Psychology is the Best Accessory to Successful Powerlifting: A Primer on The Use of Psychological Tools to Enhance Performance.

By William Andersen Dr. Thomas Orr, Editor

In this article, I am going to be discussing the psychology of powerlifting, and what all goes into it. The aim of my sharing research about the psychology of powerlifting is to prove that it is the most important aspect of the sport and one in which you can make significant improvements to your total. First, what is powerlifting? Powerlifting is a strength sport, compromised of the back squat, the bench press, and the deadlift. The athlete will take three attempts at each of the lifts, and the heaviest successful attempt of each of the three lifts will be added together to create the total. The largest total in a weight class wins the weight class. Each lift must be performed to technical standards, and in conjunction with the commands that the judge gives you. But we are not here to talk about the physical, but the psychological aspect of the sport. 

There are a few main points that I would like to talk about, starting with visualization, goal setting, grit, confidence, and finally getting into the strain of the sport on someone's mental health. For this, I was able to interview Jona Leo, a 4x Bench Press World champion, and my personal coach. First off, I will be talking about visualization and goal setting. What it means to visualize, what it means to have goals set, how to go about it, and how it impacts training and competition. After that I will be talking about grit, and what it means and how important it is in the sport. Then I am going to move into the confidence aspect of the sport. Especially what it means to have confidence in the sport. And then finally I will be talking about the toll that it can take on mental health, and how it affects every aspect of your life. In all these topics, I will also be talking about the divide between equipped and raw lifting, and the difference between the two that each subject presents. First, we need to talk about the difference between the two styles of lifting. Equipped lifting is where the lifter wears a squat suit, bench shirt, and a deadlift suit to complete the lifts. How this equipment works is by stretching a thick layer of canvas in such a way that it wants to return to the lock out position of the movement it is designed to assist. The lifters are also allowed to wear knee wraps, meter long wrist wraps, and a belt. A raw lifter, however, is only allowed to wear neoprene knee sleeves, much shorter wrist wraps, and a belt. So, when lifting raw it is much more just the lifter's own strength, and not the outside equipment. 

Getting into visualization, essentially it is extremely important to have your performance almost planned out. Top level lifters will imagine the whole meet happening before it ever happens. This is something that you can find in all high-level athletes. Jona mentioned that having an idea of each attempt that you want to take is extremely important. Having the plan makes it easier to just go in and execute the lifts. The one thing that Jona stressed the most was having experience of the platform, before you compete. He told a story about how in 2015, in Sweden, for bench press worlds, he laid down on the bench a night or two before the meet, to see what the celling looked like, and what the lights felt like. He said that if he had not done that, the heat of the lights would have thrown him off, causing him to lose the meet. He also says that for every young lifter he coaches, they should go out for their back squat, and find a focal point to focus on, same with the bench and deadlift. This is part of why he went to sit down on the bench before the meet. He was trying to find that focal point, to make sure that he was used to the environment, and then he used that image to help with his visualization. Another thing that helps with this process is performing the lifts in the gym to the standard that is expected of you in competition. This can be helpful for a few reasons. The first reason is that doing the movement as close to what it's going to be like on meet day means that your already acclimated to what it is going to be like, for example, pausing your bench press (according to competition standard, the bar must remain motionless on the chest before the head judge gives the press command). This also means that when you are imagining yourself on the bench, going for an attempt, it is the same as imagining that you are going for a heavy bench single in the gym. 

But visualization can also take a dark turn. In 2016, at the World Deadlift Championships, Eddie Hall was poised to win the event. For his final attempt, He came out to a colossal deadlift of 500 Kg, or half of a ton. He pulled the deadlift and set the world record. But to do this, he took visualization too far. He was working with a psychiatrist and a hypnotist, to unlock something called hysterical strength. He got himself to such a point mentally where he was no longer pulling a bar off the ground but rather a car off his family. While this makes one stronger, it also affects his mental health. Having to make himself believe that his wife and kids were dying, every time he went to deadlift spun him into a deep depression. It took him months to recover and get back to a semblance of normalcy. 

Getting into goal setting, going onto the platform with a solid idea of what numbers you are going to hit, which makes the entire process a lot easier. It means that you can just focus on the attempt that you are currently taking, and not what you are going to take after it. Having the goals set of what numbers you want to hit on the platform can make all the difference in a meet. In my personal experience, having a goal for what numbers you want to hit makes the experience more rewarding. It means that you have a goal that you are working towards the entire time. Each rep you do on and off the platform is done with intent, and purpose, giving you a reason to keep going. Having a goal to work towards makes sure that you always feel like you have a purpose in what you are doing, and not just lifting to lift. This does not apply to just what happens on the day of the meet, but to all the training leading up to it. If I am going into a meet wanting to hit a 200kg (440lbs) deadlift, in my training leading up to that meet I will be a lot more driven to perform well in the gym, so when it comes time to pull 200, I can do it. Having the goal will also motivate you going through your training leading into the meet. As an athlete, there are going to be workouts that you do not want to do, but you must do them. Having a goal to go along with those workouts can make all the difference. If I have a goal set of deadlifting 200kg (about 440.92 lb) on the platform, and I have a 5x5 on deadlifts, the entire time I am doing the workout I remind myself that it is for the sake of the 200kg (about 440.92 lb) pull on the platform. It makes the full process better, because if I am just training, and do not have anything pushing me, it is a lot harder to make sure that I stay motivated to complete the preparation for the meet. 

Next, I would like to talk about grit. First, what is grit? Grit is when someone faces adversity, and still finds a way to push through it and make sure that they perform to the best of their ability. It means taking the adversity, and pushing through, being the best that they can be. I think the best example of this in the sport is again, Gavin Adin. Gavin has had 4 total attempts at the world record squat in the 93kg weight class, and the first 3 times he failed. One time he failed on strength, the next time he failed on depth (the IPF requires the hip crease to drop beneath the knee joint for the lift to count), and the third time his lift got overturned after the fact. And each of these times, that squat could have made him the world champion. But he kept coming back with the same mentality that it was just him and the bar. In the most recent international competition he did, Sheffield 2024, he set the world record squat with 337kg (about 742.95 lb). This was his third attempt, and it was after he had already set the record with 331.5kg (about 730.83 lb) on his second attempt. After him, another 93kg lifter, Carlos Petterson-Grifith, set the world record on his second attempt with 332.5kg (about 733.04 lb). This meant that the final attempt Gavin had to take was all or nothing. If he did not get this attempt, he would not get the world record that he had been chasing after for so long. 

In addition to this pressure, this also was the lift that made sure he took 4th place in the meet. This is a perfect example of grit, as it shows that even though he failed that record so many times, he was able to execute when it mattered the most. Even though he was feeling every emotion that you would expect from someone in that situation, he still came out to platform and executed the lift perfectly. If you watch the attempts back from the meet, you can see the clear ramp up in energy from first to second to third. He walked out calmly to his first, and at his third he was yelling and getting the crowd loud, getting them to cheer him on. He talked about his mentality on a recent podcast, saying that when he is competing, he does not care about how anyone else is doing, that it does not matter that Carlos hit the world record moments before, all it is, is him and the bar. This mentality I think plays a huge role in how he can deal with adversity, because when he goes out for an attempt, there is no outside pressure to make the lift, it is just him. Without the outside pressure from his opponents, it makes it easier for him to not overthink, and get into his own head. Another thing that he mentioned that I found particularly important to how we need to deal with meet day psychology, is this idea of viewing a meet as just another training day. This approach can make all the difference on meet day. It can help calm nerves that someone has.

Moving into confidence, what it means in the sport, and just how important it is to have it. One thing that I have noticed across all the top-level athletes that I have watched interviews with, is they all have confidence. They all think that they are the best. Panagiotis Tarinidis, better known as Pana, the 66kg world champion said in a podcast that anyone who saw the 66kg podium at worlds without him on top had it wrong. This was after a year of lackluster coemption, where over a full year, he was unable to set a PR at any point. This just shows that even if someone is not doing the best in competition, they must have the confidence to make sure that they can go out on the platform and execute to the absolute best of their ability and show that they are the best. In addition to Pana, another notable example of this is Austin Perkins. Austin Perkins is the most notable 74kg lifter in the world currently. Just to give some perspective, at the most recent Powerlifting America Nationals meet, he won the 74kg class by almost 200kg, setting an unofficial world record and becoming the first 74kg lifter to back squat 700lbs raw in competition. Last year at USA Powerlifting Raw Nationals, he became the first 75kg lifter to total 851, setting another unofficial world record. Coming into the USAPL meet, there was talk of how strong he was. People were doubting him, but he went onto the platform and proved everybody wrong. He became the strongest pound for pound lifter on the planet at that meet, boasting an incredible 851kg (about 1876.13 lb) total at 75kg body weight. Even after that performance, people found reasons to say that he was not going to be able to replicate that performance in Powerlifting America vs. The USAPL. But again, he came to the national meet and only taking 7 attempts to set the world record. He came into both of those meets with absolute confidence in himself and his abilities to prove to everyone that he was the greatest. It was the same thing with Pana, he came into the meet as an underdog, but he had absolute confidence in himself, and he became the 66kg champion. 

Every top-level lifter that you talk to about their self-view is going to say that they are the best. They all have the confidence to go out and take what they view as theirs. This is one of the things that is consistent across all top-level athletes. They all have a level of self-confidence that is bordering on delusion. This level of confidence is needed to be the best. You must genuinely believe you are the strongest person on that platform. This also manifests not only in the athlete's belief that they are the best, but that when they get onto that platform, they are going to be able to lift whatever is on the bar. Austin Perkins has said that this can be considered the hardest part of a competition. When talking about confidence, it is also important to talk about the effect that a crowd will have on you. Lifting in front of a crowd is significantly different than lifting by yourself or with a group of friends when in the gym. This has been shown to be a boost to your lifts, as an experienced lifter will gain 10% on each of their lifts during competition, according to Vladimir Zatriosky. Considering this in terms of confidence, the lifter experiences a boost in confidence because all these people are there cheering them on. 

Now I want to talk about how powerlifting can affect every aspect of your life. The benefits and harms of sport  permeate life and extend throughout our lives. So much more goes into powerlifting than just going to the gym every day. Like any top-level athlete, a powerlifter must be on top of every aspect of their life. They must eat right, sleep right, stretch right, and live their life in such a way to make sure that they can be in the best possible shape to be the strongest version of themselves that they can be. This can become an all-consuming task. You must sacrifice so much to make sure that you are in the best possible shape. You have to go to bed early, you miss out on events with friends and family. You miss out on making those memories with people, but that is the cost of being the greatest. If you really do want to be the best, you must make sacrifices. This can impact a lifter's mental health, leading to feelings of loneliness. These feelings can often give way to depression and cause other mental health issues. 

You also have to make sure that you are eating right, to make sure that you make weight, or maintain your body weight. This brings up another thing that can be a toll on your mental health, the weight cutting process. If a lifter competes at 93kg, but their walk around is 98kg, that's 11lbs that they have to lose while keeping their strength. Most lifters opt to do a water cut, but some have to gut cut. This adds all sorts of pressure to a lifter to make sure that they weigh the right amount come meet day, and then if they miss weight, it can have a significant impact on a lifters mental going into a meet. Missing weight means that a lifter cannot compete for any titles or records. If going into a national meet, the first seed lifter in a weight class misses weight, it means that he cannot compete for the chance to represent his country. Anything that lifter does on the platform that day does not mean anything. While most lifters still choose to compete as a guest lifter, any numbers that they do mean nothing. The lifter is going out and trying their hardest, but it means nothing. They are not allowed to count the meet towards anything. For example, if Gavin Adin came into Sheffield missing weight, that would mean that the squat world record that he had been fighting for for years was now unattainable. But then there is the flip side of that equation, if a lifter has a grueling weight cut, they make weight. Something like this happened last year when Nabil Lahlou cut from 78kg to 67.5kg. This drastic of a cut severely affected his physical health, but the outcome was worth the struggle. He went on to set the world record deadlift of 325kg (about 716.5 lb). I was watching this meet on livestream, and we can also use his performance to talk about grit. The 325kg was meant to be his opening attempt, and he came out to take it for his opener, but he failed. He then failed it again on his second attempt but got it on his third attempt. This is a good example of grit because not only did he have to endure a 14% body weight cut, but he almost failed the whole reason he did this in the first place. His entire point in taking such an aggressive cut was to set the world record deadlift. But even though his dream was riding on this lift he had already failed twice, he still came out to his third attempt like it was any other and executed one of the most technically proficient deadlifts I have ever seen. He was able to keep his mentality in check, and still treat each attempt as its own attempt, not letting the one before impact him.

Now I want to spend some time talking about each of these topics, but in the equipped sense. When talking about equipped powerlifting, we have to almost treat it like a different sport. First off let's talk about visualization. When it comes to equipped powerlifting, it is not as different as one might think. In my talk with Jona, we talked about it a little bit, but the general process is the same for raw and equipped. For the example that he gave of laying down on the bench to see what it was like, that was for equipped bench press worlds, and he suggests that all his athletes, raw or equipped do that. So, this process can be the same between both disciplines. Next up on the list is grit. It appears grit is more important in equipped than raw. When benching equipped, there is a greater chance of failing the lift from a technique standpoint, and so being able to go out again and execute like it is your opener is even more important in equipped. This also plays into confidence as well because you need to be confident in your ability to use the bench shirt in the way that it is intended. 

As the example above demonstrates, you must control all the variables presented in front of you, and with equipment there are many more to control. I asked Jona if he was going to be more confident going into a max raw bench press, or an equipped max bench press, and he said without hesitation that he was going to be more confident under a raw bench press. He said that because of the reasons that I have already laid out. There are more variables to control with a bench shirt vs just benching raw. When he is taking a raw bench attempt, he says that it is just his body doing the work, and that he knows about where his top end of strength is. He can get under the bar with the knowledge that he can lift it, but with equipment he does not have that knowledge. If he were to fail a lift, it could be for any number of reasons and when he goes to attempt it again, he must have all those reasons in his mind, and what he needs to do to fix all of them. Once he has it narrowed down, then he has to fix it. Especially in equipped, fixing it can mean so many different things, he might have to take his bench shirt off, and put it back on in a different way, or he might have to re-wrap his wrists in a different way, or it might just be the idea of trying to make sure that his butt stays on the bench. Having more factors to worry about is why Jona says that he is more comfortable under a raw bench as opposed to an equipped bench. 

