Concussion is a high-profile and important brain injury, yet the on-pitch assessment of concussion in football (soccer) remains challenging due to the absence of a standardized, evidence-based assessment protocol that can be completed within a time-restrained on-pitch football-match environment. The objective of this study was to develop a football-specific, standardized on-pitch concussion assessment protocol informed by research evidence and expert opinion using an international consensus process and steering committee deliberation, which included medical experts from each of the 6 football confederations. Nominated global medical representatives with experience in the on-pitch assessment of concussion in football (≥5 assessments within previous year) from Fédération Internationale de Football Association (FIFA)-member associations completed a 2-round Delphi questionnaire to score all identified assessment items that have been used to assess an athlete with a suspected concussion within an on- or off-pitch environment (in any sport) along with expert recommendations. Consensus (≥80% agreement) was required for assessment items to be included in a football-specific on-pitch concussion assessment protocol. Results demonstrated that from 101 identified assessment items, 41 achieved greater than or equal to 80% agreement for inclusion in round 1, and 6 additional items achieved greater than or equal to 80% agreement in round 2. Four items (scoring 75%-79%) were added after steering committee review. Twelve items were merged to avoid duplication of items that assess the same issue. This resulted in the final Football-Specific Standardized On-Pitch Concussion Assessment Protocol (FOCUS) comprising 45 items categorized into 11 domains as follows: player medical history, mechanism of injury, visible signs, level of consciousness, cervical spine assessment, symptoms, orientation, balance, proprioception, oculomotor function, and activity-based assessment, with each structured for rapid on-pitch evaluation. FOCUS provided a standardized, evidence-informed protocol for the on-pitch assessment of a suspected concussion during football match play, addressing a critical gap in player health and safety. Adoption of FOCUS has the potential to harmonize concussion management globally; however, implementation feasibility and diagnostic accuracy require further evaluation.
The classification system for blind and partially sighted football is currently based on the World Health Organisation's definition of vision impairment and does not account for the impact of impairment on performance. Therefore, governing bodies require sport-specific and evidence-based classification systems. Through analysing the relationship between vision impairment and technical performance, the study aimed to produce evidence that can be used for sport-specific classification in football for athletes with vision impairment. Observational study. Forty-five footballers with a vision impairment completed a technical football-specific performance test. Visual function was measured using tests for visual acuity, contrast sensitivity, and visual field. Spearman's correlation coefficients and decision tree analyses were used to measure the relationship between visual function and performance. Normalised performance was significantly related to visual acuity (r = 0.635) and contrast sensitivity (r = -0.499). There was no relationship with visual field. A single split based on a visual acuity of 2.40logMAR offered the best option for classifying athletes who can and cannot compete with their remaining vision. Contrast sensitivity and visual field could not accurately classify performance in this test. This model would lead to those with less severe impairments being able to compete in blind football while reducing the maximum impairment eligible for partially sighted football. A 2.40logMAR class boundary optimally classified football performance in the participants recruited.
Elite male football players have high peak fat oxidation (PFO), and recently PFO was reported to increase following preseason (PS) training in semi-professional male players. Whether PFO increases from PS to competitive season (CS) in elite male football players remains unknown. This study investigated if PFO increases from PS to CS in elite male football players, and secondarily, it explored the interplay between PFO and running performance. Twenty-two elite male outfield football players reported to the laboratory during PS and CS. Testing included a resting blood sample, a dual-energy X-ray absorptiometry scan, and a graded treadmill running test. The players' load during training and matches was monitored between the test days. PFO, the intensity eliciting PFO (Fatmax) and peak oxygen consumption (V̇O2peak) did not change from PS to CS (mean difference with 95% confidence intervals: -1.0 mg·kg FFM-1·min-1 (95% CI: -2.4 to 0.3 mg·kg FFM-1·min-1), 1% V̇O2peak (95% CI: -4% to 6% V̇O2peak) and 0.2 mL·kg-1·min-1 (95% CI: -1.0 to 1.4 mL·kg-1·min-1), respectively). Intra-individual changes in PFO, Fatmax and V̇O2peak from PS to CS were not positively correlated with weekly distance covered during football training, or with changes in distance covered during matches, neither in total nor within intensity domains. Whole body fat-free mass increased by 1.2 kg (95% CI: 0.4 to 1.9 kg) and fat percentage decreased by 0.4% points (95% CI: 0.1% to 0.8% points) from PS to CS. In conclusion, PFO, Fatmax and V̇O2peak did not change from PS to CS, and PFO was not associated with training or match running performance of elite male football players.
