Moving the Goalposts: Variance in defining elite women’s football prevents inclusion in research

Background

Despite a rise in interest surrounding women’s sport, females remain underrepresented in sports science research. An analysis of over 5,000 studies in sport science journals found that 31% included only male participants, whereas 6% focused solely on females (1). Overall, males represented 66% of participants whereas females represented only 34% of participants(1).

This sex data gap is especially concerning in my field – the link between contact sport and dementia. The latest consensus statement used to inform policies and practice to prevent, recognise and treat concussions (2) is based on studies with 80.1% male participants (3) – despite evidence that females experience more frequent and severe concussions (4, 5) and face a higher risk of dementia (6). While various physiological (7), environmental (8), and methodological (9) factors have been proposed to explain differences, meaningful conclusions can’t be made without better female representation. To address this, we launched the SCORES project, an online longitudinal study monitoring brain health in former athletes of all sexes, sports and levels.

What is the issue?

When we launched the study, we were able to recruit a range of male athletes from professional, amateur and recreational backgrounds. However, we quickly noticed that very few females described themselves as professionals, despite our sample including participants who had played at a very high level. This highlighted to us that the language we were using to categorise our participants wasn’t appropriate for our intended sample. These definitions matter, because exposure to level of sport is often used as a proxy for injury exposure.

What did we do?

To improve how we categorise our sample, I searched for other studies that included female footballers as participants to see how they defined levels of play. In this initial search, definitions of women’s football participation levels varied greatly, from using elite to refer to semi-professionals, professionals, Olympians, or international levels of sport. Some of these definitions are limiting, as women’s football only became an Olympic event in 1996, and professional contracts are a recent development. As a result, studies using these definitions tend to include small, young cohorts, which are inadequate for investigating long-term brain health effects that require older participants. Interestingly, some studies didn’t include a definition of 'elite' at all.

To formalise the search, I designed a scoping review (a review designed to map and synthesise key concepts, gaps, evidence and types of studies in a research area) to identify past definitions of 'elite' in research to date. I used research about women’s footballers in the UK as a case study, due to the relatively large volume of literature available compared to other women’s sports, and to contextualise the results within one sport and national sporting structure.

In February 2025 we searched three databases (SPORT Discus, Scopus, and Web of Science Social Science Citations). Articles were eligible if they were:

• Written in English,

• Included female footballers based in the UK who were referred to as elite

• ·Included an explicit definition of elite within the full text.

Search terms were used to identify papers with “women” or “female” and “football” or “soccer” in the title, and different variations of the UK and the devolved nations in the full text. After exporting, removing duplicates and screening titles and full texts, we extracted publication dates and elite definitions, grouping them by participation level. Synthesised definitions were reviewed with a former professional footballer, a football administrator and a research team.

What did we find?

Out of 1,442 results, 62 sources met our eligibility criteria. The main exclusion reason was that they were not specific to UK athletes, with others being excluded for not focussing on female footballers or not using the term "elite." We found 11 sources that described participants as elite but did not define the level of play.

When charting definitions over time for adult and youth athletes, we found significant variation in the levels of sport referred to, as well as evolving definitions. Early publications generally used 'elite' for international-level sport and top national leagues, but since 2020, the term has also included the second and third highest national leagues. Tracing youth participation levels was more difficult due to changes in academy structures and talent pathways, but our findings show increasing variation in what is considered 'elite.'

Overall, the findings emphasise the need for a consistent definition framework for sport participation levels. Crucially, they show that what is considered 'elite' has changed over time, meaning any framework must account for this evolution to accurately apply to past athlete cohorts.

Preliminary framework to categorise sport levels

To address this, we developed a preliminary framework to categorise sport levels as a proxy for injury exposure, using UK women’s football as an example. This framework was based on our review findings and informed by discussions with academics, a football administrator and a former semi-professional female footballer.

The framework defines three key eras of development and levels of participation in each category. Specifically, this framework establishes the era before 2000 as a time where elite participation was accessible at the international level. Between 2000 and 2011, as leagues and centres of excellences developed following affiliation with men’s football associations, the definition of elite extends to players within the top national leagues, especially with the increased competition driven by the inception of the Women’s European Champions League. The third era of development begins with the inception of the Women’s Super League. The definition of elite here is extended to lower national leagues, which the literature demonstrates as requiring considerable time commitment and exposure to sport from athletes (10).

The strength of this definition framework is that it removes the need to classify participants based on whether they were paid to play, but rather by the level of sport to which they were exposed. This allows better comparisons between male and female athletes, as well as between sports and international populations.

Reflections on this work

The importance of improving research definitions was highlighted during my presentation at last year’s WiSEAN conference. After explaining my poster, an attendee shared that, despite playing at an international level, they didn’t consider themselves a professional athlete. As a result, they weren’t sure if study adverts for 'elite athletes' applied to them, which stopped them from taking part in studies. This underscores the need for researchers to refine definitions and for athletes to easily recognise whether studies apply to them.

Implications for research

Within SCORES, we plan to now use this framework to apply it to our cohort of male and female athletes, which will enable us to answer key questions within our research field surrounding the long-term consequences of contact sport.

How to get involved?

The SCORES project is an ongoing online study, and we are still open for recruitment. We are looking for male and female participants aged over 40 with a background in any contact or non-contact sport at recreational, amateur or professional level. If you’re interested in finding out more, please visit our website at www.scoresproject.org

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