When talking about raw and equipped and the differences between the two, it is essential to talk about why raw is more popular than equipped. When watching equipped lifters, you see them squatting 1000+, benching 1000+, and deadlifting 900+, but you see them wearing this suit thing that looks silly to someone who has no experience in the realm of powerlifting, but even to people who go to the gym, they more than likely have no clue what they are looking at. Why raw is more popular can be attributed to the mere-exposure effect. What this means is that people are more attracted to something that they are familiar with. If you take someone who goes to a commercial gym to try and get in shape, and show them equipped and raw powerlifting, they are more likely to watch raw for longer because they are familiar with it. They are also more likely to choose to compete in raw. This is for the same reasoning, because it is how they lift in the gym, so they are more likely to choose the one that feels the most familiar. It boils down to the fact that equipped lifters seek out other ones to lift with. Most of the time, they choose to go to a powerlifting specific gym, instead of a commercial gym.

In conclusion, powerlifting might be an extermly physical sport, but psychology might be more important to succeeding in the sport. I say this because not every top-level athlete trains in the same way, but they all have the same mentality. Everything that I have talked about in this paper has been consistent across almost every top-level athlete in the sport. If you have the hunger to be the best, then your training intensity will follow. Having the mentality that you are the best, and the want to prove it are the most important things in the sport of powerlifting. Someone can train as hard as physically possible, but still not be the best because they do not want to be. If someone has the want and need to be the best, then the necessary training will follow. That is the thing that separates a normal athlete from the best of the best. This mindset of I am the best and I must prove it. Having the right mentality is the single most important thing in powerlifting, and in every sport. If someone just has the raw talent to be great, but they do not want to be great, then they never will be. All the athletes that I have mentioned in this paper all have some form of that mentality. It might not be worded the same from Pana to Gavin, but it all comes down to the fact that they believe that they are the best, and they have a hunger to prove it. Because they have this need to prove that they are the best, they will train as hard as they can, and in the smartest way possible. This is what drives them to keep training as hard as they can. That is the goal they have set for themselves: they want to be the greatest, so they will do everything they can to ensure they become the greatest. Being the best, no matter what the sport, requires all the aspects that I have talked about in this paper. In powerlifting, it really does not matter how strong you are, if you do not have the want and need to be the best, then you never will be.

Bibliography 

Weinberg, R., & Gould, D. (2024). Foundations of Sport and Exercise Psychology (8th ed.). Human Kinetics.

King of the Lifts, (2024/8/3), Gavin Adin: Coming for PA Nats, his goal for 2024, Pitre/Cayco/Carlos/Gustav, https://www.youtube.com/watch?v=bRljIMGmk7Q

King of the Lifts, (2023/25/4), Pana Returns: Deep struggles of 2022, Rivals, France vs the World, Worlds 2023, Grizzly, & more! https://www.youtube.com/watch?v=K6j4EYfwHUQ

King of the Lifts, (2024/24/5), Austin Perkins: Moving on from Atwood to Russ, Worlds with Kjell, Sheffield, his end game https://www.youtube.com/watch?v=bLzD4vXUF-0

Grison, S., & Gazzaniga, M. (2022). Psychology in Your Life (4th ed.)

EliteFTS. (n.d.). Powerlifting: Sport Psychology & Training. EliteFTS. https://www.elitefts.com/education/powerlifting-sport-psychology-training/

Zatsiorsky, V. Science and Practice of Strength Training

Siff, M. C. Supertraining

Montoya, R. M., Horton, R. S., Vevea, J. L., Citkowicz, M., & Lauber, E. A. (2017). A re-examination of the mere exposure effect: The influence of repeated exposure on recognition, familiarity, and liking. Psychological Bulletin, 143(5), 459–498. https://doi.org/10.1037/bul0000085

Leo, Jona, March 28, 2024, via Zoom 

Capitalizing on Women’s Sport Triumphs

Dr. Lynn M. Jamieson, Professor Emerita

​The sport world is undergoing a very dynamic series of changes brought, in part, about by the rise of popularity of women’s sport participation and spectator interest in attending the many triumphs of female athletes. As stadia become packed with fans of female sport contests and as women compensation approaches parity with men, it is a great time to predict the potential opportunities and pitfalls in the path of women’s rise to greater visibility on the international stage.  One major theme in this article is that it is essential that the growth of popularity in women’s sport and the improvement of the competitive environment, while becoming similar to men’s sports, are ways to forge new ways to improve the sport environment and not replicate a system that mimics the current men’s port environment.

​What are concerns with respect to women’s sports today?  First, a noted by Simon Biles, “I’m not the next Usain Bolt or Michael Phelps. I’m the first Simon Biles” (Uplifter, 2019). This organization to increase parity with men’s sports does not mean that the structures and functions have to be repeated.  Women’s sport organizations and the women’s department within sport organizations should achieve a process to avert issues that have been plaguing current sport structures – sport violence, sport injury, control of events, monetary issues, and many other categories that successful organizations strive to avoid.  With the additional revenue supporting the creation of new systems, a great opportunity exists to construct a better sport environment.  Further, many issues of parity still remain, to name a few, such as coaching selection and salary structures, training and development opportunities, injury mitigation, psychological support mechanisms, facilities, and opportunities to gain greater visibility.

​It is inevitable that those who wish to capitalize on new opportunities for women, may strive to do so for a purely monetary gain.  With that comes efforts to control the environment, make it profitable, and becoming more like the current environments in men’s sport – gambling opportunities, profit orientations of investors, pressure to focus on the entertainment value of the sport contest at the expense of players health and wellbeing, and other issues encountered in the current sport model today. It is time for the expertise of women to dominate the planning of their future ascension in the sporting world. It is important to avoid the current male power structure and forge a new and different model.​​

​According to Jon Solomon (2021), who posed this question : “What if pro sports were owned, designed and run by women?”  He suggests that women would set up an entirely different model, involving at the forefront a “more equitable playing field”.  Some of the ways that this could be accomplished is through athlete ownership of their team, where they automatically benefit from  profitability, encouraging more investment in teams, keep a separation, operationally from men’s sports, and produce a different viewer experience than what we have become used to in men’s sports.  While many other approaches may exist, it really doesn’t take much to learn from the “Lasso” model portrayed with a men’s soccer team in Great Britain and owned by a female as it gives a different coaching philosophy, fan experience, and lastly, development of a women’s soccer team.  

​The final word in this opinion piece is that as women’s sport increase in value, let that value reflect much beyond monetary gain known as “money and power” common in present day sport, and evolve into an elevated sport experience for players and fans.  The drafting table is new and there is only the future ahead to see if women can rise beyond the structure and functions of today’s sports.  This future wide open!

References

Solomon, J. (2021). Future of sports; Women reimagining pro sports. The Aspen Institute, April ​23, 2021.

Author Unknown. (2019). Gender inequity in sports and how to grow female sports audiences. ​Uplifter, March 22, 2019.

Tobacco and Sports: A Dying Relationship

Once upon a time, tobacco was ingrained in the fabric of athletic culture. From iconic images of baseball players chewing tobacco in the dugout to the association of smoking with sophistication in certain sports, tobacco has been a pervasive presence. Formula One was the epitome of cool, with fast cars, beautiful women and huge characters in the cockpits – at one stage in the eighties, almost every car had a cigarette logo emblazoned on the side.

However, in recent years, this relationship has undergone a transformation, with a growing awareness of the detrimental health effects of tobacco. Smoking has gone from being seen as cool to being viewed as a dirty, destructive habit. Much of that change has been driven by sports – after all, smoking is still prevalent on-screen in films and in the world of music.

Here’s how the change has happened and how, as a sports fan, you can help yourself if you’re still chained to tobacco.

Historical Context

Tobacco and sports shared a symbiotic relationship for much of the 20th century. Tobacco companies often sponsored sporting events, and athletes were featured in advertisements promoting various tobacco products. In the fifties, the NFL signed Philip Morris’ Marlboro as its major television sponsor and permitted players to appear in tobacco adverts, and even into the eighties, Formula One racing was one big cigarette advertising mechanism.

Whilst smoking was also perceived as cool, athletes looking to build a brand were often seen smoking to help cement their persona as style icons. Indeed, smoking was considered a norm in sports culture, with many athletes using it to cope with stress or as a perceived performance enhancer.

The turning point in this relationship can be traced back to the surge in scientific research in the late seventies, highlighting the severe health risks associated with tobacco use. Athletes, always viewed as epitomes of health and fitness, began to distance themselves from tobacco to align with the emerging understanding of the importance of clean living. Sports figures started to embrace healthier lifestyles, becoming advocates for physical well-being and setting positive examples for their fans - today, the route to becoming a champion is very different from that of the seventies.

Changing minds

Starting in the late 1970s, on the back of tobacco research, endeavors were initiated to counteract the influence of tobacco sponsorship in American sports. In 1977, Doctors Ought to Care (DOC), a health promotion group comprised of physicians, took the initiative. They commenced a campaign by acquiring counter-advertising space in various cities, utilizing billboards, bus benches, newspapers, and both TV and radio platforms. Beyond that, the group extended its influence by sponsoring diverse sports entities, including a motorcycle racing team, drag cars, a racing sailboat, and even the US Boomerang Team.

Regulations and bans

In line with these changes on the field or track, governments and sports organizations worldwide have implemented stringent measures to combat tobacco use in sports. For instance, in 2010, the Food and Drug Administration (FDA) utilized authority granted by the Family Smoking Prevention and Tobacco Control Act (FSPTCA) and implemented a restriction on tobacco-brand sponsorship. This prohibition extended to the sponsorship of sports events prohibiting the use of tobacco brand names or any elements associated with cigarette or smokeless tobacco brands.

State by state, smoking bans are being enforced in stadiums and arenas, whether as part of a wider ban on smoking in public places or, in some instances, regulations aimed at specific venues. Currently, 24 MLB stadiums prohibit smoking, whilst of the 30 NFL stadiums, 26 have bans in place. Often, these bans include all tobacco products and even some alternatives, such as vaping.

What it means for you

As a sports fan, this could be bad news if you’re a smoker. Indeed, whilst smoking rates have reduced, research suggests there are still 28.3 million smokers in the United States, around 11.5% of the population. If you’re one of them, it could make your trip to watch your local sports team a challenge.

There have been huge steps in developing tobacco-free alternatives to help with cessation. These often come in the form of a nicotine derivative, delivered in several different ways. One of the most popular methods in the United States today is the nicotine pouch, a flexible and discreet alternative. These are small pouches that fit between the lip and gum, dispensing nicotine over the course of half an hour or so. As demonstrated by the nicotine pouches available on Prilla, they come in a range of flavors, such as citrus or wintergreen, and different strengths to alleviate symptoms for the heaviest of smokers.

Nicotine patches by the likes of NiQuitin are another alternative - they fix to the skin and deliver a hit of nicotine over a period of time. They are suitable for athletes, should they be needed, as they last for up to 24 hours and even come clear, so they can’t be seen on the skin.

Conclusion

Sports and tobacco have a chequered history, with early sports leagues happy to take tobacco money to develop. As we move deep into the 21st century, that association is long gone, and for athletes and spectators, sports and tobacco are no longer bedfellows.

For more information on policy within sports, be sure to bookmark our Sports Policy Center homepage.

The Bloody Truth of the Matter; We Must have Mandatory Neck Protection in Competitive Ice Hockey

By Jamison Ness, Tucker Kruse & Dr. Thomas Orr

As Adam Johnson moved towards the middle of the ice in an exciting hockey move, his neck was exposed and in a split second the skate blade of a rival player, Matt Pettgrave slashed through his skin and minimal protection essentially slitting his throat. The blood poured out and with no time for first aid or even to get to his bench, Adam died on the ice. This reality was the nightmare of anyone who cares about someone who plays a competitive sport; death on the playing field. Why did this happen and can it happen again were two of the many questions that stakeholders began asking. Solutions and ideas to keep players safe became the hot topic related to the critical question; Did Matt Pettgrave intend to cause harm and death to a co-participant in ice hockey? 

Would have better equipment helped? The idea of a mandatory neck guard is not a new idea as this has been an area of debate in hockey for years. Several days after the incident a 16 year old AAA hockey player in Eastern Ontario had a skate cut into his neck, however not as deep partially because of the neck guard he was wearing. As an article published virally across Canada and the world proclaimed the neck guard was successful in preventing a deeper and potentially fatal cut. ““Luckily, he was wearing a neck guard or this could have been much worse," the tweet by the HEO officiating program said. “This can happen any night in any rink. Protective equipment matters for everyone.”" (Kierszenblat, 2023)

As a lifelong hockey player, Co-Author Dr. Orr has had his own knee gashed open that required going to the hospital. While directing a hockey camp a high school age player lost his edge and fell towards Dr. Orr with his skate blade coming first causing a great deal of blood and a tough situation as he had to be rushed to the ER while the other coaches kept things under control and completed the camp. Though not a neck injury the gash was deep enough to have killed him had it been on the neck. Dr. Orr had been the first to support a goalie who was sliced and bleeding while participating as a peewee hockey player in his youth. Just last season his son Lyndon Orr sliced open the arm of his Helena Bighorns teammate, ending his teammates season after he cut through tendons and much of his arm in an accidental play where they were tied up with an opponent and trying to get back in the play quickly. Lyndon did not even notice what had happened until the game came to a stop and his teammate rushed off the ice for emergency care. He was saved with some quick work and the luck that it was an arm and not a neck. Earlier in that season while coaching for the University of Mary defensemen Ryan Wolf had a skate slice through the side of his face and ear while playing against North Carolina State that produced a very gruesome picture and without his helmet may have killed him. These real stories demonstrate the frequency of these dangerous players and when Dr. Orr reflected on his time in Canada where our 18u players had to wear “goofy neck guards” he expained the sense in having some safety from the modern and sharper blades we are now using. People were slow to react to concussions and even safety nets to protect fans from flying pucks so it is not a surprise that their has not been a quicker and better reaction from USA Hockey. 