Emotions play a crucial role in youth football performance and development, yet no validated instrument exists for measuring football-specific emotions among young players. This study aimed to develop and validate the Football Emotion Scale (FES) for Chinese youth football players. A cross-sectional survey was conducted among youth football players in China. The study included 492 participants in the exploratory factor analysis (EFA) phase (males 51.8%, females 48.2%) and 450 participants in the confirmatory factor analysis (CFA) phase (males 52.2%, females 47.8%). Participants were recruited through purposive sampling from 12 cities across Shandong Province. The scale's psychometric properties were evaluated using Content Validity Index (CVI), Face Validity Index (FVI), EFA, CFA, Composite Reliability (CR), Average Variance Extracted (AVE), Cronbach's alpha, and Intraclass Correlation Coefficient (ICC). The EFA identified a six-factor structure explaining 67.027% of the total variance. The CFA confirmed this structure and supported a second-order model with two higher-order factors. Both models demonstrated excellent fit indices (RMSEA = 0.033, CFI = 0.971, TLI = 0.968, SRMR = 0.037). The scale showed good internal consistency (Cronbach's alpha = 0.793-0.894) and test-retest reliability (ICC = 0.703-0.915). Construct validity was satisfactory, with composite reliability ranging from 0.793 to 0.894 and appropriate inter-factor correlations. The newly developed FES, consisting of 26 items, demonstrates robust psychometric properties and provides a valid and reliable tool for assessing football-specific emotions among Chinese youth players, facilitating research on emotional experiences and informing interventions to enhance player development and wellbeing.
Developing technical and motor skills during adolescence is critical for long-term football performance. This study aimed to examine the relationships between passing skill, dribbling skill, and agility performance in elite young football players and to determine whether these relationships differ according to playing position and age group. A total of 242 male football players aged between U14 and U19, competing in the academy teams of four professional clubs, participated in the study. Dribbling performance and agility were assessed using the Illinois Dribbling Test (IDT) and Illinois Agility Test (IAT), respectively, while passing skill was evaluated using the Loughborough Passing Test (LPT). Analysis of variance, Pearson correlation, and regression analyses were used to analyze the data. Pearson correlation analysis revealed a moderate and significant relationship between dribbling performance and agility (r = .482, p < .001, 95% CI [0.38, 0.57]). In addition, dribbling performance was significantly and positively correlated with passing skill (r = .234, p < .001, 95% CI [0.11, 0.35]), and agility performance showed a low but significant positive correlation with passing skill (r = .154, p = .016, 95% CI [0.03, 0.27]). Multiple regression analysis demonstrated that dribbling and agility performances together explained a low but significant proportion of the variance in passing skill [F(2,239) = 7.207, p < .001, R² = 0.057].In conclusion, monitoring the development of elite youth football players using objective and quantitative performance indicators is of great importance for coaches and sports scientists. The findings indicate that passing, dribbling, and agility performances are significantly interrelated across all age categories, highlighting the integrated nature of technical and motor skill development in youth football. Based on these findings, incorporating passing, dribbling, and agility skills together within youth football training programs appears to be important for supporting holistic technical and motor skill development.
While physical exercise has been shown to benefit the attentional networks in adolescents, older adults, and clinical populations, the specific associations regarding typically developing children remain unclear. This study aimed to investigate the association between football training experience and attentional sub-networks in boys aged 7-11 years. A total of 94 boys aged 7-11 years were recruited in this cross-sectional study and categorized into a football group (n = 47, ≥1 year of systematic football training) and a control group (n = 47, with no systematic extracurricular sports training, engaging only in regular school physical education classes). All participants completed the Attention Network Test to assess the efficiency of three sub-networks: alerting, orienting, and executive control. The football group showed significantly higher efficiency in both the alerting and executive control networks compared with the control group, with the latter characterized by a smaller conflict effect. Conversely, no significant group difference was found in orienting network efficiency. These findings suggest a selective association between football training experience and attentional networks, specifically highlighting advantages in the alerting and executive control networks. This study provides empirical support for considering football as a developmentally appropriate activity that is associated with specific attentional advantages in boys aged 7-11 years.
