Steve Den Hollander

Objective: To determine the neurocognitive functions of women professional football players and explore their potential connection to concussions. Methods: An observational cross-sectional study was conducted via electronic questionnaires. Neurocognitive function was assessed with the “CNS Vital Signs” testing tool. Results: In total, 68 participants performed the neurocognitive function testing. Compared with the reference population, players scored within the average range (≥90) for 11 of 12 neurocognitive domains. Motor speed was above average (SS = 111.7). Overall, no significant neurocognitive deficits were observed. Thirty-two participants (43%) reported one or more concussions, with defenders being most affected (50%). Among defenders, 64% (n = 16) have a history of one or multiple concussions. Players with a history of three concussions showed significant deficits in the simple attention domain. Conclusion: Professional women footballers did not show significant signs of neurocognitive function deficits. However, a history of three concussions was significantly associated with lower standard scores for the simple attention neurocognitive domain.

Given the challenges and concerns associated with the congested schedule dictated by the International Match Calendar (IMC), there is a need for a player‐centric expert position statement with specific recommendations and guidance related to the key dimensions of the IMC in men's professional football. Following a review of scientific and occupational health literature and surveys of players and staff in professional football, 19 statements across 6 key dimensions of the IMC were formulated. The statements were then reviewed and refined through a three‐round Delphi study, engaging experts to a consensus‐based position statement. Expert consensus was reached on 12 statements across 5 key dimensions of the IMC: in‐season rest and recovery, off‐season break, mid‐season break, travel, and young player workload. Although consensus was not reached on statements related to match workload, 69% of experts agreed on the need for a maximum limit of matches per player per season. The expert position statement provides recommendations and guidance on structural safeguards within the IMC that prioritize the long‐term health and performance of players.

To compare the probability of tackle success (the tackler preventing the ball‐carrier and ball from progressing towards the tackler try‐line) when contacting the ball‐carrier at different heights (shoulder, mid‐torso and legs) for different types of tackles (active, passive, smother and arm) while accounting for other tackler situational factors within seven playing levels. Video footage of 271 male rugby union matches were analysed across seven playing groups (Under [U] 12, n = 25 matches; U14, n = 35; U16, n = 39; U18 Amateur n = 39; U18 Elite n = 38; Senior Amateur, n = 40 and Senior Elite, n = 50) across England, New Zealand, South Africa, Portugal and USA (a total of 51,106 tackles). A multi‐level logistic regression model with tackle success as the outcome variable and first point of contact and type of tackle as the explanatory variables were computed. Included in the model as cofounders were the situational variables tackle direction, tackle sequence, number of players in the tackle and attacker intention. Post‐estimation marginal effects were used to calculate the probabilities (expressed as a percentage %) of tackle success for each interaction between tackle type (active shoulder, smother, passive shoulder and arm) and the first point of contact (shoulder, mid‐torso and legs). The probability of tackle success in relation to where the ball‐carrier is contacted varied by tackle type and within each age group. The probabilities (Pr) for contacting the shoulder versus mid‐torso at the senior levels (elite and amateur) did not differ in relation to tackle success (for instance, for active shoulder tackles within senior elite; shoulder Pr 86% 95% CI 82–89 and mid‐torso Pr 82% 95% CI 77–86), whereas at the junior levels, contacting the shoulder had a higher probability than other points of contact. Active shoulder tackles had the highest probability of tackle success across the different playing levels across the different contact heights, whereas arm tackles had the lowest probability (for instance, for mid‐torso tackles within senior elite, active Pr 82% 95% CI 77–86 vs. arm Pr 69% 95% CI 64–75). Coaches and practitioners can use this information to improve tackle training design and planning within the different age groups and facilitate player development.