Canada has always been more progressive than the United States when it comes to the usage and mandatory provisions related to a neck guard. Again taking the lead, “the WHL has announced that all players must wear protective neck guards moving forward. The mandate goes into effect on Friday, Nov. 3, 2023, or as soon as the equipment is available. According to the WHL, these neck guards must be used during all on-ice activities, which include games and practices.” (Eltherington, 2023)

One particular problem with implementing the rule has been the incredible increase in demand that has decimated the supply of neck protection available. An initial rush cleaned out most of what stores had in stock. In several personal interviews stores reported that they had sold exponentially more in the days after than they had ever sold. One of the most popular sport stores in Minnesota which is located by the Blaine Super Rink sold a record number of neck guards. According to a group of their employees, “Many neck guards that had been collecting dust were now flying off our shelves.” (Orr, Lettermans, 2023) In neighboring North Dakota Duffys in both Minot and Bismarck are feeling the need to keep their store stocked with neck protection. Clarke Dingeman who manages Duffys said, “Parents have come in feeling the need to make sure their kids are safe when they are playing hockey. They made it a priority and are making sure their kids have them.” (Orr, Duffys, 2023)

Anticipating a supply chain challenge Hockey Canada required teams to get the additional protection as soon as possible. We found in a personal interview that November 9th was the first time a particular player used his in a WHL game as it did take some time to arrive. The player said, “I do not mind having to wear one. It does not effect my play and it is like any other piece of equipment. The rule does not effect our play but only makes us safer” (Ness, 2023)

In Sport Marketing we have a concept called “Cool Kids” effect and this is a simple idea that when our sport celebrities endorse something it becomes “cooler” because they are associated with the brand or idea. T.J. Oshie, a current NHL hockey player best known for a series of incredible shoutouts against Russia during the Olympics is generally regarded as a popular hockey player. 

INSERT https://www.youtube.com/watch?v=MUxJXzKY4LE

The fact that he instantly made a public profile showing his usage of a neck guard was a great example of a sport star using their celebrity status to make something that is not seen as cool to wear, a little bit cooler. Wearing extra protective gear in a sport ripe with masculinity is not always received well so having this type of star wear one is a great message for little kids and big kids all over the world. A cynic would quickly point to his ownership and financial gain from his affiliation with Warroad Hockey Company who makes cut resistant clothing already. You can view the site and quickly see that TJ is going to benefit financially, however the end result will be safer hockey and that is the good thing. 

TJ Oshie    Insert picture>  https://i0.wp.com/russianmachineneverbreaks.com/wp-content/uploads/2023/11/tj-oshie-neck-guard-warroad-aland.jpg?fit=2000%2C1333&ssl=1 

USA hockey is planning to do something but are yet to do anything substantial. The governance of hockey in not just an American issue. Because of the Olympics, World Cup of Hockey, Junior Hockey World Championships and the many international affiliations of hockey the USA cannot dictate what rule will be enforced for all of hockey. If American athletes have to play in an international event they would have to abide by that set of rules, so if the rest of the world decides to require neck protection at their events then American players would need to either adapt those rules and be used to those rules or at a minimum comply with those rules when engaged in International competition. In this sense it seems imperative that all players start getting used to playing with some type of neck protection if this is the way of the world. Even if the majority of countries do not react to this current incident, its only a matter of time before another tragedy happens. 

We cannot wait for more incidents to tip the scales of our decision on this critical matter. A “hot stove strategy” where each sport organization quickly and thoroughly conducts their due diligence by implementing a mandatory policy for protective neck gear is necessary immediately to ensure we are doing the best we can to prevent “the next victim”. 

References

Eltherington, W. (2023). Eastern Ontario Youth Hockey Player Saved by Neck Guard. CTV News. Path: 

https://ottawa.ctvnews.ca/eastern-ontario-youth-hockey-player-saved-by-neck-guard-1.6648012

Kierszenblat, A. (2023). WHL Mandates Neck Guard Protection. Hockey News. Path:

WHL Mandates Neck Guard Protection - The Hockey News Western Hockey League

Ness, J. (2023). Interview with a WHL Player. 

Orr, T. (2023). Interview with Clark Dingeman, Manager of Duffy’s Sports. 

Orr, T. (2023). Group Interview with Lettermans Sports Employees. 

It’s Never ‘Maybe’. You Are Always Ready: Implementing Psychological Training for Brazilian Jiu-Jitsu Competitors

By Emmaline M. Gappa

Department of Psychology, University of Mary

My heart beat painfully within my chest as blood pulsed through my ears. The loud, rhythmic pounding drowned out all the noise. The smell of sweat flooded my senses and my muscles began to twitch with anticipation. My hands were bricks and my mind a broken record - this is it, this is it. All this waiting, all this time, training, effort, pain, it all came to this moment. Suddenly one voice sounded above the rest. “Are you ready?” I looked up. I mustered a “maybe.” My teammate grabbed me by the arm and looked me dead in the eye…“It’s never maybe. You are always ready.” 

As any athlete in combat sports comes to find out, the ability to choose when one is ready is a luxury. Brazilian Jiu-Jitsu seeks to simulate this experience through competition so as to prepare athletes for the most practical application of learned skill sets in a controlled environment. Competitions allow Brazilian Jiu-Jitsu (BJJ) competitors to test their abilities and skill but in a safe environment with particular rules, regulations, referees, and judges (Scoggin, 2014) and are a crucial step for BJJ athletes. BJJ athletes and coaches typically focus all attention solely on physiological performance; however, new research suggests psychological tools such as arousal regulation, imagery, confidence, motivation, concentration, and injury management, may be the most powerful weapons for a brand new competitor in BJJ tournaments. 

In general, “the art of jiu-jitsu searches for truth: pragmatically, since it works well in physical fights, and ethically because it seeks to defend both the lives of the assaulted and the assaulter” (Le, 2022). Many find that participating in BJJ helps to relieve stress and extraneous energy, provides an opportunity for exercise, builds confidence, has mental health benefits and more (Marc, 2020). However, these benefits can be questioned as tournaments loom overhead and the stress of competing begins to take over. While psychological tools are important in any sport, and naturally implemented for all athletes (i.e. goal setting), these tools become even more precious for an athlete who is new to the field of BJJ and approaching his/her first tournament. 

Most BJJ athletes enter their first competition with at least six months of preparation and a training plan which focuses on “the manipulation of resistance training variables and the design of energetically specific metabolic conditioning drills, along with sports-specific training that accurately reflect the demands of competition” (Lachlan, 2014). Many research papers emphasize the importance of developing greater resistance and strength, striving to “generate maximal power…to develop force, storage and utilization of elastic energy, interactions of contractile and elastic elements…” (Cormie, 2011) and research is concentrated on topics such as blood glucose, lactate and maximal isometric grip strength (Andreato, 2013). However, such heavy training loads and the consequent stress can initiate great psychological changes and a higher risk of injury (Silva, 2019). 

Based on the BJJ Tournament Preparation Questionnaire (see Appendix B) given to six BJJ competitors of ranging years of experience and number of competitions, injuries, confidence, and self-efficacy were the highest point of concern. Brazilian Jiu-Jitsu focuses on “takedowns, joint locks, leverage, and strategy to immobilize, control, submit, and disable an attacker…[and] allows a smaller or physically weaker person to successfully subdue a larger, stronger opponent by using proper technique, including joint locks and chokeholds” (Scoggin, 2014). The results of a study done by Dr. Rodriego Silva and his colleagues highlight the dangers of this approach, claiming that BJJ athletes are exposed to a high risk of injuries during competition, particularly resulting from falls, overexertion, or joint locks (2019). Furthermore, results from the BJJ Tournament Preparation Questionnaire show that confidence and self-efficacy consistently ranked lower for all athletes, regardless of their level. Experience can naturally build up or tear down confidence, but new research says that there may be other tools athletes can use. 

Psychological skills training (PST) “refers to systematic and consistent practice of mental or psychological skills for the purpose of enhancing performance, increasing enjoyment, or achieving greater sport and physical activity self-satisfaction” (Weinberg, 2019). The methods and techniques that make up PST come from a wide range of sources in psychology such as, cognitive behavior therapy, rational emotive therapy, goal setting, attentional control, progressive muscle relaxation, and systematic desensitization (Weinburg, 2019). PST helps prepare athletes for losses, choking (poor performance under pressure), injuries, loss of motivation, lack of focus, and anger management (Weinburg, 2019). However, it is important that PST is approached with balance which is why careful planning is crucial. 

Most PST programs today implement the following skills during training: arousal regulation, imagery, confidence building, increasing motivation and commitment, attention or concentration skills, and coping with injury (Weinburg, 2019). As Sport Psychology continues to grow as a science, numerous studies have proven that “(a) both psychological and psychosocial interventions significantly enhanced sport performance, although psychosocial interventions produced the largest positive effects, (b) performance effects lasted about a month after the completion of the intervention, (c) effects were greater when coaches delivered the intervention, and (d) effects were somewhat greater for males than females” (Weinberg, 2019). Furthermore, international-caliber athletes often “employ more elaborate and complex mental strategies and techniques” than the average athlete which is directly linked to their success (Weinburg, 2019). 

PST requires three stages: Education (learning the importance of PST and how PST affects performance), Acquisition (acquiring strategies and techniques), and Practice (automate skills through overlearning, integrate psychological skills into their performance, and simulate those skills used in competition) (Weinberg, 2019). It is a long-term process that should be implemented from the beginning (or during off seasons) and is not effective as a “last resort”. PST sessions are typically 10-15 minutes long and 3-5 days a week at the beginning or end of physical training. The skills chosen should be customized to the athlete and implemented by both the coach and sport psychology consultant. Furthermore, each type of sport may have a particular area that needs more psychological support than others. 

Many martial art forms focus on both the physical and psychological responses so that “fighting should be a last resort, for a just cause, engaged with the intention for peace and reconciliation, with the appropriate amount of force, while keeping emotions in check” (Le, 2022). Higher levels of cortisol have been reported in BJJ competitors and 100% of the participants in the BJJ Tournament Preparation Questionnaire experience the greatest amount of stress before the competition. “This suggests that BJJ athletes experience greater amounts of both psychological and physical stress during the competition than practice” (Lachlan, 2014). Consequently, it is paramount for beginner athletes to be able to regulate arousal. Wojciech J. Cynarski, the Chair of Cultural Foundations for Physical Education at the University of Rzeszow and a Martial Arts instructor since 1987 summarizes this point succinctly. “What is the meaning of fighting? This is above all a test of skills and emotional self-control” (Cynarski, 2016). But if the same amount of cortisol is not present in athletes who are practicing, then it does not adequately prepare a new athlete for regulating arousal during competition, and especially not for real life situations. 

There are many approaches to regulating arousal in sport psychology, i.e. Multidimensional Anxiety Theory, Reversal Theory, Catastrophe Theory, Challenge and Threat States, and more (Turner, 2018). Dr. Turner and Dr. Marc Jones, faculty members of Health Sciences at Staffordshire University, identify two ways to regulate arousal without the actual situation. First, create a challenging environment during practice. Challenge instructions focus on raising resource appraisals, self-efficacy, goal setting, and goal orientation, while teaching the athlete to decrease demand appraisals, such as uncertainty. Instructional sets, the information an athlete is or isn’t provided, and threat instructions, the level of difficulty and perseverance required, can also alter an athlete’s arousal (Turner, 2018). “Challenge instructions promoted high self-efficacy, high perceived control, and a focus on approach goals; threat instructions promoted low self efficacy, low perceived control, and a focus on avoidance goals…Therefore, information offered to individuals that promotes high perceived resources, such as the instructions used in past research…may help those who receive them to enter a challenge state” (Turner, 2018). Implementing tournament rules and regulations along with fluctuating schedule changes during practice gives athletes the opportunity to adapt and build confidence. Furthermore,“a significant body of research indicates that social support provides a buffer for the adverse effects of stress” (Turner, 2018). Dr. Turner and his colleagues found that social support:

…provides those in receipt with coping guidance, similar to challenge instructions, and contributes to positive appraisal by helping those in receipt clarify their understanding of threatening stimuli…Informational social support can be used to help convince an individual that they can cope with the stressor…[and therefore] promotes high perceived resources…[and] positively influences performance, regardless of the level of stress” (Turner 2018). 

Finally, reappraisal (perceiving anxiety as helpful), relaxation techniques, and imagery also can contribute to more successful arousal regulation. 

Imagery is a newer, yet very natural psychological tool that has emerged as a powerful resource for all athletes. “Mental imagery typically refers to internal representations and the attendant experience of sensory information without an external stimulus…[and] has a stronger impact on subjectively experienced emotions than verbal processing” (Hiskey, 2021). Imagery can be visualized through a first-person lens or as an observer and can be further broken down into five categories “correcting/adapting new skills, devising/updating plans, imagining success, managing anticipation and excitement, and mastery (remaining confident)” (Hiskey, 2021). Research shows that conflicts continue influencing the mind through retroactive and proactive imagined interactions through mental imagery, whether purposefully or naturally replayed by the athlete and “constructive conflict resolution is likely enhanced by vividly imagining more positive interactions and outcomes” (Hiskey, 2021). Consequently, regular imagery helps with cognitive and motivational purposes and can increase self-confidence and self-efficacy. Mastery and goal imagery in particular indirectly influence the intensity and direction of cognitive and somatic anxiety through confidence. (Hiskey, 2021). Imagery can help new competitors prepare for the additional emotional and situational factors that don’t arise in practice for competitions and teach themselves to account for unexpected holds, blows, or pain before even experiencing it. 

Almost all participants of the questionnaire claimed to visualize working through tough situations prior to competition. Through PST, these skills can be heightened. New research shows that imagery is most successful when paired with layered stimulus response training (LSRT) which “aims to help users better generate and control their experiences of imagery by adding three components in successive layers of information” (Hiskey, 2021). “Imagery is not simply visualising yourself winning or crossing the finishing line. It’s about putting your mind in the best space to achieve this” (Sport Resilience, 2016). For the best results, imagery should be constantly updated to reflect new goals and be done in real-time. Finally, all imagined scenarios should include the following categories: physical, environmental, task, timing, learning, emotion and perspective (Sport Resilience, 2016).

Replaying these experiences will naturally result in confidence, that is, “the belief in achieving the desired outcome in competition, despite personal or competition-specific distractions and irrespective of the performer’s actual competence” (Chen, 2013), which is a major proponent of Brazilian jiu-jitsu (Reusing, 2014). Confidence is influenced by a range of different factors athletes should be aware of, such as performance accomplishments, vicarious experiences (modeling), verbal persuasion, imaginal experiences, psychological states, and emotional states (Weinberg, 2019). The relationship between confidence and performance can be represented by an inverted-U. Too little or too much confidence results in poor performance, and PST helps athletes achieve this balance. The results of the BJJ Tournament Preparation Questionnaire revealed that confidence, though vital to competition, was markedly low.