To characterize the composition and specialty training of sideline medical providers present during National Collegiate Athletic Association (NCAA) Division I (Power 5) college football games. Cross-sectional survey study. Power 5 NCAA Division I football programs during the 2023 to 2024 season. Head team physicians from 69 institutions were contacted; 53 (76.8%) completed the survey.Intervention: A 25-question REDCap survey assessing on-site personnel during home and away football games, including physician specialties, emergency coverage, imaging availability, emergency medicines, and athletic training support. Presence, specialty training, and roles of medical providers on the sideline during football games. All responding programs had orthopedic surgeons (OS) on-site at home games, and all but 1 had a primary care sports medicine physician (SMP). SMPs most commonly trained in family medicine (54.2%), followed by emergency medicine (13.5%) and pediatrics (11.9%). OSs were most frequently fellowship-trained in sports medicine (68.6%). Emergency/airway management physicians were present at 37.7% of schools; neurotrauma-specific providers were present at 15.1%. Away game coverage was reduced, with fewer SMPs and OSs traveling. Athletic trainer coverage remained consistent. Only a minority of schools traveled with additional medical specialists. There is significant variability in sideline medical staffing across Power 5 college football programs. While all schools met or exceeded NCAA minimums, these findings highlight opportunities for standardization and alignment with professional sports models to optimize athlete safety.
Anterior cruciate ligament (ACL) injuries are frequent among professional American football players and often require surgical reconstruction followed by prolonged rehabilitation. Return to play (RTP) is a key outcome, yet substantial variability persists in reported RTP rates, timelines, level of return, and re-injury risk. This systematic review and meta-analysis aimed to compare RTP rates, time to RTP, return to pre-injury performance, and ACL re-rupture rates in professional American football players across three time periods. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of PubMed, Embase, and the Cochrane Library identified studies reporting RTP outcomes following ACL reconstruction in professional American football players, including selected high-level collegiate cohorts. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Four outcomes-overall RTP rate, time to RTP, return to pre-injury level, and ACL re-rupture rate-were extracted and meta-analyzed across three publication periods (before 2016, 2016-2020, and after 2021), used to explore temporal trends. Twelve studies met the inclusion criteria, including 1,166 professional American football players. The pooled RTP rate was 73.1% (95% CI, 62.5-80.5). No significant differences were found across periods (p > 0.05), although RTP rates numerically decreased from 78.9% to 69.8%. Among players returning to sport, 93.6% (95% CI, 77.7-100) regained their pre-injury performance level, with no significant temporal differences (p > 0.05). The pooled ACL re-rupture rate was 4.4% (95% CI, 2.0-7.3), with comparable rates across periods. Mean time to RTP was 340.1 days (95% CI, 313.1-367.1), with no temporal differences. More than 70% of professional American football players return to play after ACL reconstruction, and most returning athletes regain their pre-injury performance level, with low re-rupture rates. Although more recent studies reported numerically lower return-to-play rates, these differences were not statistically significant.
The aim of this study was to develop the Football Fan Identity Inventory and to examine its psychometric properties. The study was conducted using a multi-stage scale development design. In the initial stage, an item pool was developed based on qualitative responses obtained from participants and expert evaluations. Data were collected from football fans through convenience sampling across four independent samples (n = 256, n = 299, n = 308, and n = 208). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to determine and validate the factor structure of the scale. The results revealed a four-factor structure consisting of 22 items, explaining 74.24% of the total variance. The model demonstrated a good fit to the data (χ²/df = 2.29-2.41, CFI = 0.98-0.99, RMSEA = 0.065-0.068). Reliability analyses indicated high internal consistency (Cronbach's α = 0.957). The findings suggest that the Football Fan Identity Inventory is a valid and reliable instrument for assessing different dimensions of football fan identity. The scale provides a useful tool for researchers and practitioners to better understand fan behavior and engagement.
