Summary
This comprehensive survey provides the first step in investigating the health status of former women’s soccer/football players to obtain a better clinical picture of the risks and benefits of competing at the highest levels.
Abstract
Introduction
There is ample evidence to suggest that women are under-represented in the sports and exercise medicine literature, despite increasing rates of sports participation. Soccer/football, the most popular sport played by women and girls around the world, provides an ideal population for addressing the need for more research on female athletes.
Aim
To investigate the risks and benefits of a playing career dedicated to elite-level women's soccer/football in 5 health areas: physical, musculoskeletal, female athlete, neurocognitive, and mental
Methods
The study population consisted of retired college, semi-professional, professional, and national team soccer/football players based in the US. An anonymous online survey was distributed using personal networks, email, and social media. The shortest validated questionnaires possible were used to evaluate each of the health areas: physical (UCLA Activity Score), musculoskeletal (SANE score), female athlete (custom questionnaire), neurocognitive (PCSS), and mental (GAD-7).
Results
A total of 560 eligible players participated in the study over a 1-year period. The median time for survey completion was 11 minutes. The highest competitive levels of the players were 90% college or semi-professional, 6% professional, and 4% national team. The mean age was 34 years (SD=9, range 20-60), and the mean number of years since retirement was 13 (SD=9, range 0-40). The most common reasons for retirement were graduation (61%), injury (12%), pursue another career (9%), burnout (6%), and personal/family (4%). The majority (63%) reported that their current activity level was participating in impact sports. The mean SANE scores (0-100 scale as percentage of normal) for joint health were knee=75% (SD=23), hip=83% (SD=23), and shoulder=87% (SD=21). A substantial proportion of players had irregular menstruation during their careers: 40% reported having fewer or no periods with increased exercise and 22% had no periods for >3 consecutive months. A high number of respondents answered that they worried about their weight while playing and about their current weight (both 61%). The mean number of time-loss concussions was 1 (SD=2, range 0-10). For the 189 (34%) players who reported any post-concussion symptoms, 23% felt that their symptoms were due to soccer-related concussions, 47% did not, and 30% were unsure. The mean GAD-7 score was 4 (SD=4, range 0-21), indicating an overall mild level of anxiety.
While the most common answer for career satisfaction was Somewhat satisfied (49%), a greater number of players (56%) reported being Very satisfied with their post-soccer life. The same proportion was still involved in soccer after retirement. When asked to rank the 5 health areas, the most important area was 1. mental health followed by 2. physical 3. neurocognitive 4. female athlete and 5. musculoskeletal. Among the 99 written comments, 30% contained the words “Thank You”.
Conclusions
This comprehensive survey provides the first step in investigating the health status of former women’s soccer/football players to obtain a better clinical picture of the risks and benefits of competing at the highest levels. These initial results will lay the foundation for further subgroup analyses and much-needed research studies to help protect all female athletes.