The beautiful game for women: A spotlight on the 2023 Women's football medicine conference

Summary

The 9th FIFA Women's World Cup (FWWC) marked several milestones: the first hosted by two Nations, held in the Southern Hemisphere, comprising 32 teams, and >1.9million spectators (FWWC attendance record). The overwhelming success of the tournament stimulated huge public interest in women's football. The importance of maximising player health was apparent throughout the tournament with injuries and illnesses affecting team selection and performance, emphasising the need for continued focus on women's football player health. This short report summarises the key takeaway messages from the Women's Football Medicine Conference held online during the round stages of the 2023 FWWC.

1. Introduction

The Women's Football Medicine Conference, hosted by La Trobe Sport and Exercise Medicine Research Centre and Football Australia, was held online on Sunday July 30th, 2023. The conference showcased 17 global leaders in women's football coaching, clinical servicing, and research.

1.1. Session 1: Socio-cultural influences on women's football player health

Dr Dawn Scott opened with a fascinating account of women's football history from the first professional game played in Scotland in 1881 to the modern day. She examined the enormous impact of the 50-year ban (1921–1971) on women playing professional football. Research and innovation to assist women playing football such as: the sports bra (1977), professional leagues (2001), women specific football boots (2020) are relatively recent developments with many research gaps still evident. Dr Scott's research demonstrated the significant increases in physical match demands that have occurred with professionalism, both in terms of intensity and number of matches played [1], and the clear consequences to player health.

Dr Nonhlanhla Mkumbuzi highlighted how the under-representation of women and girl participants in sports-related research intersects with the lack of data collected in people from low- and middle-income countries (LMIC) [2]. Lack of funding and infrastructure, low representation of women from LMIC as decision makers, implicit bias, and poor dissemination opportunities exacerbate the challenges of conducting research in LMICs. Recognising this intersectionality, the creation of more global collaborative networks and online conferences will encourage global participation and improve the representation of LMICs in sports medicine research. Dr Liesel Geertsema discussed the large discrepancies in pay rates between men and women football players, despite the surge in participation, interest, viewing, and professionalism in women's football. The lack of facilities and resources available for medical support needs to be addressed to level the playing field for women and optimise player health. Dr Kat Kryger presented her FIFA-driven program of research aimed to identify gaps in women's football research which resulted in 6 scoping reviews [3]. The next phase involves FIFA women's football program providing collaborative opportunities and a platform for addressing these research gaps.

Ms Rae Dower drew on her vast player and coaching experience to describe the evolution of women's football culture in Australia. The importance of enhancing multidisciplinary teamwork, the components of successful leadership in sport and how to bring the best out in your support staff and players were highlighted. All speakers discussed the need for research, innovation, and resource allocation for women's football to be accelerated to stay ahead of the game and optimise player health.

1.2. Session 2: Breaking research updates

This session provided a platform for communicating and disseminating the great football research work being done by early career researchers. An action-packed session filled with high quality 10-min presentations from all speakers.

Dr Donna Lu and Dr Matt Whalan opened with an overview of injury surveillance in the Australian Women's A-League and the updated National Team surveillance systems. The importance of robust and consistent injury surveillance was emphasised, and the need to adapt data collection methods to your setting. Ms Stella Veith presented her work on the role of external factors that contribute to injury risk in elite adolescent footballers with preseason and the periods immediately following school holidays representing higher risk for injury in this population [4]. Dr Kate Yung provided a fascinating insight into complex systems theory and how it may be applied in the injury and prevention field [5]. Dr Yung expertly guided us through this novel approach with practical and theoretical application for clinicians and researchers.

Dr Anthea Clarke then discussed her excellent work exploring the use of coach education to improve female athlete support. Dr Clarke showed the impact that improving coach health literacy can provide, and practical ways to enhance athlete support. Ms Chelsea Oester then presented an excellent overview of the challenges and current state of play regarding menstrual cycle symptom screening tools. This fascinating PhD work provided an insight into what it takes to validate a screening tool, highlighting some of the limitations to existing methods. The session was rounded off by Ms Georgia Brown who took a deep dive into women's match running distances and the factors which impact them. Of interest in the time of the FWWC, total distance and high-speed running distance was significantly reduced with <3 days between matches. Overall, the session highlighted the great work being done in female health and performance and showcased the rising stars in Sports Medicine research.

1.3. Session 3: career ending severe injuries

Dr Jessica Orchard opened this session presenting on the athlete's heart and sex-related differences [6]. Dr Orchard highlighted the need to increase the representation of women as both participants and authors of athlete cardiac research. When understanding the athlete heart, she raised the questions “is it protective to be female?” and “could pregnancy be a performance enhancement?” These questions relate to work showing that athletic women were 5–10 times less likely to have acute coronary events compared with athletic men, and the many stories of women who achieved personal best performances after pregnancy.

Dr Kerry Peek outlined the role of sex and gender in football concussion risk, where women and girls appear more susceptible to sustaining concussion. The known inequities of support to develop technical proficiency and protective body positioning during heading duels are likely to be more important than biological factors [7]. This discussion of nature versus nurture, continued in Dr Brooke Patterson's presentation on ACL mechanisms and prevention in women's football. Dr Patterson highlighted the differences between men and women in pressing and tackling techniques and the role of injury prevention programs such as the Perform+. She outlined the implementation plan used to broaden the reach and adoption of the Prep to Play injury prevention program in Australian Rules Football, including the use of coach champions [8].

Ms Alicia Edge spoke about energy availability in the female football player and explained how to assist players to be mentally and physically ready to perform. The subtle early signs of Relative Energy Deficiency in Sport (RED-S) are lack of focus, or poor decision making, with physical performance commonly impacted later. Although nutrition is a science, eating is a behaviour so just telling athletes to eat more is not helpful or effective without understanding why. This segued into the final presentation of the conference by Dr Matt Whalan on player availability. Dr Whalan outlined the role of primary, secondary, and tertiary injury prevention strategies and that football does not need a sex-specific injury prevention program, women and girls just need a context specific support system to facilitate adherence.

Hosting the Women's Football Medicine Conference online provided the opportunity for global participation of speakers and attendees to share their passion for women's football. The high-quality content of this conference was presented by >90 ​% female speakers, hence we look forward to improved gender equity in future international football medicine research conferences. We need more collaboration, consensus, application of the female lens, tracking, and monitoring of female-specific health concerns. Let's build on the momentum and progress research optimising female player health and performance!

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.