American football carries a risk of traumatic injuries, including spinal cord injury (SCI). Proper management of suspected spinal injury in athletes, including safe equipment removal, is essential to prevent secondary injury. Emergency medicine (EM) physicians may encounter these scenarios, but often have limited formal training. This study evaluates EM residents' prior training on this and assesses changes in self-reported confidence and comfort following a targeted educational intervention on football equipment removal. We conducted a single-center, pre-post quasi-experimental study among EM residents at a three-year residency program. Participants completed a pre-intervention survey assessing prior exposure and confidence. They then underwent a brief educational intervention consisting of a video and a hands-on workshop on football equipment removal. A post-intervention survey measured changes in confidence and comfort using a 5-point Likert scale. Paired responses were analyzed using Wilcoxon signed-rank tests. Of 76 eligible residents, 29 participated and 23 completed both surveys (n=23/29, 79% completion rate). Most participants reported having minimal prior training or lecture on this topic (n=23/28, 82%). Following the intervention, there were statistically significant improvements in self-reported confidence across all domains, including timing of removal, cervical spine stabilization, airway access, and equipment removal (p < 0.001). Self-reported comfort in managing these trauma scenarios also improved (p < 0.001). EM residents reported limited prior exposure to managing and treating suspected spine-injured athletes during residency training. A brief, simulation-based workshop significantly improved self-reported confidence and comfort in removing football equipment and may help address gaps in training for high-risk but infrequent clinical scenarios.
Guided by ecological systems theory, this study employs psychological network analysis to investigate how parental and peer support interact with children's football participation and whether these ecological dynamics differ by gender. We estimated regularized partial correlation networks using EBICglasso on a sample of 287 primary school students (M age = 9.704, SD = 1.010, age range = 8 to 13 years) and computed centrality, clustering, and bridge centrality metrics. Gender differences were tested via the Network Comparison Test. Self-efficacy emerged as the most central node and the primary bridge connecting social support to football participation. The global network structure did not differ significantly between boys and girls, suggesting a largely similar psychological architecture across genders. Descriptive patterns suggested that internal persistence items were more central for boys, whereas participation and relational support items were more central for girls. These findings suggest a possible integration of social cognitive and ecological systems perspectives within a network framework. They offer tentative insights that could be considered when developing broadly applicable or gender-responsive interventions to support children's sustained football participation.
While research advisory boards are common in community-based research, there are challenges with forming a board on sensitive topics and among communities who are less often engaged in research such as youth football organizations. We share our processes for forming a national board, challenges associated with engaging some football community members, and feedback from our board members. Board members were recruited with a multidisciplinary team of youth football organization employees. Researchers compared demographic characteristics of interested individuals who joined the board to those who did not. Board members were different in several ways to those who did not participate. Additionally, board members experienced minimal harm from participating in discussions on sensitive topics. Although several interested individuals joined the board, more than one-half of the interested individuals did not. It is important for researchers to make intentional efforts to engage underrepresented individuals and ensure the research is beneficial to all community members.
To explore Relative Energy Deficiency in Sport (REDs)-related risk in talented youth female football players in Poland using the International Olympic Committee (IOC) REDs Clinical Assessment Tool version 2 (CAT2), and to examine associations with injury-related outcomes. Observational cross-sectional study. Twenty-nine talented U-17, U-15, and Talent Pro female football players from the national talent pathway were assessed. REDs-related risk was classified using the IOC REDs CAT2 framework, including clinical history, menstrual status, injury history, bone health assessed by DXA, and selected biochemical markers. Athletes were categorised using the traffic-light system. Associations between REDs indicators and injury history were examined using Fisher's exact test. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Haldane-Anscombe correction. Thirteen athletes (44.8%) were classified as having mild REDs-related risk. Stress fracture history and disordered eating attitudes were significantly associated with mild REDs-related risk (p = 0.001; OR 21.0, 95% CI 1.12-395.2). Primary and secondary REDs indicators were more prevalent amongst athletes classified as at risk. Given the exploratory design, small sample size, and wide CIs, ORs were interpreted descriptively. In this selected elite youth female football cohort, nearly half demonstrated indicators consistent with mild REDs-related risk. These findings support the value of early screening and targeted prevention strategies in women's football. However, the cross-sectional design, small sample size, potential selection bias, and limited statistical power require cautious interpretation and preclude causal conclusions.
