable measure of increased plantar pressures for any foot region. The use of plantar pressure measures is therefore needed to optimise injury prevention when designing studded footwear.

Medical reasons behind player departures from male and female professional tennis competitions.

BACKGROUND: The number of retirements, withdrawals, and "lucky losers" (the replacement of a player who withdraws before the start of the tournament by a losing player from the qualifying round) from professional tennis tournaments has increased, but the reasons behind such departures have not yet been analyzed. An official consensus statement has been conducted to allow a general categorization of injuries in tennis. PURPOSE: To determine the reasons for departure and injury rates in professional tennis. STUDY DESIGN: Descriptive epidemiology study. METHODS: All reasons for departures were collected from official Association of Tennis Professionals (ATP) and Women's Tennis Association (WTA) web pages. All tournaments apart from the 4 major competitions (the Australian Open, French Open, Wimbledon, and US Open) were included for the period 2001-2012 for men and women. Personal data, tournament information, surface, match setting, date, and reason were obtained for each departure scenario. RESULTS: Variations in departure and injury rates were seen throughout the season. Women left and were injured significantly more than men. Women mainly left because of thigh injuries, whereas men left mainly because of back injuries. Playing surface only had an influence on the risk of lower back injuries. Only women's departures were affected by the tournament round. CONCLUSION: A high number of departures from tournaments have occurred during the past 10 years on the ATP and WTA circuits. Injuries were the main reasons of these departures, regardless of the type of departure and player sex. The back and thigh were the main locations of injuries for men and women, respectively.