The Women’s Soccer and Basketball Health Study: From Head to Toe

Public health research is filled with many examples of longitudinal studies that investigate health outcomes in select populations. The Framingham Heart Study predicts the development of cardiovascular disease in its study participants. This study has spanned 3 generations and expanded beyond cardiovascular outcomes. The Nurses’ Health Study investigates risk factors for chronic diseases in women. In sports, the Football Players Health Study focuses on the health conditions of retired NFL players. More recently, the Drake Football Study was launched to evaluate the health effects of male professional soccer players over a 10-year period from the end of their careers to retirement. Notably, both of these studies involve male athletes.

There is ample evidence to show that women are under-represented in the sports medicine literature. In a review of published articles in the American Journal of Sports Medicine, British Journal of Sports Medicine, and Medicine and Science in Sport and Exercise, the proportion of female participants was significantly lower than that for male participants, with an average male-to-female ratio of 2:1 in more than 1,000 published articles. This sex disparity does not align with the rise of female athlete participation, which has increased from 2% for the 1900 Paris Olympics to almost 50% for the recently-completed 2021 Tokyo Olympics. 

The principles of public health are based on prevention, protection, and promotion that apply regardless of the population. Building upon the long history of public health research and to tackle the male-centered literature, we have launched a study for retired elite female athletes in soccer and basketball, two of the most popular sport played by girls and women across the globe. The Women’s Soccer and Basketball Health Study investigates the risks and benefits of a career at the elite level (collegiate, semi-professional, professional, and national team) in 5 health domains: physical, musculoskeletal, female athlete, neurocognitive, and mental. 

While the association between knee injuries, particularly ACL ruptures, and premature osteoarthritis has been well-studied, the relationship between concussions and neurocognitive health in female athletes has not garnered the same amount of attention as that for American football and chronic traumatic encephalopathy (CTE). In our series of meta-analyses, women have higher incidence of concussions in soccer and basketball, are more likely to have ball or equipment contact as the mechanism of injury, and experience more recurrent concussions compared to men. 

The long-term impact of the Female Athlete Triad (menstruation, nutrition, and bone health) has also not been well-studied. More recently, the Triad has expanded to Relative Energy Deficiency in Sport (RED-S), which can impair several bodily systems, including the metabolic, immunological, and cardiovascular systems. As for mental health, we need look no further than Simone Biles and Naomi Osaka, two of the top athletes today, to see the toll of competing at the highest levels, not to mention the mental health issues related to injury and loss of athletic identity after retirement.

Rather than investigate one single area like most conventional studies, our wide-ranging study evaluates the whole player from head to toe. Furthermore, the health domains are likely related and should not be evaluated in isolation. We have designed the study to use the shortest validated questionnaires possible in each of the health domains, enabling us to cover a lot of ground in an average time of 10-15 minutes for completion of the online anonymous survey. Former players have the power of hindsight, which will be used to look ahead to prevent injuries, protect future generations of female athletes, and promote a lifetime of sports participation. While Equal Pay has been a rallying cry for the progress of women’s sports, it is also time to add Equal Health to the discussion.

Links to the survey can be found below. We are currently looking for international collaborators to conduct this study on a global scale and to plan for future prospective studies.



Daphne Ling, PhD, MPH

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