Non-contact injuries in professional football impose significant performance and economic burdens, yet the influence of workload feature representation on injury risk modelling remains insufficiently characterised. Traditional monitoring approaches, including the acute-to-chronic workload ratio (ACWR), may inadequately capture the temporal dynamics and instability of training load that underlie injury aetiology. This study systematically compared four complementary temporal feature engineering strategies-rolling workload aggregates, workload balance and exponential smoothing metrics, stability and stress indicators, and polynomial regression residuals-to evaluate their relative discriminative contribution to non-contact injury risk prediction in professional football. GPS-derived external load data from 69 professional male football players across two clubs were analysed over one full competitive season. A total of 23 non-contact injury events were recorded; under a 7-day pre-injury risk window labelling scheme, these generated 109 positive athlete-day observations across 10,134 total daily observations (1.08% positive prevalence). Decision Tree (DT), Random Forest (RF), and XGBoost models were evaluated using stratified group k-fold cross-validation with athlete-level grouping to prevent data leakage. Minimum redundancy-maximum relevance (mRMR) feature selection was applied independently within each fold. Model performance was assessed using Recall, F2-score, ROC-AUC, and Precision-Recall AUC (PR-AUC). Overall sensitivity remained limited across baseline configurations, reflecting the extreme class imbalance of injury data. Polynomial residual features, encoding deviations from expected workload trajectories, produced the most consistent gains in discriminative capacity across models (mean ΔROC-AUC + 0.078; largest absolute improvement: RF ΔROC-AUC =  + 0.131). Compact mRMR-selected subsets (34-42 variables) consistently outperformed full feature spaces. ACWR-based features degraded performance across all classifiers (mean ΔROC-AUC - 0.023). A supplementary optimisation analysis demonstrated that, under calibrated hyperparameters and SMOTE oversampling, RF achieved Recall = 0.667 and ROC-AUC = 0.676 on an independent held-out test set, confirming that the near-zero baseline Recall reflects deliberate methodological conservatism rather than fundamental feature inadequacy. Within this dataset, deviation-based workload representations provided greater discriminative value than traditional ratio-based indicators, suggesting that temporal instability and unexpected departures from established training patterns may carry more predictive information than absolute load magnitude. Given the limited sensitivity achieved under default model configurations, these findings should be interpreted as exploratory methodological evidence rather than a basis for immediate clinical deployment. Future work should integrate larger multi-season datasets, internal load markers, and prospective validation to improve clinical utility.
OBJECTIVES: The primary aim was to assess the radiographic features of the pubic symphysis in elite female football players. The secondary aim was to explore associations between radiographic findings and groin complaints. DESIGN: Cross-sectional study. METHODS: This was a multicenter study of 100 elite female football players from three Dutch professional clubs. Players completed questionnaires (including Hip and Groin Outcome Score) and had clinical assessments (including palpation and squeeze tests) and radiographic imaging. Skeletal maturity was graded using the Maturing Adolescent Pubic Symphysis (MAPS) classification. Five radiographic pubic symphysis findings were evaluated using the Aspetar protocol. Players were classified as having groin complaints if player-reported complaints and positive clinical findings from the symphyseal and/or adductor region were present. RESULTS: MAPS stages increased with age. In 23% (7 of 30) of otherwise skeletally mature players, the pubic symphysis was immature, including players up to age 27 years. Sixty-nine (69%) players had 1 or more radiographic findings. The most prevalent findings were bony proliferations (49%) and sclerosis (47%). Fifteen of the 100 players had groin complaints. No differences were found in number or type of radiographic findings in those with and without groin complaints. Fifty-eight players (68% of 85) without complaints (vs. 11 [73% of 15] with complaints) had at least one Aspetar protocol finding. CONCLUSION: Radiographic findings of the pubic symphysis were common in female football players and appeared irrespective of groin complaints. Nearly one quarter of otherwise skeletally mature young adult players were not fully mature at the pubic symphysis. J Orthop Sports Phys Ther 2026;56(7):448-455. Epub 4 May 2026. doi:10.2519/jospt.2026.13580.