Fortunately, there are a variety of ways to improve confidence (Weinberg, 2019). First, many athletes are naturally encouraged by focusing on performance accomplishments. But what if this is the first time an athlete is competing? Weinberg (et. al) suggests turning one’s attention to the smaller accomplishments done in practice (2019). Acting confident, responding with confidence, and thinking confidently, even if the athlete doesn’t feel like it, is statistically proven to positively influence performance. But this doesn’t mean one shies away from unpleasant feelings. On the contrary, Vealey and Vernau suggest the ACT method: “Accept bad feelings/performance, center yourself with a comfortable, confident posture, and think using prepared self-talk and focusing on the aspects one has control over” (Weinberg, 2019). As stated above, imagery can also build confidence by repeating past or potential scenarios as a way to learn and build up consistent patterns. Goal mapping (personalized plans that include a range of different types of goals) and optimizing physical conditioning and training, while they may seem like obvious ways to build confidence, are surprisingly hard to keep up over long stretches of time. 

Motivation and concentration skills can waiver at times, particularly under high amounts of stress. Motivation is the ability to persist at an activity in the face of boredom, fatigue, pain, and the desire to do other things (Taylor, 1995). It is a hypothetical construct which describes the internal or external forces that shape and advance initiative, direction, intensity, and the duration of any behavior (Jocić, 2021). “Motivation, according to the self determination theory, stretches along the continuum from amotivation (when an individual has no desire or intention to participate in an activity) through extrinsic motivation (when an individual is active only because of the very value that activity brings) to intrinsic motivation (participating for pleasure)” (Jocić, 2021). The key point of the Self-Determination Theory is to reach autonomous self-regulation because in this mindset, athletes will self-initiate and persist in any activity due to the fact that they perceive tasks to be interesting and important (Jocić, 2021). “Therefore, autonomous motivation refers to engaging in a particular type of behaviour because it is perceived to be consistent with intrinsic goals or outcomes” (Jocić, 2021). Dr. Taylor’s research shows that gross motor skills, long duration, and long, intensive pre-competition preparation require high motivation (Taylor, 1995). “Ways to maintain motivation include short-term goal setting, using motivational keywords, engaging in motivational imagery and increasing intensity” (Taylor, 1995). Furthermore, putting more emphasis on the process, such as tactics and technique, instead of the outcome naturally focuses on what the athlete can control, and will lead to better performance (Taylor, 1995). But when there is extraordinary noise or pressure, it becomes hard to force one’s attention to the task at hand, and thus, motivation and concentration are integrally linked. 

There are four main types of concentration that aid an athlete during stressful situations: 1) the ability to focus on key environmental cues (selective attention), 2) maintaining focus on what is directly at hand, 3) being aware of the situation and 4) any performance errors, and the ability to shift attention when necessary. “Expert players attend more to advanced information…[and] movement patterns of their opponents, search more systematically, selectively attend to the structure inherent in their particular sport, and are more successful in predicting” (Weinberg, 2019). The first step to better maintaining focus is to understand the different categories, i.e. broad attentional focus (assess the whole situation), narrow attentional focus (assessing one/two cues), external attentional focus (assessing environment), and internal attentional focus (assess inward thoughts/feelings), and knowing how they relate to one another (Weinberg, 2019). A second key factor of concentration includes mindfulness: “awareness that emerges through paying attention on purpose to the present moment, and nonjudgmentally to the unfolding of experience moment by moment” (Weinberg, 2019). Athletes use mindfulness to use positive-self talk and self-regulate by “attending to one object for long periods, shifting attention between objects, and inhibiting task-irrelevant thoughts and feelings” (Weinberg, 2019). Mindfulness consequently reduces arousal enough to be entirely attentive to the task at hand. Finally, predicting one’s behavior, most accurately through imagery, can encourage better results. But motivation and concentration can come to an abrupt halt when unpredicted setbacks, such as injuries, occur. 

All athletes must learn to cope with injury and, depending on the severity, athletes have a range of responses when coping with setbacks. “This grief reaction has been widely cited in early articles about the psychology of injury, but evidence shows that although individuals may exhibit many of these emotions in response to being injured, they do not follow a set, stereotypical pattern or necessarily feel each emotion in these five stages [denial, anger, bargaining, depression, and acceptance and reorganization]” (Weinberg, 2019). Athletes generally experience these three processes consistently: injury-relevant information processing, emotional upheaval and reactive behavior, and positive outlook and coping. Athletes can also experience identity loss, fear and anxiety, lack of confidence, performance decrements, and a reduction of team cohesion. Consequently, injuries affect athletes mentally, physically, and psychologically with varied severity and long-term effects. As mentioned above, BJJ athletes are specifically trained to inflict injuries and thus, competitions are naturally a cause for concern. 

BJJ techniques are designed to either restrict blood flow to the brain or manipulate the joints to cause serious or permanent injury (Le, 2022). It is important to note, however, that injuries affect the whole person. “Injury can be one of the most frustrating elements of being an athlete. However, when your body is healing, your mind needs to remain strong. To help focus the mind, and for overall wellbeing, imagery in sport can be a welcomed tool.” (Sport Resilience, 2016). Positive psychology techniques, such as goal setting and positive talk can constructively affect the athletes’ mood, coping skills, and confidence. There may be evidence that suggests imagery can even expedite the healing time period. Having these tools prepared before entering competition can reduce the fear of injury and the stress of putting oneself in a vulnerable position. Consequently, less stress allows for greater arousal regulation, concentration, and confidence.

All psychological training aims to reach an optimal experience, known by sport psychologists as flow, “a harmonious and intrinsically rewarding state characterized by intense focus and absorption in a specific activity, to the exclusion of irrelevant thoughts and emotions, and a sense of everything coming together or clicking into place, even in challenging situations” (Le, 2022). Flow can be reached by training both the physical skill sets required as well as psychological tools such as arousal regulation, imagery, confidence building, increasing motivation and commitment, attention or concentration skills, and coping with injury prior to competition. There are a range of ways to implement individualized PST programs for each athlete which increase the athlete’s chances of remaining in control and performing well. These tools particularly come to the aid of new BJJ competitors who lack significant experience. However, as is seen by the questionnaire, athletes from all different levels of experience could benefit from building confidence and coping with the stress of potential injuries. Brazilian Jiu-Jitsu athletes, don’t always have the privilege of being fully prepared, of squeezing in an extra second to put on a positive mindset, an extra lesson on joint-locks…another day to get up and try again. “It’s never maybe. You are always ready.” 

References

Andreato, L. V., de Moraes, S. M. F., Del Conti Esteves, J. V., Miranda, M. L., Pastório, J. J., Pastório, E. J., Magnani Branco, B. H., & Franchini, E. (2014). Psychological, Physiological, Performance and Perceptive Responses to Brazilian Jiu-Jitsu Combats. Kinesiology, 46(1), 44–52.

Andreato L. V., Franchini E., de Moraes SM, Pastório J.J., da Silva D.F., Esteves J.V., Branco B.H., Romero P.V., and Machado F.A. (2013). Physiological and Technical-tactical Analysis in Brazilian Jiu-jitsu Competition. Asian J Sports Med. 4(2):137-43. doi: 10.5812/asjsm.34496. Epub 2013 Feb 12. PMID: 23802056; PMCID: PMC3690734.

Chen, M. A. and Cheesman, D. J. (2013). Mental Toughness of Mixed Martial Arts Athletes at Different Levels of Competition. SAGE Publications Inc. 905-917. doi: 10.2466/29.30.PMS.116.3.905-917

Cormie P, McGuigan M.R., and Newton R.U., (2011). Developing maximal neuromuscular power: Part 1--biological basis of maximal power production. Sports Med. 41(1):17-38. doi: 10.2165/11537690-000000000-00000. PMID: 21142282.

Cynarski, W. J. (2016) Ido Movement For Culture. Journal Of Martial Arts Anthropology. Vol. 16, No. 2, Pp. 1–7 Doi: 10.14589/Ido.16.2.1

Imagery (2016). Sport Resilience. https://sportresilience.com/imagery/. 

Jocić, J. T., & Petrović, J. (2021). Understanding of Dropping out of Sports in Adolescence - Testing the Hierarchical Model of Intrinsic and Extrinsic Motivation. Kinesiology, 53(2), 245–256. https://doi-org.ezproxy.umary.edu/10.26582/k.53.2.7

Hiskey, S. and Clapton, N, E. (2021). Distress Tolerance Imagery Training. Martial Arts Studies 11, 46-55. 10.18573/mas.121.

Lachlan J., P. MSportCoach, MExercSc. (2014) An Evidenced-Based Training Plan for Brazilian Jiu-Jitsu. Strength and Conditioning Journal 36(4):p 14-22, DOI: 10.1519/SSC.0000000000000053 

Le, “Joey” Alan. (2022). Martial Arts in Search of Transcendence: Beauty, Truth and Goodness in Brazilian Jiu - Jitsu. Journal of Interdisciplinary Studies, 34(1/2), 172–194. https://doi-org.ezproxy.umary.edu/10.5840/jis2022341/210

Marc (2020). The 17 Time-Tested Benefits of Brazilian Jiu Jitsu. BJJ Success. https://www.bjjsuccess.com/benefits-of-brazilian-jiu-jitsu/

Scoggin., J, F,. Brusovanik, G., Izuka, B. H., Van Rilland, E. Z., Geling O., and Tokumura, S., (2014). Assessment of Injuries During Brazilian Jiu-Jitsu Competition. The Orthopaedic Journal of Sports Medicine. https://doi.org/10.1177/2325967114522184

Silva, R. S., Andrade, A., Guimarães Bevilacqua, G., Schlösser, A., Alencar Flores Junior, M., Dos Santos Severino, B., & Soares Rodrigues, M. E. (2019). Mood states and self-rated health of Brazilian jiu-jitsu fighters in competition. Revista de Artes Marciales Asiaticas, 14, 43–46. https://doi-org.ezproxy.umary.edu/10.18002/rama.v14i2s.5970

Reusing, H. M. (2014). The language of martial arts: The transformative potential of brazilian jiu-jitsu through the lens of depth psychology. Publicly Available Content Database. https://www.proquest.com/dissertations-theses/language-martial-arts-transformative-potential/docview/1656449017/se-2

Taylor, J. (1995). A conceptual model for integrating athlete’s needs and sport demands in the development of mental preparation strategies. The Sport Psychologist, 9, 339-357.

Turner, M., & Jones, M. (2018). Arousal Control in Sport. Oxford Research Encyclopedia of Psychology. https://doi.org/10.1093/acrefore/9780190236557.013.155

Weinberg, R, & Gould, D. (2018). Foundations of Sport and Exercise Psychology, 7th Edition. Human Kinetics.

Concussions in American Football by Austin Link and Dr. Thomas Orr

Since the work of Dr. Omalu and many academic experts in identifying and warning parents, coaches, administrators and young athletes of the dangers of concussions and high probability of one occurring in the sport of football; football continues to be popular. Football is played by millions of young athletes across the United States and injuries happen. According to the University of Pittsburgh Medical Center, between 1.7 and 3 million recreation/sport related concussions happen every year. Around 300,000 of these concussions are from the sport of football (Collins, 2023).

In 2014, former NFL center Michael Oriard asked the question: “Is football dying?”
(Pielke, 2020). At the time, the question seemed outlandish, as 34 of the 35 most-watched
television programs were occupied by the National Football League (Smith, 2014). In a culture
that is dominated by sports, where the best players in every league are viewed as superheroes,
football reigns as the supreme competition at every level of the game. But recently, a new trend has started to develop that reflects Oriard’s concerns. According to statistia.com, in 2006, 8.4 million Americans over the age of six participated in tackle football (Stripp, 2022). That number has shrunk significantly, as the same data shows that 5.23 million Americans participated in tackle football in 2023. While some may attribute this trend to restrictions of the COVID-19 pandemic, this decline in youth tackle football participation has been shown over the entire course of the 21st century. This suggests that there is a more significant underlying cause for the reduced participation in tackle football: concussions.

The topic of concussions in football has become a very controversial topic, but
that was not always the case. In the past, “getting your bell rung” was something very natural to the game of football, and players were expected to just get up and keep playing. This notion
started to shift when Chronic Traumatic Encephalopathy research by Dr. Bennet Omalu began to gain popularity in the media. “Concussions: The Marketing Nightmare that Faces the NFL and Youth Sports”, written by Dr. Orr (2015) along with more examples in his and Dr. Jamieson’s Sport Violence text book (Jamieson and Orr, 2009) provided solutions and best practices they gleaned from industry leaders across disciplines to help with the epidemic and fight the old way of doing things. 

Much of the work done was educating the public. Making sure that people appreciate that CTE is developed by repeated sub-concussive blows to the head, which progressively and subtly causes pathophysiological changes to the brain was a simple but effective strategy. Visuals showing repeated blows and how the nature of this disorder leads to a high prevalence rate in athletes playing contact sports like tackle football made people rethink safety. 

Making sure people were aware was also key. Early onset factors of this disorder can be identified in collegiate and even high school athletes and with simple training a myriad of coaches and community members can now screen and identify athletes who may need further examination for concussions. It is important for coaches, parents, and athletes to continue to be educated on the signs and symptoms of concussions and to take appropriate action if necessary.

These same concerned people made sure that athletes received safer equipment and training. The mantra, football has never been safer has spread like a gospel between coaches in the last few years as they reinforce the response. Coaches further improve the research behind the prevention and treatment of concussions and CTE by changing how they did things.

The integration of biomechanics into the realm of athletics has been a growing field, and there are many precautions being taken by the NFLPA (National Football League Players Association) and other organizations to emphasize player safety. NFL helmets are constantly being adjusted to prevent concussions, adding more padding and streamlining the helmet to reduce impact. “2nd Skull Technology” is another application of biomechanics that is a skull cap made from urethane molecules - a flexible fabric that hardens under pressure to protect the head (Wilner, 2022). 

Another potential remedy for concussions and CTE in football lies within the medicinal field. Posted in the Journal of Neurotrauma, research from the University of Georgia points towards bio-manufactured exosomes as an effective form of prevention for CTE. Exosomes have the natural ability to enhance anti-inflammatory responses within the brain, and the research done at the University of Georgia involves dosing bio-manufactured exosomes with an injection. In rats with TBI (traumatic brain injuries), the injection has shown an improvement in functional recovery (Terry, 2019). There is still plenty of research to be done regarding the diagnosis and prevention of concussions and CTE, but these experimental steps are instrumental and provide hope for the progression of neurotrauma research and its application for sport.

