Female Athlete Performance and Health research programme

The purpose of this study is to investigate the relationship between salivary hormone profiles and symptoms across the menstrual cycle as monitored by a menstrual cycle tracking app (WILD AI) in healthy eumenorrheic (naturally regularly menstruating) females. The hormones included in the salivary measures will be estrogen, progesterone and cortisol. The second part of this study is to confirm salivary measures of estrogen and progesterone against blood serum.

Estrogen and progesterone, the primary female sex hormones, are typically associated with reproduction and are linked to brain health. Cortisol is the primary stress hormone, and levels of cortisol can influence female sex hormones.

Knowledge gained from this study about how salivary hormone profiles change in relation to symptoms throughout the menstrual cycle will be used to inform a related study that will investigate symptoms in females recovering from sports-related concussion.

(AUTEC 21/167 valid to 9 July 2024)

Rates of female ACL injuries have increased in recent years. Results after surgery are worse for females and females are more likely to suffer another injury. Quadriceps strength has shown to be able to predict outcomes and further injuries for those who have had anterior cruciate ligament (ACL) surgery. Females usually have less quadriceps (knee muscle) strength compared to males. Menstrual cycle phased strength training programmes have been shown to increase quadriceps strength and size in females. However, before, this has only been researched in people who don’t have injuries.

The purpose of this research is to understand what effect completing certain exercises at certain parts of the menstrual cycle has on the strength of knee muscles and ability for females to use their knee following rehabilitation after ACL reconstruction surgery.

Principal Investigator: Emma O’Loughlin

AUTEC Approval Number: 21/CEN/92

The purpose of this study is to increase our understanding of how the female sex hormones influence the symptomology and time to recover from concussion/mTBI (from all environments) in general population females. This study also considers whether energy availability may be a modifier in the symptomology and time to recover from concussion/mTBI in females.

This knowledge will help direct future research and inform clinical decision making for doctors and other members of the multidisciplinary team during treatment and rehabilitation of females with concussion/mTBI.

Participants

A cohort of female patients presenting with suspected concussion/mTBI to Emergency Departments (ED) will be recruited for the study.

Patients will be included if they are biologically female and have a confirmed diagnosis of concussion/mTBI from their consulting clinician at the respective clinical recruitment sites. This includes all females of reproductive age (16-50 years). Participants will be excluded if they have a pre-diagnosed mental illness, neurological condition (i.e. epilepsy, cerebral palsy) or if they have had more than 3 previous concussions.

Principal investigator: Natalie Hardaker

(HDEC EXP 11655)

The purpose of this study is to understand how sex hormones may influence the occurrence of and recovery from sports related concussion (SRC) in female athletes. This study will also consider whether the female sex hormones influence biomarkers specifically related to concussion.

This knowledge will help direct future research and inform the development of female specific prevention and recovery protocols for female athletes with SRC.

Participants

The study is prospectively investigating a cohort of eumenorrheic athletes from sports with a high risk of SRC including; Football (soccer), League, Rugby and Netball in New Zealand. The athletes will be recruited into 3 groups:

1. SRC group - athletes that sustain an SRC during the season;
2. Control group - age matched athletes that do not sustain an SRC or any other musculoskeletal injury;
3. SubConc group - athletes (four per match) recruited at random by the research team to undergo repeat baseline concussion testing

Principal investigator: Natalie Hardaker

(HDEC EXP 11904)

The purpose of this study is to develop practical clinical guidelines for clinicians, coaches, and female athletes to navigate the process of returning female athletes to running following a tibial bony stress injury.

The current treatment principles regarding bony stress injury management are not specific to females, and the guidelines regarding return to running processes and progression are limited and varied. There is a lack of consideration of multidisciplinary expert opinion consensus in the current evidence base. Therefore, this study will aim to synthesise the evidence behind each component of the process with expert opinion to develop clinically applicable multidisciplinary guidelines for returning females to running following a tibial bony stress injury. These guidelines will contribute towards achieving better patient outcomes, faster recovery times and reduced injury recurrence rates.

AUTEC Approval Number: 21/411

This study will examine the current level of knowledge around recognising concussion and the attitudes towards concussion (what players and coaches would do if they suspected a concussion). The study will target as many amateur football players and coaches from around the world as possible and will also examine if there is a difference in these two domains (knowledge and attitudes) between females and males.

Findings from this study will highlight areas to target education to address knowledge deficiencies and unsafe attitudes towards concussion. A greater understanding of how players and coaches perceive concussion will help direct how we can support players to stay in the game and protect long term health. The results of this study can also be used as a baseline against which the effectiveness of any interventions used to improve knowledge and attitudes around concussion can be measured.

The Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS) will be made available online and takes approximately 10 minutes to complete. The study will be promoted through social media channels (facebook and twitter), email databases and via posters advertising the study in football club rooms (in NZ only).

Look out for the study on social media and share across your networks.

Principal investigator: Natalie Hardaker

(AUTEC Reference number 22/192 valid until 23 August 2025)

The menstrual cycle is theorised as a factor which could influence injury risk, severity and type in athletes due to cyclical fluctuations in reproductive hormones. Hormones coordinate all our bodily functions, including our metabolism, reproduction, growth, mood, and sexual health. As a female goes through her menstrual cycle, the levels of hormones in the body change. These changes in the reproductive hormones affect muscles, tendons and ligaments, but can also impact our coordination, reaction times and body control. The purpose of this study is to investigate if there is a relationship between phase of menstrual cycle and injury incidence in elite female rugby players.

There is little literature on women’s rugby injuries, particularly intrinsic risk factors. With the growing popularity, professionalism, and performance expectations in the women’s game, it is important to begin to combat the many knowledge gaps.

Contact: Natasha Doyle

AUTEC Approval Number: under review

This intervention study will utilise a TONAL (San Francisco, USA) strength training machine that can be used to understand whether a “digital gym instructor” can help educate the correct technique and potentially prevent injury by improving knowledge, attitude and behaviours of gym users.

Project under development.

Principal investigator: Melissa Cuthbertson-Moon