Tackle football is the most participated youth sport in the U.S. with leagues beginning as early as age 5. Exposure to cumulative repetitive head impacts (RHI) over years of play is increasingly viewed as a major contributor to chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease documented in contact sport athletes. Amid growing awareness of CTE, parents may turn to online information to guide decisions about youth tackle football participation. This cross‑sectional study examined the readability of online CTE information. Using the search term, 'CTE,' 68 URLs providing non‑technical information were identified after applying exclusion criteria. Online software was used to generate metrics from six widely-used readability formulas. Grade-level readability scores were categorized as ≤ Grade 8, 9-12, and ≥ 13 and summarized using descriptive statistics; distributions were compared by URL designation using chi-square tests (P < 0.05). Web page publication/revision date and presence of references were recorded. Median readability scores ranged from high school to early college with few pages meeting the recommended ≤ Grade 8 reading level for the general population. Levels were similarly high across non-commercial (.org,.gov,.edu) and commercial (.com) domains. Nearly 40% lacked clear publication or revision dates; fewer than half (47.1%) included references. Commonly accessed online CTE resources exceed recommended reading levels. This digital barrier impairs parents' functional health literacy and capacity for informed decision-making. As research on CTE and tackle football participation evolves, there is a need for plain‑language, clearly-sourced, updated online resources tailored to this decisional context.
Despite considerable research, strength screening has shown limited value for injury prediction. The concept of muscle stability assessed by Adaptive Force (AF) offers a distinct perspective-addressing neuromuscular holding capacity closer to injury-prone motions rather than pushing strength. This study aimed to assess the prevalence and distribution of muscle stability deficits in football players and their discriminative capacity relative to conventional strength parameters. AF and maximal voluntary isometric contraction (MVIC) were measured in 23 male semi-professional football players. Five muscle groups were tested bilaterally (knee extensors/flexors; hip flexors/adductors/abductors). AF was assessed by objectified manual muscle tests with a handheld device recording force and angular velocity. AF parameters, MVIC and the conventional hamstrings-to-quadriceps (H:Q) ratio were compared between stability categories. Stability deficits were highly prevalent: 83% of players had at least one deficit; 31% of all tested muscle groups were unstable, highest in hip abductors (52%) followed by hamstrings (46%). The maximal holding capacity was selectively impaired in unstable muscles (on average 61% lower than the maximal force output), while MVIC and maximal AF did not differ between stability categories. The ratio of holding capacity to maximal AF (AF-Ratio) was the strongest discriminator (stable vs. unstable: d = 6.62, ω2 = 0.88), largely consistent across muscle groups and uncorrelated with the H:Q ratio. The H:Q ratio failed to discriminate between stable and unstable hamstrings (d = -0.04), whereas the AF-Ratio discriminated strongly (d = 6.43). Muscle instability represents a selective impairment of holding capacity with preserved maximal strength, not detected by MVIC testing. By capturing a distinct neuromuscular function, AF offers a novel mechanistic framework beyond pushing strength. Further studies in larger samples and prospective designs are required to assess the potential utility of stability assessment in clinical practice. Level III, diagnostic studies.
Sport fans can experience a variety of dysfunctional emotions and maladaptive behaviors, including anger, hatred, depression, anxiety, and violence. For many years, rational emotive behavioural therapy (REBT) has used the concepts of rational and irrational beliefs to explain the emotions and behaviours exhibited by different groups, such as athletes, students and employees. The current study examines the relationships between rational and irrational fan beliefs, and psychological distress (depression, anxiety, and stress), in football fans. It also investigates the moderating role of gender, marital status, and match outcomes in these relationships. The study involved 256 football fans, aged between 23 and 48 (Mage = 26.34). Moderator effect analysis was performed using PROCESS Macro. The analyses revealed that psychological distress was negatively correlated with rational fan beliefs and positively correlated with irrational fan beliefs. The moderating role of gender, marital status and match outcome was not significant. Male gender, single status, and losing a match were risk factors for mental health. Overall, the findings indicate that psychological distress is positively associated with irrational beliefs and negatively associated with rational beliefs, regardless of gender, marital status, or match outcome. The results are discussed in relation to REBT and fan studies.