Another potential solution for the rising rates of concussions in youth sports is to
innovate how the game of football is played. Pop Warner Youth Football, the largest and oldest
youth football organization in the US has recently made gameplay changes to prevent
concussions in their young athletes. These changes include banning the common three-point
stance, and replacing it with a two-point stance that is more functionally safe for players.
Another change was to eliminate kickoffs in the game, as there were a disproportionate amount of injuries on kickoffs compared to other plays (Flaherty, 2019). Combining injury data with the form and function of football is a promising strategy for lessening the prevalence of head injuries in youth sports, and has set the future of football in the right direction.
Although biomedical, biomechanical, medicinal and strategic advancements made in
reducing concussion prevalence in youth football are promising, there is no way to eliminate the risk of concussion entirely.

Making sure people recognize the damage and problems with concussions has also been a key component. Research from the NINDS (National Institute of Neurological Disorders and Stroke) shows that 110 of 111 former National Football League players, 48 of 53 former college football players, and 3 of 14 former high school players had been pathologically diagnosed with CTE (McKee, 2020). Symptoms of CTE include memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, anxiety, suicidality, parkinsonism, and, eventually, progressive dementia (BU Research Center). This research has become very mainstream, and is a significant reason for the recent decline in tackle football participation in youth sports.
Concussions and CTE are aspects of football that are widely recognized at the
professional level of football, but what are their implications for youth football?

Common research literature has assumed that youth football players are more susceptible to concussions than adults for years, but not until recently has this been proven. Research from the Biomedical Engineering Lab at Virginia Tech monitored the head impacts of six youth football teams consisting of players ranging from age 9-14. For high school, collegiate, and professional players, concussion impact is generally associated with 102 g of acceleration. This research found that youth athletes are at risk for concussions when experiencing collisions accelerating at 62 g (Kolenich, 2021). Although young athletes experience concussions at a much lower acceleration, the title of overall frequency of concussions belongs to the high school demographic. A study conducted in 2019 and published in The Archives of Clinical
Neuropsychology found that the relative risk for a concussion was almost two times greater in
18-year olds than 13-year-old athletes (Tsushima, 2019). This seemingly contrary finding in the
relationship between concussion acceleration threshold and concussion age prevalence is due to a multitude of reasons. These reasons include: increased practice/playing time for high school athletes, increased frequency of high-impact collisions because of stronger and faster players, and a lack of proper equipment. Because of this, a parallel trend to the youth tackle football participation proportion can be seen with high school football players. According to data from The National Federation of High Schools, 1.006 million students were involved in football, which is actually a significant decrease of 100,000 students compared to the last decade (Conley, 2015). This data becomes even more significant considering the increasing population size of high schools and the increasing popularity of football as a sport in American culture. The youth and NFL have a shared concern over how they are perceived and must be seen as not excessively dangerous or they will lose financial dollars as well as parts of their fanbase.

By revisiting the success and steps forward we hope to continue the discussion about concussions and specifically, develop more effective preventative measures and solutions. All of the concerns for player safety as a result of concussion and CTE research are
justified and should be taken seriously.

References

Collins, M. (2023). Concussion statistics and facts: UPMC: Pittsburgh. UPMC Sports Medicine.

Retrieved April 16, 2023, from
https://www.upmc.com/services/sports-medicine/services/concussion/about/facts-statistics

Conley, M. (2015, January 20). Where should parents put their foot down with football? Slate Magazine. Retrieved April 16, 2023, from

https://www.slate.com/articles/sports/esquire_fnt/2015/01/where_should_parents_put_the
ir_foot_down_with_football.html 

Flaherty, D. (2022, May 9). Is "America's game" on the decline or the rebound. SportsEvents Magazine. Retrieved April 16, 2023, from
https://sportseventsmediagroup.com/is-americas-game-on-the-decline-or-the-rebound/

Jamieson, L., & Orr, T. (2009). Sport and Violence; A Critical Examination of Sport. London: Elsevier. From https://www.routledge.com/Sport-and-Violence/Jamieson-Orr/p/book/9780750684057 

Kolenich, E. (2021). Youth football players are more susceptible to concussions than older
players. Prince George County, VA. Retrieved April 16, 2023, from
https://www.princegeorgecountyva.gov/news_detail_T6_R2803.php

McKee, A. C. (2020). The neuropathology of chronic traumatic encephalopathy. Handbook of clinical neurology. Retrieved December 12, 2022, from
https://pubmed.ncbi.nlm.nih.gov/30482357/

Omalu, B., Hammers, J. L., Bailes, J., Hamilton, R. L., Kamboh, M. I., Webster, G., &
Fitzsimmons, R. P. (2011, November 1). Chronic traumatic encephalopathy in an Iraqi
war veteran with posttraumatic stress disorder who committed suicide. focus. Retrieved

December 12, 2022, from
https://thejns.org/focus/view/journals/neurosurg-focus/31/5/2011.9.focus11178.xml

Orr, T. (October, 2015). Concussions: The Marketing Nightmare that Faces the NFL and Youth Sports. Journal of Business and Economics, 6, 10, 1735-1739. From http://www.academicstar.us/UploadFile/Picture/2016-3/20163922612901.pdf 

Pielke, R. (2022, October 12). The decline of football is real and it's accelerating. Forbes.
Retrieved April 16, 2023, from
https://www.forbes.com/sites/rogerpielke/2020/01/28/the-decline-of-football-is-real-and-i
ts-accelerating/?sh=24f3bb62f372

Smith, M. (2014, January 8). 34 of America's 35 most-watched fall TV shows were NFL games. ProFootballTalk. Retrieved April 16, 2023, from
https://profootballtalk.nbcsports.com/2014/01/08/34-of-americas-35-most-watched-fall-tv
-shows-were-nfl-games/

Steinfeldt, J., Rutkowski, L., Orr, T., & Steinfeldt, M. (2012). Masculine Norms and moral atmosphere in college football. The Sport Psychologist, 26, 3, 341-358. From https://scholarworks.iu.edu/dspace/handle/2022/15244 

Stripp, H. (2022, December 8). U.S. Americans who played tackle football 2021. Statista.
Retrieved April 16, 2023, from
https://www.statista.com/statistics/191658/participants-in-tackle-football-in-the-us-since-
2006/  

Terry, M. (2019, December 13). New technology could help treat traumatic brain injury.
BioSpace. Retrieved December 12, 2022, from
https://www.biospace.com/article/new-technology-could-help-treat-traumatic-brain-injur
y/  

Tsushima, W. T., Siu, A. M., Ahn, H. J., Chang, B. L., & Murata, N. M. (2019). Incidence and
Risk of Concussions in Youth Athletes: Comparisons of Age, Sex, Concussion History,

Sport, and Football Position. Archives of Clinical Neuropsychology, 34(1), 60–69.
https://doi-org.ezproxy.umary.edu/10.1093/arclin/acy019
Wilner, B. (2022, January 5). Riddell's axiom could be breakthrough helmet for football. AP
NEWS. Retrieved December 12, 2022, from

https://apnews.com/article/nfl-technology-sports-football-8b534f21090992d07a3bdcd0a04e7bdf 

Should Transwomen be allowed to Compete in Women’s Sports?

A view from an Exercise Physiologist

Gregory A. Brown Ph.D., Professor of Exercise Science, Physical Activity and Wellness Laboratory, Department of Kinesiology and Sport Sciences, University of Nebraska Kearney,

Tommy Lundberg Ph.D., Assistant Senior Lecturer, Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, Stockholm, SWE

Correspondence:                     Gregory A Brown, Ph.D.

1410 w 26th st

Department of Kinesiology and Sport Sciences

University of Nebraska at Kearney

Kearney, NE 68849

(308) 865 – 8333

Fax (308) 865-8073

brownga@unk.edu

Key Words:  Transgender women, testosterone suppression, sports performance, physiology, policies and procedures

Background

Transgender women (transwomen) are individuals whose biological sex is male, but their gender identity is that of a woman. In 2003, the International Olympic Committee (IOC) released their initial policy on transgender athletes, in 2011 the NCAA adopted a transgender athlete inclusion policy, and in 2015 the IOC adopted a revised policy on transgender athletes. Starting in 2019 there were several high-profile cases of transwomen competing for championships in women’s sports (for example see these articles on ESPN.com, APNews, and the Washington Times). In response to these situations and concerns from athletes and the public, the International Olympic Committee, the NCAA, FINA, British Cycling, US Rowing, World Boxing, World Athletics and many other sports governing bodies have recently revised their policies regarding transgender athletes, particularly regarding transwomen. These policies vary considerably from the inclusion of transwomen in women’s sports based on self-identification as a woman, participation of transwomen in women’s sports if they meet testosterone suppression requirements, or participation in women’s sports allowed only for those who are recorded as female at birth.

Furthermore, in response to the prominent cases of transwomen competing in women’s sports, many state legislatures in the U.S. have considered bills stating that only members of the female sex can participate in girl’s and women’s sports (37 states in 2021 alone) and by July 6, 2022 eighteen states had passed such laws.  At the time of this writing in February 2023, it is the beginning of legislative sessions in many states and there will likely be more debate and discussion on similar bills with the possibility of more laws being enacted. As described by Gillian R. Brassil and Jeré Longman writing for the New York Times in August 2020, “Sporting Organizations are confronted with ‘two almost irreconcilable positions’ in setting eligibility standards — one relying on an athlete’s declared gender (i.e. inclusion) and the other on biology (i.e. fairness)”. The purpose of this writing is to provide some context to this debate from the view of an exercise physiologist.

The Biological Basis of Sex

From a biological perspective, the first place to look when considering the issue of transwomen participating in women’s sports is the importance of sex as a biological factor. The American Psychological Association defines sex as “the traits that distinguish between males and females. Sex refers especially to physical and biological traits, whereas gender refers especially to social or cultural traits.” As an extremely brief summary, human reproduction requires the male gamete (sperm) to unite with a female gamete (ovum). At fertilization sex is determined by the paired sex chromosomes, 46-XX for female and 46-XY for male. Sex differentiation then occurs as the fetus develops along either the male or female pathway. Humans are sexually dimorphic with male anatomy & physiology centered around the production of sperm and female anatomy & physiology centered around the production of ova (2, 6). Out of 20,000 known human genes, approximately 6,500 are expressed differently in  males and females (16). Therefore, sex is an extremely important factor in regards to health and athletic performance.

Although there are disorders of sex development (DSDs; sometimes called differences of sex development), in which a person does not experience typical sex development, possibly caused by unusual combinations of sex chromosomes or gene expression, these conditions are very rare (approximately 0.017% of all births) and are a separate issue from gender dysphoria (6, 12, 18, 30, 38).  It is important to point out that there is not a known biological underpinning for being transgender and there is no biologically based test to diagnose a person as transgender (6, 12). A more detailed explanation for the possible causes and diagnosis of gender dysphoria are beyond the scope of this article.

As demonstrated in countless research papers, the vast majority of textbooks on Anatomy, Physiology, Exercise Physiology, and Fitness Testing, and as reviewed by Bassett et al. (5) and Hilton and Lundberg (23), the performance differences between males and females are caused by biological sex-based differences. Males are taller, have more lean body mass, less body fat, higher bone mineral density, larger hearts and lungs, higher VO2max, greater circulating hemoglobin levels, and many other anatomical and physiological factors that create in them athletic performance advantages over females. For example, the average height of western men is 5’10” (177.8 cm) with an average weight of 200 lbs. (90.7 kg) while western women average 5’5” (165.1 cm) and 170 lbs. (77.1 kg). An evaluation of 10,894 European men and women between the ages of 18–81 years indicates that, on average, men have 3.5 lbs. (1.6 kg) less body fat and 36.6 lbs. (16.6 kg) more lean body mass than women (34). Another way to look at this is that men have 6% less fat mass and 42% more lean body mass spread across 8% more body height than women. In some sports height is an advantage, and a well known tenet of exercise science is that having more lean body mass is advantageous to sports performance.

Sex Differences in Sports Performance

An important place to start when considering the inclusion of transwomen in women’s sports is the incontrovertible fact that adult males have athletic advantages compared to adult females. Where the performance can be easily and equally quantified for comparison, such as swimming, track and field, powerlifting, weightlifting, speed skating, and cycling, males are faster, jump higher, throw farther, or lift more weight than females.  Overall, by mid-puberty, males outperform comparably aged, gifted, and trained females by 10-60%, depending on the sport, with the smallest differences in running and swimming and the largest differences in weightlifting and baseball pitching (reviewed in (8, 10, 22, 23, 29, 37, 40, 42, 46, 47, 51) and illustrated in Figure 1 from Hilton and Lundberg (23)). In weightlifting and powerlifting, where athletes compete based on body weight, males still outperform females by approximately 30%.

There is much less clear evidence of sex-based differences in sports performance in children before puberty, largely because sports in this age group typically focus on recreation and fundamental skill development.  However, evaluations of fitness testing in children as young as 3 years old shows that boys perform better than girls of the same age on tests of throwing, muscular strength, muscular endurance, and aerobic fitness (9, 13, 28, 45, 48-50).  For example, Tomkinson et al. (49) observed that at age 9 boys are running an average of 3.2% faster than girls of the same age during the last stage of a 20 m shuttle run.  In terms of aerobic endurance capacity, when comparing the maximum oxygen uptake (VO2max) in 6–7-year-old girls and boys, the boys have 12% higher absolute VO2max (measured in liters of oxygen per minute), and 2% higher relative VO2max (measured in milliliters of oxygen per kilogram of body mass per minute) (13). When evaluating muscular strength and endurance, Tomkinson et al. (50) reported that at age 9 boys have a bent arm hang time that is an average of 48.1% longer than girls of the same age.  Records from USA Swimming for the 10 & Under age group indicate that boys are faster than girls in eleven out of twelve individual short course events and eight out of eleven individual long course events. Furthermore, youth records from USA Track & Field in the 8-and-under age group and in the 9-to-10-years-old age group (who can reasonably be assumed to be pre-pubertal) show that boys outperform girls in all events.  The smallest difference in track and field records between boys and girls is 0.94% in the 8-and-under 100 m run, and the largest difference is 38.42% in the 8-and-under javelin throw.

Effects of Gender Affirming Hormone Therapy

Gender Affirming Hormone Therapy (GAHT) refers to a broad variety of hormones and drugs that can be prescribed so a person will develop physical characteristics that align with their gender identity. The use of gonadotropin-releasing hormone analogs (GnRHa) (aka Puberty Blockers), anti-androgens, testosterone suppression, or exogenous estrogens can all be part of GAHT for transwomen. A detailed explanation of GAHT is beyond the scope of the present article, but more information can be found in the reviews by Randolph (35) or T’Sjoen (43).