Background: Elite athletes encounter various situations and conditions that may disrupt their sleep, a crucial factor for optimal performance and well-being. Objectives: The aim of this study was to synthesise existing research on the effect of sleep interventions on sleep quantity and quality in elite sports and to provide evidence-based guidance for athletes, coaches, and other stakeholders in elite sports who seek to enhance sleep quantity and quality. Methods: This review followed the PRISMA guidelines, whereas the search was executed in September 2023 utilising the electronic databases SCOPUS, PubMed and Web of Science. Studies were included if they met the inclusion criteria. Results: A total of 1014 studies were retrieved from the databases, and data extraction was performed on 32 studies. The included studies evaluated sleep hygiene education/strategies, acute cold exposure, light therapies, supplementation, neurostimulation/neurofeedback, and other (mindfulness and massage therapy) strategies. Sleep hygiene education was the most effective intervention to improve sleep quantity. Supplementation and light therapy interventions showed improved sleep quality and quantity. Additionally, cold water immersion and mindfulness showed improved sleep quality, but further studies are required for confirmation. Conclusion: Future research should use reliable and valid methods to improve the quality of evidence and ensure conclusive findings.

Women's football has grown in popularity, competitiveness and professionalism, increasing the demands placed on players and their injury risk. This study aimed to identify differences in the match workload and international travel between injured and non‐injured professional women's footballers. The study was conducted as an observational, retrospective, case‐control study over two football seasons (2021/2022 and 2022/2023) in four top‐tier European women's football leagues. Fifty‐eight professional women football players (81 injuries) formed the injury group and were matched with 81 elite women football players (162 non‐injuries), from the same league, to form the control group. For each injury, cumulative match workload (minutes played, appearances, days between matches, rest) and international travel (distances, time, time zones crossed) were calculated over a 28‐day period preceding the injury, for both the injured players and matched controls. The injured group had a higher number of instances of less than 5 days between matches compared to the controls (p = 0.03, effect size = 0.3, small). The anterior cruciate ligament injury group made more appearances (p = 0.09, effect size = 0.8, moderate), had more instances of less than 5 days between matches (p = 0.09, effect size = 0.8, moderate) and had less rest time (p = 0.12, effect size = 0.8, moderate) than the control group. No meaningful differences were observed between the hamstring injury group and the control group. These findings underscore the importance of careful consideration when developing match fixture schedules in elite women's football, particularly concerning the number of matches scheduled in a short period. Strategies to increase rest and recovery are recommended to safeguard players against injuries.

There are concerns over the impact of the congested international match calendar on professional footballers’ physical and mental well-being, and injury susceptibility. This study aimed to determine whether there were differences in match workload and international travel between injured and non-injured male football players over two elite competition seasons. An observational, retrospective, case–control study was conducted using data from the 2021/2022 and 2022/2023 seasons of five top-tier European men’s football leagues. Student t-tests were used to compare cumulative match workload and international travel data over a 28-day period preceding 1270 injuries and 2540 controls. There were significant differences in match workload and international travel variables between the injured groups (all injuries and hamstring injuries) and the control group. Match workload variables were higher (p < 0.01), recovery variables lower (p < 0.01), and international travel variables higher (p < 0.01). An overload of match workload and international travel contribute to increased injury susceptibility in professional men’s football. This emphasizes the need to address international match calendar concerns, including the number of games per season, the frequency of back-to-back games, and international travel requirements. Additionally, the findings highlight the importance of monitoring player match workloads, and implementing squad rotations and tailored training programs to mitigate injury risks.

Objectives: The primary objective of this study was to describe the self-reported reproductive health of retired elite women’s footballers with specific reference to menstrual function, pregnancy and motherhood, contraceptive use and pelvic floor function. Methods: An electronic survey was disseminated to women’s footballers (18 years or older) who had retired from elite football within 10 years of completing the survey. Results: 69 respondents completed the survey (mean age 35.8 years, mean age at retirement 30.3 years). One-third of participants self-reported experiencing at least one episode of amenorrhoea (>3 months without menstruation) for reasons other than hormonal contraceptive use or pregnancy. Three participants (mean age of 41 years, range 30–54) reported having reached menopause at the time of the study. 54 (78.3%) participants were not using any form of contraception. 17 (24.6%) of the participants are mothers (range 1–3 children). 51 of the participants (73.9%) had never been pregnant, and the majority of those who had been pregnant (86.7%) became pregnant in less than 2 years following the onset of desire for pregnancy. Four of the retired players gave birth during their playing career, and the mean time to return to competitive matches following delivery was 22 weeks. The mean Pelvic Floor Distress Inventory-20 score for participants was 72. Conclusion: These insights can be used to inform future efforts to promote positive reproductive health outcomes for current, former and future women’s footballers. Research efforts should focus on improving the understanding of how to effectively support women’s footballers in the perinatal period. Best practice guidelines on the use of menstrual cycle monitoring and pelvic health support would improve standards of care for women’s footballers. Stakeholders should consider gender-specific postretirement care for women’s footballers.