To describe and analyse mechanisms of potential head injuries across a range of playing age-groups during women's European international tournaments and explore whether there were any 'coachable moments' which might prevent a similar incident from being repeated in the future. (NB 'coachable moment' was defined as a player action or behaviour that could be modified through coaching (i.e. it is considered modifiable).) METHODS: This mixed-methods video analysis study reviewed all potential head injuries from the broadcasted match footage from the 2022 UEFA European Women's Football Championship (WEURO), 2024 UEFA Women's Under-19 Championship (WU19), and 2024 UEFA Women's Under-17 Championship (WU17), including an in-depth independent analysis of 10 potential head injury events by 11 different coders (including professional women players and coaches) to identify any coachable moments. Across the three tournaments, there were 108 potential head injuries (WEURO n = 55, 52.08/1000 match hours (MH); WU19 n = 29, 57.31/1000 MH; WU17 n = 24, 45.45/1000 MH). Positionally, midfielders (excluding wingers) sustained the most potential head injuries (n = 32), followed by centre-backs (n = 26). The most frequently observed mechanism of a potential injury was opponent player-to-head impact (n = 74, 35.41/1000 MH), followed by unintentional ball-to-head impacts (n = 17, 8.13/1000 MH). Coachable moments were identified in all 10 events categorised into five themes: body positioning, awareness, communication, technique, and decision-making. The identification of coachable moments provides insight into player actions that may contribute to a higher potential head injury risk in women's football. These data could be used to support a player-centric injury prevention approach being embedded into the coaching ecosystem.
Shoulder instability and labral pathology are common in National Football League (NFL) players, yet contemporary return-to-play (RTP), return-to-performance (RTPf), and postreturn career longevity outcomes after surgical labral repair are incompletely characterized. To (1) describe RTP timing and rates after surgical labral repair, (2) quantify season-to-season changes in usage and performance versus matched controls, and (3) evaluate post-RTP career longevity. Cohort study; Level of evidence, 3. Using publicly available NFL data (2015-2024), 111 labral repair episodes were identified and indexed to surgery date. RTP was defined as the first in-game snap after surgery, with rates summarized at 2, 6, 12 and 24 months and overall (ever RTP). For RTPf, episodes required ≥100 snaps in both a preindex season (T1) and a first post-RTP season (M1); 60 cases met criteria and were matched 1:2 to 120 controls by season and position group, with additional matching on age and T1 snap rate. Changes from T1→M1 (and T1→M2 when available) were compared between groups. Outcomes included usage (games, total snaps, snaps/game) and Pro Football Focus (PFF) season grades. Career longevity post-RTP was assessed using Kaplan-Meier and stratified Cox models. Among 111 episodes, defensive backs (25.2%) and offensive linemen (21.6%) were the most common position groups. Overall, 86.5% returned at a median 265 days (IQR, 234-316); 3.6% returned within 6 months, 73.9% within 1 year, and 84.7% within 2 years. In the matched RTPf cohort (60 cases; 120 controls), usage changes from T1→M1 did not differ (all P > .05). Offensive PFF grade trended lower versus controls (Δdiff -3.78; P = .09), while defensive PFF grade declined significantly more (Δdiff -7.13; P = .01). In the M2 subset (34 cases; 68 controls), usage and offensive PFF remained nonsignificant, whereas defensive PFF remained significantly lower (Δdiff -10.12; P = .02). Career longevity did not differ between cases and controls by log-rank or stratified Cox analyses (all P > .05). NFL players undergoing isolated labral repair demonstrated high RTP rates with preserved postreturn workload and career longevity versus matched controls. However, defensive players showed a sustained reduction in performance grades through 2 postreturn seasons, suggesting that RTP may not uniformly translate to RTPf and may vary by position.