Currently, research on the sports performance related effects of GAHT in transgender women consists of a total of 19 published peer reviewed research reports. Sixteen of these papers reported on the changes in body composition (1, 3, 4, 14, 15, 17, 19, 24, 26, 27, 31, 44, 52-54, 56), eight papers on changes in handgrip strength (1, 3, 27, 39, 44, 52, 53, 56), one paper on isometric and isokinetic thigh muscle strength (55), one a cross sectional evaluation of VO2max after 14 years of GAHT (1), and two papers on pushup, sit up, and 1.5 mile running performance in U.S. Air Force personnel (11, 36). To summarize all of this briefly, men typically have 40-45% more lean body mass than women, and testosterone suppression reduces lean body mass by ~4-5%.  Men typically have 30-60% higher muscle strength than women, and testosterone suppression reduces muscle strength by 0-9%. For example, Scharff et al. (39) observed that before GAHT transwomen had a mean handgrip strength of 41.8 kg, and after 12 months of GAHT handgrip strength has decreased to a mean of 40.0 kg (it is important to note that this reduced handgrip strength was still in the 95th percentile for comparable females). Wiik et al. (55) observed that 12 months of GAHT reduced thigh muscle volume by ~5%, but knee extension and flexion strength were not reduced.  Roberts et al. (36) observed that before transition transgender women members of the US Air Force completed a 1.5 mile running fitness test 21% faster than comparably aged female members and after 2.5 years of GAHT the transwomen still completed the 1.5 mile running fitness test 12% faster than the female members. Alvares et al. (1) reported that after 14 years of GAHT transwomen still have 14% higher VO2peak than comparable females. Chiccarelli (11) observed that after 4 years GAHT the transwomen still performed 17.7% more pushups and 8.3% more situps in 1 minute than comparable females. A case study of an NCAA Division 1 swimmer who competed in the men’s category, then underwent two years of GAHT (per NCAA guidelines at the time) and subsequently competed in the women’s category “suggest that the transgender woman swimmer had superior performances relative to rank-matched female swimmers” (41).  Collectively, the existing research indicates that while GAHT affects biology, the changes it creates are minimal compared to the initial biological differences between typical males and typical females, which means that both biological attributes and performance differences are retained even after years of GAHT.

Hilton and Lundberg (23), Harper et al. (20), and Heather (21) have published review articles, and World Rugby, the Sporting Councils of the United Kingdom, and FINA (the world governing body for aquatic sports) have also released scientific reviews regarding the present research on the effects of testosterone suppression on muscle strength, body composition, and other factors that can influence athletic performance.  In spite of testosterone suppression in transwomen reducing circulating hemoglobin concentration to the levels of reference women, all of these reviews came to the conclusion that even after 3 years of testosterone suppression there are still lasting male athletic advantages in transwomen. 

Discussion about allowing only members of the female sex to participate in girl’s and women’s sports may lead to questions about the effects of puberty blockers on physical fitness and athletic performance in male children and adolescent who identify as girls (i.e. transgirls). However, there is considerable controversy regarding the quality of evidence supporting the use of puberty blockers (12), and there are sufficient concerns regarding the untoward health consequences of using puberty blockers that some countries prohibit the use of puberty blockers except in clinical research.  Unfortunately, there is limited research on the effects of puberty blockers on factors affecting physical fitness and athletic performance, including no data on the effects of puberty blockers on muscle strength, running speed, or endurance capacity.

Klaver et al. (25) examined the use of puberty blockers on body composition and demonstrated that in Tanner stage 2-3 teenagers body fat was increased and lean body mass was decreased in transgirls, but the use of puberty blockers did not eliminate the differences in body composition between transgirls and comparable female teenagers.  Specifically, before the start of puberty blockers the transgirls had ~75% lean body mass and comparable female teenagers had ~63% lean body mass.  After ~2.5 years of puberty blocker use, the transgirls had ~69% lean body mass while comparable female teenagers had ~61% lean body mass.  By 22 years of age, after ~8 years of puberty blocker and cross sex hormone use, the transgirls had ~66% lean body mass while comparable females had ~59% lean body mass. Two other papers indicate the use of puberty blockers (33) and cross sex hormones (32) in transgender teenagers does not eliminate the male sex based advantages in lean body mass. Another recent study reported that height in adulthood is relatively unaffected by prior treatment with GnRH analogs and estradiol during adolescence, implying that transgirls grow taller than reference females (7). This height advantage could confer athletic advantages in various sports, not least because height in general is also strongly correlated with total lean body mass. Therefore, while there is very limited information on the effects of puberty blockers and GAHT in children, the current evidence suggest that male children retain sex-based advantages in body height and lean body mass which may allow for retained male athletic advantages.

Summary

In summary, there are clear sex-based differences between males and females in physical fitness and athletic performance even before puberty.  Boys run faster, jump farther and higher, and have greater muscle strength than comparable girls. These pre-pubertal sex-based differences are smaller than the differences between post pubertal males and females, which increase significantly with the rise in circulating testosterone in males during puberty, but are likely meaningful in competition. Shortly after the onset of puberty and throughout adulthood, males outperform females by ~10-60% in measures of physical fitness and during athletic performance. Once puberty has occurred, the suppression of testosterone and the administration of estrogen fails to eliminate acquired male biological traits (e.g. greater body mass and height) and minimally reduces measured performance differences (e.g. greater muscle strength and faster running performance), with the likely implication that sporting performance advantages are retained in transwomen despite testosterone suppression.  Currently, there is insufficient evidence to determine what effects puberty blockers have on physical fitness and athletic performance in children, but the limited evidence that exists suggests that male growth is not entirely suppressed which may confer athletic advantages on transgirls.

The question of what constitutes fair competition is challenging. Historically sports have been separated by sex to allow girls and women a level competitive playing field because of the 10-60% advantages provided to boys and men by male biology. Anabolic-Androgenic steroids provide a 5-20% enhancement in strength and are almost universally considered to be unfair. In 2008 non-textile swimsuits were released which were reported to improve swimming performance by 2-4% and were deemed to be unfair and banned in 2010. Research to date indicates that identifying as a transwoman with or without the use of GAHT does not eliminate the male physiological athletic advantages. Whether the male athletic advantage remaining after GAHT is unfair is a question that is currently being debated by scholars, sport governing bodies, and legislators.

References

1.         Alvares LAM, Santos MR, Souza FR, Santos LM, Mendonca BB, Costa EMF, Alves M, and Domenice S. Cardiopulmonary capacity and muscle strength in transgender women on long-term gender-affirming hormone therapy: a cross-sectional study. Br J Sports Med 56: 1292-1298, 2022.

2.         Arnold AP. A general theory of sexual differentiation. J Neurosci Res 95: 291-300, 2017.

3.         Auer MK, Cecil A, Roepke Y, Bultynck C, Pas C, Fuss J, Prehn C, Wang-Sattler R, Adamski J, Stalla GK, and T'Sjoen G. 12-months metabolic changes among gender dysphoric individuals under cross-sex hormone treatment: a targeted metabolomics study. Sci Rep 6: 37005, 2016.

4.         Auer MK, Ebert T, Pietzner M, Defreyne J, Fuss J, Stalla GK, and T'Sjoen G. Effects of Sex Hormone Treatment on the Metabolic Syndrome in Transgender Individuals: Focus on Metabolic Cytokines. J Clin Endocrinol Metab 103: 790-802, 2018.

5.         Bassett AJ, Ahlmen A, Rosendorf JM, Romeo AA, Erickson BJ, and Bishop ME. The Biology of Sex and Sport. JBJS Rev 8: e0140, 2020.

6.         Bhargava A, Arnold AP, Bangasser DA, Denton KM, Gupta A, Hilliard Krause LM, Mayer EA, McCarthy M, Miller WL, Raznahan A, and Verma R. Considering Sex as a Biological Variable in Basic and Clinical Studies: An Endocrine Society Scientific Statement. Endocr Rev, 2021.

7.         Boogers LS, Wiepjes CM, Klink DT, Hellinga I, van Trotsenburg ASP, den Heijer M, and Hannema SE. Trans girls grow tall: adult height is unaffected by GnRH analogue and estradiol treatment. J Clin Endocrinol Metab, 2022.

8.         Brown GA, Orr T, Shaw BS, and Shaw I. Comparison of Running Performance Between Division and Sex in NCAA Outdoor Track Running Championships 2010-2019. Med Sci Sports Exerc 54: 1, 2022.

9.         Catley MJ and Tomkinson GR. Normative health-related fitness values for children: analysis of 85347 test results on 9-17-year-old Australians since 1985. Br J Sports Med 47: 98-108, 2013.

10.        Cheuvront SN, Carter R, Deruisseau KC, and Moffatt RJ. Running performance differences between men and women:an update. Sports Med 35: 1017-1024, 2005.

11.        Chiccarelli E, Aden J, Ahrendt D, and Smalley J. Fit Transitioning: When Can Transgender Airmen Fitness Test in Their Affirmed Gender? Mil Med, 2022.

12.        Cohn J. Some Limitations of "Challenges in the Care of Transgender and Gender-Diverse Youth: An Endocrinologist's View". J Sex Marital Ther: 1-17, 2022.

13.        Eiberg S, Hasselstrom H, Gronfeldt V, Froberg K, Svensson J, and Andersen LB. Maximum oxygen uptake and objectively measured physical activity in Danish children 6-7 years of age: the Copenhagen school child intervention study. Br J Sports Med 39: 725-730, 2005.

14.        Elbers JM, Asscheman H, Seidell JC, and Gooren LJ. Effects of sex steroid hormones on regional fat depots as assessed by magnetic resonance imaging in transsexuals. Am J Physiol 276: E317-325, 1999.

15.        Gava G, Cerpolini S, Martelli V, Battista G, Seracchioli R, and Meriggiola MC. Cyproterone acetate vs leuprolide acetate in combination with transdermal oestradiol in transwomen: a comparison of safety and effectiveness. Clin Endocrinol (Oxf) 85: 239-246, 2016.

16.        Gershoni M and Pietrokovski S. The landscape of sex-differential transcriptome and its consequent selection in human adults. BMC Biol 15: 7, 2017.

17.        Gooren LJ and Bunck MC. Transsexuals and competitive sports. Eur J Endocrinol 151: 425-429, 2004.

18.        Hamilton BR, Lima G, Barrett J, Seal L, Kolliari-Turner A, Wang G, Karanikolou A, Bigard X, Lollgen H, Zupet P, Ionescu A, Debruyne A, Jones N, Vonbank K, Fagnani F, Fossati C, Casasco M, Constantinou D, Wolfarth B, Niederseer D, Bosch A, Muniz-Pardos B, Casajus JA, Schneider C, Loland S, Verroken M, Marqueta PM, Arroyo F, Pedrinelli A, Natsis K, Verhagen E, Roberts WO, Lazzoli JK, Friedman R, Erdogan A, Cintron AV, Yung SP, Janse van Rensburg DC, Ramagole DA, Rozenstoka S, Drummond F, Papadopoulou T, Kumi PYO, Twycross-Lewis R, Harper J, Skiadas V, Shurlock J, Tanisawa K, Seto J, North K, Angadi SS, Martinez-Patino MJ, Borjesson M, Di Luigi L, Dohi M, Swart J, Bilzon JLJ, Badtieva V, Zelenkova I, Steinacker JM, Bachl N, Pigozzi F, Geistlinger M, Goulis DG, Guppy F, Webborn N, Yildiz BO, Miller M, Singleton P, and Pitsiladis YP. Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement. Sports Med, 2021.

19.        Haraldsen IR, Haug E, Falch J, Egeland T, and Opjordsmoen S. Cross-sex pattern of bone mineral density in early onset gender identity disorder. Horm Behav 52: 334-343, 2007.

20.        Harper J, O'Donnell E, Sorouri Khorashad B, McDermott H, and Witcomb GL. How does hormone transition in transgender women change body composition, muscle strength and haemoglobin? Systematic review with a focus on the implications for sport participation. Br J Sports Med, 2021.

21.        Heather AK. Transwoman Elite Athletes: Their Extra Percentage Relative to Female Physiology. Int J Environ Res Public Health 19, 2022.

22.        Higerd GA. Assessing the Potential Transgender Impact on Girl Champions in American High School Track and Field, in: Sports Management. PQDT Open: United States Sports Academy, 2020, p 168.

23.        Hilton EN and Lundberg TR. Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage. Sports Med, 2020.

24.        Klaver M, de Blok CJM, Wiepjes CM, Nota NM, Dekker M, de Mutsert R, Schreiner T, Fisher AD, T'Sjoen G, and den Heijer M. Changes in regional body fat, lean body mass and body shape in trans persons using cross-sex hormonal therapy: results from a multicenter prospective study. Eur J Endocrinol 178: 163-171, 2018.

25.        Klaver M, de Mutsert R, Wiepjes CM, Twisk JWR, den Heijer M, Rotteveel J, and Klink DT. Early Hormonal Treatment Affects Body Composition and Body Shape in Young Transgender Adolescents. J Sex Med 15: 251-260, 2018.

26.        Klaver M, Dekker M, de Mutsert R, Twisk JWR, and den Heijer M. Cross-sex hormone therapy in transgender persons affects total body weight, body fat and lean body mass: a meta-analysis. Andrologia 49, 2017.

27.        Lapauw B, Taes Y, Simoens S, Van Caenegem E, Weyers S, Goemaere S, Toye K, Kaufman JM, and T'Sjoen GG. Body composition, volumetric and areal bone parameters in male-to-female transsexual persons. Bone 43: 1016-1021, 2008.

28.        Latorre Roman PA, Moreno Del Castillo R, Lucena Zurita M, Salas Sanchez J, Garcia-Pinillos F, and Mora Lopez D. Physical fitness in preschool children: association with sex, age and weight status. Child Care Health Dev 43: 267-273, 2017.

29.        Millard-Stafford M, Swanson AE, and Wittbrodt MT. Nature Versus Nurture: Have Performance Gaps Between Men and Women Reached an Asymptote? Int J Sports Physiol Perform 13: 530-535, 2018.

30.        Miller VM. Why are sex and gender important to basic physiology and translational and individualized medicine? Am J Physiol Heart Circ Physiol 306: H781-788, 2014.

31.        Mueller A, Zollver H, Kronawitter D, Oppelt PG, Claassen T, Hoffmann I, Beckmann MW, and Dittrich R. Body composition and bone mineral density in male-to-female transsexuals during cross-sex hormone therapy using gonadotrophin-releasing hormone agonist. Exp Clin Endocrinol Diabetes 119: 95-100, 2011.