Objective: To determine the neurocognitive function of active professional male footballers, determine whether deficits/impairments exist, and investigate the association between previous concussion(s) and neurocognitive function. Methods: An observational cross-sectional study conducted via electronic questionnaires. The CNS Vital Signs online testing system was used to evaluate neurocognitive function. Results: Of the 101 participants, 91 completed the neurocognitive function testing. Neurocognitive function domain deficits or impairments were unlikely in 54.5–89.1%, slight in 5.9–21.8%, moderate in 1.0–9.9%, and likely in 4.0–14.9% of participants. A history of zero concussions found a significant association between the neurocognitive index (Odds Ratio [OR] 0.6; 95% CI 0.2–0.4) and complex attention domain (OR 0.3; 95% CI 0.1–0.9), with 40% and 70% less odds, respectively, of deficit/impairment. Among the 54.5% who reported any number of concussions, there were increased odds of neurocognitive domain deficits/impairments for complex attention (CA) [3.4 times more] and simple attention (SA) [3.1 times more]. Conclusion: In the active professional male footballer, most neurocognitive functions do not have significant deficits/impairments. The odds of neurocognitive function deficit/impairment were significantly increased threefold for CA and SA in those who reported a history of any concussion(s).

Background: Rugby is a physically demanding sport with a high injury rate. Professional male rugby players have a notably greater risk of sustaining injuries that require hospitalisation or surgery than male athletes from non-contact sports. Retired elite male rugby players experience physical and mental health conditions as well as varying levels of pain, negatively impacting their quality of life. Retired rugby players could use medication or substances as a coping mechanism to deal with chronic pain and a lower quality of life. However, research is scarce on how retired rugby players manage pain and how this affects their quality of life. Objectives: This study aimed to understand joint pain and impairment, mental and physical quality of life, and pain medication use in retired professional male rugby players. Methods: A cross-sectional study was conducted using a questionnaire completed by retired professional male rugby players. Joint pain and impairment were explored through three questions, health-related quality of life was assessed through the PROMIS-GH, and medication use was explored through 12 questions. Results: Retired rugby players (N=142) reported higher scores than matched controls (N=49) for joint pain and impairment, including significantly higher scores for joint impairments for activities of daily living (p=0.047). The global mental health scores of retired rugby players were significantly lower compared to matched controls (p=0.043) and the global physical health scores were also lower in retired rugby players. Most retired rugby players reported not using prescription pain medication (75%) or over-the-counter pain medication (56%). Conclusion: Professional rugby careers have a considerable impact on the joint health and overall well-being of retired players, resulting in unique challenges. The findings of this study emphasise the need for specific after-career support for challenges faced by retired rugby players.

The aims of this study were 3-fold: (1) to compare technical proficiency scores between training and matches for tackling, ball-carrying, and rucking outcomes; (2) to determine the relationship between technique in training and technique in matches for tackling, ball carrying, and rucking; and (3) to determine how contact technique (in training and matches) relates to match performance and injury outcomes. Twenty-four male players from an amateur rugby union club participated in the study. At the beginning of the season, players’ contact technique proficiency was assessed in a training drill. Contact technique in matches was assessed during 14 competitive matches. The technique proficiency was assessed using standardized criteria, and the outcomes of each tackle, ball carry, and ruck were recorded. In training and matches, positive performance outcomes were associated with higher contact technique proficiency scores. For instance, in both settings, tackle technique was significantly lower in missed tackles when compared to effective and ineffective tackles. Players’ contact technique scores in matches also had a positive effect on their tackle performance in matches. Ball-carry technique was associated with tackle breaks in matches (P < .05, r² = .31). In training and match environments, tackler, ball-carrier, and ruck technique scores were significantly associated with effective tackles, ball carries, and rucks. Despite the relationship between technical proficiency scores and performance, there were small to moderately higher scores in training compared with matches. The current study highlights the importance of contact skill training, in different environments and conditions, to ensure that skills developed in training are transferred to match performance.