32.        Nokoff NJ, Scarbro SL, Moreau KL, Zeitler P, Nadeau KJ, Juarez-Colunga E, and Kelsey MM. Body Composition and Markers of Cardiometabolic Health in Transgender Youth Compared With Cisgender Youth. J Clin Endocrinol Metab 105: e704-714, 2020.

33.        Nokoff NJ, Scarbro SL, Moreau KL, Zeitler P, Nadeau KJ, Reirden D, Juarez-Colunga E, and Kelsey MM. Body Composition and Markers of Cardiometabolic Health in Transgender Youth on Gonadotropin-Releasing Hormone Agonists. Transgend Health 6: 111-119, 2021.

34.        Ofenheimer A, Breyer-Kohansal R, Hartl S, Burghuber OC, Krach F, Schrott A, Wouters EFM, Franssen FME, and Breyer MK. Reference values of body composition parameters and visceral adipose tissue (VAT) by DXA in adults aged 18-81 years-results from the LEAD cohort. Eur J Clin Nutr 74: 1181-1191, 2020.

35.        Randolph JF, Jr. Gender-Affirming Hormone Therapy for Transgender Females. Clin Obstet Gynecol 61: 705-721, 2018.

36.        Roberts TA, Smalley J, and Ahrendt D. Effect of gender affirming hormones on athletic performance in transwomen and transmen: implications for sporting organisations and legislators. Br J Sports Med, 2020.

37.        Sandbakk O, Solli GS, and Holmberg HC. Sex Differences in World-Record Performance: The Influence of Sport Discipline and Competition Duration. Int J Sports Physiol Perform 13: 2-8, 2018.

38.        Sax L. How common is intersex? a response to Anne Fausto-Sterling. J Sex Res 39: 174-178, 2002.

39.        Scharff M, Wiepjes CM, Klaver M, Schreiner T, T'Sjoen G, and den Heijer M. Change in grip strength in trans people and its association with lean body mass and bone density. Endocr Connect 8: 1020-1028, 2019.

40.        Seiler S, De Koning JJ, and Foster C. The fall and rise of the gender difference in elite anaerobic performance 1952-2006. Med Sci Sports Exerc 39: 534-540, 2007.

41.        Senefeld JW, Hunter SK, Coleman D, and Joyner MJ. Case Studies in Physiology: Male to Female Transgender Swimmer in College Athletics. J Appl Physiol (1985), 2023.

42.        Sparling PB, O'Donnell EM, and Snow TK. The gender difference in distance running performance has plateaued: an analysis of world rankings from 1980 to 1996. Med Sci Sports Exerc 30: 1725-1729, 1998.

43.        T'Sjoen G, Arcelus J, Gooren L, Klink DT, and Tangpricha V. Endocrinology of Transgender Medicine. Endocr Rev 40: 97-117, 2019.

44.        Tack LJW, Craen M, Lapauw B, Goemaere S, Toye K, Kaufman JM, Vandewalle S, T'Sjoen G, Zmierczak HG, and Cools M. Proandrogenic and Antiandrogenic Progestins in Transgender Youth: Differential Effects on Body Composition and Bone Metabolism. J Clin Endocrinol Metab 103: 2147-2156, 2018.

45.        Tambalis KD, Panagiotakos DB, Psarra G, Daskalakis S, Kavouras SA, Geladas N, Tokmakidis S, and Sidossis LS. Physical fitness normative values for 6-18-year-old Greek boys and girls, using the empirical distribution and the lambda, mu, and sigma statistical method. Eur J Sport Sci 16: 736-746, 2016.

46.        Tang L, Ding W, and Liu C. Scaling Invariance of Sports Sex Gap. Front Physiol 11: 606769, 2020.

47.        Thibault V, Guillaume M, Berthelot G, Helou NE, Schaal K, Quinquis L, Nassif H, Tafflet M, Escolano S, Hermine O, and Toussaint JF. Women and Men in Sport Performance: The Gender Gap has not Evolved since 1983. J Sports Sci Med 9: 214-223, 2010.

48.        Thomas JR and French KE. Gender differences across age in motor performance a meta-analysis. Psychol Bull 98: 260-282, 1985.

49.        Tomkinson GR, Carver KD, Atkinson F, Daniell ND, Lewis LK, Fitzgerald JS, Lang JJ, and Ortega FB. European normative values for physical fitness in children and adolescents aged 9-17 years: results from 2 779 165 Eurofit performances representing 30 countries. Br J Sports Med 52: 1445-14563, 2018.

50.        Tomkinson GR, Lang JJ, Tremblay MS, Dale M, LeBlanc AG, Belanger K, Ortega FB, and Leger L. International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries. Br J Sports Med 51: 1545-1554, 2017.

51.        Tonnessen E, Svendsen IS, Olsen IC, Guttormsen A, and Haugen T. Performance development in adolescent track and field athletes according to age, sex and sport discipline. PLoS One 10: e0129014, 2015.

52.        Van Caenegem E, Wierckx K, Taes Y, Schreiner T, Vandewalle S, Toye K, Kaufman JM, and T'Sjoen G. Preservation of volumetric bone density and geometry in trans women during cross-sex hormonal therapy: a prospective observational study. Osteoporos Int 26: 35-47, 2015.

53.        Van Caenegem E, Wierckx K, Taes Y, Schreiner T, Vandewalle S, Toye K, Lapauw B, Kaufman JM, and T'Sjoen G. Body composition, bone turnover, and bone mass in trans men during testosterone treatment: 1-year follow-up data from a prospective case-controlled study (ENIGI). Eur J Endocrinol 172: 163-171, 2015.

54.        Wierckx K, Van Caenegem E, Schreiner T, Haraldsen I, Fisher AD, Toye K, Kaufman JM, and T'Sjoen G. Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: results from the European network for the investigation of gender incongruence. J Sex Med 11: 1999-2011, 2014.

55.        Wiik A, Lundberg TR, Rullman E, Andersson DP, Holmberg M, Mandic M, Brismar TB, Dahlqvist Leinhard O, Chanpen S, Flanagan JN, Arver S, and Gustafsson T. Muscle Strength, Size, and Composition Following 12 Months of Gender-affirming Treatment in Transgender Individuals. J Clin Endocrinol Metab 105, 2020.

56.        Yun Y, Kim D, and Lee ES. Effect of Cross-Sex Hormones on Body Composition, Bone Mineral Density, and Muscle Strength in Trans Women. J Bone Metab 28: 59-66, 2021.

Football Hooliganism

Gabrielle Parks, M.S.

Thomas Orr, PhD.

Football Hooliganism

Violence is not a rare occurrence in the sporting realm. In fact, it is mostly unheard of that an instance of verbal abuse does not occur in a single game, independent of level, sport, or age. Violence is not categorised solely by inflicting physical injuries, but is said to be any type of behaviour which causes harm, occurs outside the rules of sport, and is unrelated to the competitive nature of the sport (US Legal Definitions). As well as violent occurrences involved on the playing field or court between players, violence of any kind is often seen between coaches and players, parents and coaches, officials, and fans and spectators. Because of this high incidence rate of violence between opposing spectators, this paper will examine the existence of this type of violence in the form of football hooliganism, and some theories as to why this phenomenon occurs in society.

According to the Merriam-Webster Dictionary, a fan is described as “an enthusiastic devotee (as of a sport or a performing art) usually as a spectator,” but football fans, particularly in Europe, usually take the term ‘devoted’ and transform the meaning into something drastically different. From this, there is an entirely different sub-category definition of ‘fan’ that lends itself to a particular group in society; football hooligans. Although much of the research concerned with football hooliganism centres around English football clubs, there are many other fans in Europe, and the rest of the world, that exhibit the same types of behaviour. Football hooliganism, whilst a declining event, is still very much a serious issue in today’s society.

Historically, a hooligan is a person who engaged in a type of behaviour that was considered rowdy, or even possibly criminal (Spaaij and Anderson 6). Hooliganism was not pre-meditated and violent fights during matches between rival teams were mostly due to the large crowds in small spaces, and the presence of alcohol at games. However, in 19th century England, a change occurred that was categorised as ‘The English Disease.’ In the simplest terms, Braun and Vliegenthart defined football hooliganism as “…organised groups that try to initiate fights with rival groups…” This change, around the 1960-80’s, coined football hooliganism, was a change that presented acts of violence that were planned and related to person engaging in fighting that did not transmit to the specific match itself. This change also saw the formation of rival gangs called firms. Firms were groups of people that came together through their love of a specific team, with the intent to intimidate and physically attack opposing supporters (Brewin).

Although hooliganism is said to be declining in England, it is still very much alive all across the globe. In the present day, the parametres concerning the act of football hooliganism is far spread, and not always involved with the timing of the game itself. According to Dunning, Murphy, and Williams, there are many situations where hooliganism is evident. For example, there may be hand-to-hand fighting between two people, a group out on the streets, numerous amounts of fans rioting in a stadium, fights between teams travelling to the games, or groups following rival teams after the match has concluded. In an effort to evade police, rival firms may also plan to surprise their counterparts on different days of the week leading up to a specific game. As well as this, there has also been instances where weapons have been used. Although there is clear intent to participate in physical violence, many ‘football hooligans’ state that the intent to harm another is not evident. Leeson, Smith, and Snow state that many fans fight other fans because they believe that this type of behaviour is a part of the game of football, as it always has been.

Even though football hooliganism received widespread media attention only after the 1960’s, there are many examples in history that exhibit violence before this time. Caribella, Marsh, Marsh and McCann listed many incidents that occurred prior to media coverage that showcased the unorganised nature of football rivalry. In 1906, a match between Tottenham and Aston Villa had to be abandoned because spectators invaded the pitch. In 1920, Birmingham fans constructed missiles using bottles from inside the stadium, and deployed them into the rival fan seating areas during the game. As well as these incidents occurring around England, many other parts of Europe were experiencing unorganised football hooliganism. In 1931 in France, policemen were needed to suppress disturbances in a crowd during a Nice and Wolves match, and in 1933 in Germany, Hertha fans invaded the pitch which led to an injury sustained to an opposing team player.

Although incidents increased during after this time, the majority of incidents still occurred inside the stadiums in the 1960-80’s. One particular disaster on May 29, 1985, lays in the minds of every football fan all around Europe: the Heysel Stadium disaster. Liverpool were the defending European Cup champions, and Juventus were champions in numerous other competitions around the globe. For fans on either team, and football fans in general, this match provided an enormous rivalry game for the ages. Although the Heysel Stadium was considered Belgium’s national stadium, it was in dire need of repair before the game, and many parts of the walls surrounding the stadium were crumbling by the time the match was to be played.

The stadium was divided into sections, fans of Juventus allocated one end of the stadium, and Liverpool fans allocated the other. There was a smaller section immediately next to the Liverpool section that was allocated for ‘neutral’ Belgium fans, but could be purchased from any ticketing agency (Vulliamy). Many of the tickets in this section went to Juventus fans, who stood yards away from the rival Liverpool fans, with only a temporary chain-link fence separating the sections. About an hour from kick-off, Liverpool fans started to throw stones from the crumbing walls towards the Juventus fans in the ‘neutral’ area. The intensity of supporters increase and Liverpool fans started to move towards the separated area. The Juventus fans, trying to flee, attempted to jump the wall but already crumbling, the wall could not withstand the extra weight and collapsed. The majority of the thirty nine deaths and over six hundred reported injuries were attributed to this (Vulliamy).

The fighting, however, did not stop there. Juventus fans across the stadium could see the wall crumbling and their ‘comrades’ fleeing the Liverpool rioters. The fans rushed to help, only for police to intervene. The brawling and riots between the police and the Juventus fans lasted for hours, but eventually subsided due to the force of the police (Vulliamy). After the incident, many Liverpool fans were arrested and charged for manslaughter, which led to a five year ban for all English football club teams to participate in European competitions. From this disaster, there has been many changes to the seating areas of stadium, and the amount of police present at every game.

After this disaster, the Football Spectators Act, passed in 1989, banned convicted hooligans from attending international matches, and the Football (Disorder) Act in 1999, sought to make no distinction between domestic and international bans. From the increase in police presence, and the imposing bans, many football hooligans had to find new ways to dominate rival firms, and thus resorted to violence that occurred outside of game day. These newly-formed attacks were an organised and pre-meditated form of violence (Spaaij and Anderson 2). The increase in diversity of violent incidents involving football sparked a media frenzy and the world began to take notice of football hooliganism as a serious social problem.

Even though these acts were in place, rioting did not stop altogether and happened on very large scales occasionally. In 1995, a friendly between England and Ireland sparked a violent frenzy where English fans threw things into the stands below them, and started to destroy the stadium seats and benches. In 2009, West Ham United and Millwall fans set out to invade the pitch and riot in the streets following the game. There were many injuries from the riots, but the most severe was a man with multiple stab wounds (Caribella et al). Although there is research concerning the causes of football hooliganism, these disasters proved that this type of fan violence was not only problematic in society, but also very dangerous.

Scholars from all across the globe concluded the more they understood the reasons football hooliganism existed, the more they could do to counteract the issue. Many researchers disagree about the exact causes of hooliganism, but all come to an understanding that this type of behaviour is a social phenomenon, engrained with psychological factors. Some of the earliest publications on the causes of football hooliganism were courtesy of Ian Taylor and John Clarke (Spaaij “Aspects of Hooligan Violence”). Taylor and Clark both argued that football was a sport that young working-class males identified with. In essence, football hooliganism “…should be interpreted as a kind of working-class resistance movement,” (Taylor 354) that involved a way for these men to resolve conflict in their own lives (Clark). These publications looked at hooliganism as a way for working-class males to blow off steam about the frustrations in other parts of their lives. Both of these researchers were quickly criticised, however, because they lacked any empirical evidence (Spaaij “Understanding Football Hooliganism”).

From these publications, researchers came to recognise football hooliganism as a ‘figurational sociological phenomenon.’ Figurational sociology is defined as “a structure of mutually-orientated and dependent people,” (Aya 223) that have developed a set of values regarded as ‘civilised’ behaviour. These values however, did not integrate into the lower class (Spaaij “Transitional Phenomenon” 212). These forms of civilisation, namely lack of violence in this case, was not valued in the working class society. Dunning, Murphy and Williams state that the working class also did not have as many forms of excitement as the other classes in society, so the men resorted to fighting as a means for entertainment, disregarding the social normality and expectations of the higher-level social classes around them.

These lower-class males developed aggressive behaviours because of their willingness to fight and their adoration of masculine leaders. Both of these factors were the criteria for becoming part of a group. From expressing their behaviours in a lower-class, males were often rewarded and received ‘pleasurable’ feelings, rather than anxiety about violent occurrences. The more that these men were rewarded for violent behaviours, and the more they joined the ranks of a sought-after ‘firm,’ the more the responded to situations with violence.

Although many scholars still discuss figurational sociology in sport today, many of these theories have been disproved because these types of behaviour and civilisation values are not exhibited in other football hooliganism incidents around the world. Ek noted that in West Germany, there was an increase in football hooliganism from the upper and middle class. As well as this, other countries football hooliganism patterns suggest that differences are due to religious beliefs, geographic location, generational variance, and race, rather than a difference in social class (Dunning and Elias).

After this theory was shown to not represent football hooliganism as a world-wide phenomenon, researchers sought to find other causes for this violent behaviour. In 2008, a theory outlined by Braun and Vliegenthart suggested that there are four factors that relate to violent incidents in football matches. These include repression, or “…the number of arrests to the number of violent attacks reported at matches,” media coverage, grievances, or changes in unemployment, and the intensity of aggressiveness during a game. The latter involves the number of cautions and expulsion cards a referee may hand out to the players.

Although this study proved to provide some of the causes for football hooliganism, it was widely considered incomplete. Drawing from all the theories mentioned, Spaaij and Anderson adopted the position that football hooliganism is a form of collective violence that shapes social actions based on social identification (3). As defined by the World Health Organization, collective violence is “the instrumental use of violence by people who identify themselves as members of a group…against another group or set of individuals, in order to achieve political, economic, or social objectives.” From collective violence, Spaaij and Anderson displayed a conceptual model of soccer fan violence that involved macro-level influences such as match specifics, interventions, place, and communication, and mediating influences such as second nature and fan identity (6). These three influences, as shown in the diagram below, lead to the type of behaviour seen as football violence, or hooliganism.

The first of these influences relate at a macro-level and have been explained by Braun and Vliegenthart, concerning economic, political, social, and cultural features. Factors such as lower working-class individuals, a large crowd, alcohol, rivalries between teams, and the intensity of the match and between the players combine to form a perfect scenario where crowds can start to become violent, and engage in behaviours concurrent with the definition of football hooliganism.

From the combinations, comes a number of other influences that are far more psychological. “Mediating influences explain how cause translates into effect, while moderating influences are those factors which affect the intensity of direction of effects” (Spaaij and Anderson 17). Individuals identify with a collective, in this case a firm, and then learn behaviours that are directed at “…the object of their contention,” such as a rival firm. Each individual has inherent differences and diverse personal experiences, but their second nature is the ability to act the same in similar situations as others in the group. From this, the members of the group can identify with each other, and share common interests, as is the case for fan violence. The identity that comes with being a member of a firm is the result of economic, political, social, and cultural differences that intertwine together to make one collective group with a common goal: dominance over a rival firm (16).

Although these mediating influences explain how cause turns into effect, moderating influences explain why some incidents of football hooliganism are more intense than others. According to Bairner, the hooligan experience is based on excitement and arousal, and involve individuals who want to engage in thrilling behaviours (585). Although many fights occur at rivalry games, and between firms that have well-known rivalries, these fights do not always occur because of their distaste for the other firm, rather from the excitement, or the hype of fighting against a well sought-after rival. Most of society views hooliganism as mindless fighting, but it is rather a very rational and organised form of social control within a sub-culture (Spaaij and Anderson 6). The media also plays an influence in moderating forms of fan violence in football, as the more masculine the headlines seem to the public, the more firms want to start fighting to show their own dominance.

Taylor, Clark, and Braun and Vliegenthart recognised and labelled key macro-level influences in regards to football violence. These influences described first and foremost from crowd size and increasing rivalries between teams, initiate hooligan behaviour in football for working-class males and their need to release the frustrations of their everyday life. Combined with the need to identify with a group, and the notion of dominance and masculinity, these influences highlight the behaviours exhibited by fans that leaders to football hooliganism, or pre-meditated violent attacks on opposing teams.

Violence is not rare in today’s society, nor is it rare to continuously see all types of violence occur at sporting events and games throughout the world. Violence at these types of events are social phenomenons, with football hooliganism paving the way. Hooligans exhibit behaviours that cannot be broken down and labelled by one specific cause, but always display the need for social identity, masculinity, excitement, and dominance over others. Although declining in many parts of the world, football hooliganism is still a very serious issue in sport’s violence, and the work and research of the scholars mentioned in this paper may be a factor to consider when looking at aggressive behaviour in other contact sports.

Works Cited

Aya, Rod. “Norbert Elias and the ‘Civilizing Process.’” Theory and Society 5.2 (1978): 219-28. Web. 29 October 2015.

Brewin, Ed. Hooliganism in England: The Enduring Cultural Legacy of Football Violence. ESPN FC, February 2015. Web. 2 November 2015.

Bairner, Alan. “The Leicester School and the Study of Football Hooliganism.” Sport in Society 9.4 (2006): 583-98. Web. 30 October 2015.

Braun, Rovers and Rens Vliegenthart. “The Contentious Fans: The Impact of Repression, Media Coverage, Grievances and Aggressive Play on Supporters Violence.” International Sociology 23.6 (2008): n. pag. Web. 29 October 2015.

Carnibella, Giovanni, Kate Fox, Peter Marsh, and Joe McCann. Football Violence and Hooliganism in Europe. The Amsterdam Group. Oxford: The Social Issues Research Centre, 1996. Web. 17 October 2015.

Clark, John. Football Hooliganism and the Skinheads. Birmingham: University of Birmingham Centre for Contemporary Cultural Studies, 1973. Print.

Collective Violence. World Health Organization. WHO, July 2002. Web. 15 October 2015.

Dunning, Eric, and Norbert Elias. Quest for Excitement: Sport and Leisure in the Civilizing Process. Oxford: Blackwell, 2009. Print.

Dunning, Eric, J Maguire, Patrick Murphy, and John Williams. “The Social Roots of Football Hooligan Violence.” Leisure Studies 1.2 (1982): 139-56. Web. 29 October 2015.

Dunning, Eric, Patrick Murphy, and John Williams. “Spectator Violence at Football Matches: Towards a Sociological Explanation.” The British Journal of Sociology 37.2 (1986): n. pag. Web. 27 October 2015.

Dunning, Eric, Patrick Murphy, and John Williams. The Roots of Football Hooliganism: A Historical and Sociological Study. London: Routledge, 1988. Print.

Ek, Ralf. Hooligans: Fakten, Hintergrunde Analysen. Works: Cicero Verlag, 1996. Web. 29 October 2015.

Fan. An Encyclopedia Britannica Company. Merrium-Webster Dictionary, 2015. Web. 15 October 2015.

Leeson, Peter, Daniel Smith, and Nicholas Snow. “Hooligans.” Economie Polituque (2012): n. pag. Web. 28 October 2015.

Spaaij, Ramon. “Aspects of Hooligan Violence. A Repraisal of Sociological Research into Football Hooliganism.” Amsterdam School for Social Science Research (2006): n. pag. Web. 27 October 2015.

Spaaij, Ramon. “Understanding Football Hooliganism: A Comparison of Six Western European Football Clubs.” Amsterdam University Press (2006a): n. pag. Web. 28 October 2015.

Spaaij, Ramon. “Football Hooliganism as a Transnational Phenomenon: Past and Present Analysis: A Critique – More Specificity and Less Generality.” International Journal of the History of Sport 24.4 (2007): 411-31. Web. 15 October 2015.

Spaaij, Ramon, and Alastair Anderson. “Soccer Violence: A Holistic Approach. A Reply to Braun and Vliegenthart.” International Sociology 25.4 (2010): 1-19. Web. 28 October 2015.

Sport Violence Law and Legal Definition. US Legal. Definitions, 2015. Web. 15 October 2015.

Taylor, Ian. “Football Mad: A Speculative Sociology of Football Hooliganism,” in Dunning, Eric. The Sociology of Sport: A Selection of Readings. London: Frank Cass, 1971. 352-77. Web. 17 October 2015.

Vulliamy, Ed. Heysel Stadium Disaster. The Guardian, May 2015. Web. 27 October 2015.

National Referee Shortage

Jake Wolf and Thomas Orr

            It is almost time for the big game. Both teams have taken infield and the pitchers are throwing their last warm-up pitches in the bullpens. Both coaches are standing in front of their dugouts anxiously waiting to meet and go over the ground rules. The fans sit in anticipation, some excited to cheer on their son in the championship game, some just excited it is the last of six games of another long summer weekend. The starting pitchers are finished now and are walking back to the dugout. The coaches look at their watches and then they look at each other, it’s game time. There is only one problem, there are no umpires on the field. The coaches talk, they hope the umpires are just running late. Then, the site supervisor appears from behind the backstop and approaches the coaches. They are told one umpire was supposed to be here, but that his game on another field is in extra innings and he will be here when he can. They ask if any other umpires are available. “No,” said the supervisor. The coaches look at each other, then look at the crowd, can anyone help? They look at their players, their innocent faces, they are excited and ready to go. Will the game go on?

            This situation is unfortunately not uncommon in today’s landscape of all youth sports. Whether it’s baseball, softball, basketball, soccer or hockey it does not matter. The shortage of officials for youth and high school sports across this country has hit crisis levels. A recent survey by the National Federation of State High School Associations (NFHS) indicates that approximately 50,000 individuals have stopped officiating since the 2018-2019 season. In Nebraska, the state has seen a decline of 15-20% in high school officials since the 2020 season. New sports in the state like female wrestling are unable to find officials as there is not enough officials for the traditional boys season let alone the many new female teams. The shortage of officials across the nation is due to a number of causes and has resulted in an unstable youth sports landscape. The recruitment and retainment of new officials has never been more important.

            The officiating shortage is not new, the trend has been going on since prior to the 2020 pandemic. As an older generation of officials has slowly begun to retire, the younger generation is not seeing the same numbers of newer officials. In 2020, the average age of an official in the United States was 53 years old (Niehoff, 2020). In the state of Kansas, the average age of a softball umpire is 60 years old (Ohio University, 2018).  The numbers are not sustainable, older officials will undoubtedly retire as the physical demands of officiating catch up to them, and with nobody to take their place the landscape of youth and high school sports is in trouble.

            The Covid 19 pandemic, like so many aspects of our lives, has had a negative impact on the world of sports officiating. In the spring of 2020, the sports world was shut down due to the pandemic. With no sporting events at any level that spring and a drastic decline in the year that followed depending on the state in which you lived, many officials were left without any games to officiate. Now, with restrictions lifted and games coming back and seasons being played in full, we are seeing many officials decide not to come back. According to Dana Pappas, the director of officiating services for the National Federation of State High School Sports, from 2018-2021, an estimated 50,000 high school referees quit.

            One of the major reasons for officials quitting and not coming back after the pandemic is the verbal and sometimes physical abuse they take during contests. A survey conducted by NASO (National Association of Sports Officials) in 2020, the largest survey of its kind in the officiating industry, found that 57% of respondents feel that sportsmanship is getting worse. Those respondents indicated that parents (40%) and coaches (30%) are the ones who cause the most problems with sportsmanship. According to Jon Dolliver of the NSAA (Nebraska School Activities Association), “We’ve noticed a decline in how our officials are treated. Not only in basketball but in all activities that have officials or umpires.” Another survey, this one done by Officially Human, an organization that promotes the respectful treatment of officials, conducted a survey of 19,000 officials in 2019, when asked what would likely make them quit, 60% responded with verbal abuse from parents and fans.

Why such abusive behavior towards officials? Has it really gotten worse over the years? According to Dr. Jerry Reynolds, a Ball State professor of social work, “the problem is that, as parents spend more time and money on children’s sports, families are coming to these events with professional-level expectations.”  A Harris Poll in 2019 found that one in four parents reported spending $500 a month on youth sports. That same poll found that youth sport expenses impacted 74% of parent’s ability to save and invest for retirement. Parents are spending big money and sacrificing a great deal of time for their children to participate in youth sports, so their expectations for everything, including officials, are unrealistic. Reynolds believes this has a negative impact on the retention of officials and has led to a cycle of new referees getting yelled at and quitting. That referee then quits, a new referee comes in and gets yelled at and that official quits as well. It’s a cycle that is unfortunately playing out all across the United States.

So, what are the effects of the nationwide shortage? Around the country games in all sports and at all levels from high school on down are being moved, postponed and even canceled in some cases. You don’t have to look very far to see schools from across the state having to adjust schedules simply so they can have officials. This fall, schools around the state of Nebraska are having to play games on Thursday night, Friday afternoons and even on Saturdays just so they can have officials. Some schools are increasing pay as a way to ensure officials will choose to work their games on Friday nights. “I’m not against paying them what they're worth, but it does cut into our budget,” said Bruning-Davenport-Shickley Activities Director Ruth Kowalski. NSAA Assistant Director Nate Neuhaus summed it up when he said “Who is going to be the victim of all of this? The student athletes in high school who don’t get to play their games on Friday night, or at all, because of the lack of officials.”

So, what can we do to help solve this problem? To start, think about this stat for a moment. According to the NFHS, an average of only two of every ten officials return for their third year of officiating (USA Today, 2017). This means that the sports world is having a very difficult time retaining officials. Yes, large numbers of older officials are retiring, but we are losing way too many younger or newer officials who only have a year or two of experience and decide not to continue officiating. If we want to keep with the ever-growing landscape of youth sports in this country, we must focus on the recruitment and retainment of officials in all sports.

The NFHS started a campaign a few years ago called the #BecomeAnOfficial program. Its goal is to help recruit and retain sports officials in an effort to help keep the pipeline for high school officials strong. The program has seen some positive results on the recruiting side as about 70,000 individuals have expressed interest in officiating in the last four years. Dana Pappas, the NFHS director of officiating services said this past April the NFHS helped orchestrate the first ever National Officials Consortium Summit in Indianapolis. In attendance were 60 leaders from 30 national level sports organizations that included youth, high school, college and professional sports organizations. Leaders spoke and shared ideas on ways to combat the declining numbers of officials. One key theme emerged from the summit and that is the treatment and respect for officials must improve if we are to reverse the current referee shortage. More specifically, most at the summit expressed concerns that unsporting behavior by fans at all levels of sports is becoming normalized. What used to be good-natured heckling has turned personal, vulgar and in many cases violent.

Do a quick google or YouTube search and you can find dozens of recent physical attacks towards officials by coaches, fans and players. Surveys have shown that nearly one of every two officials have been threatened after a game. The plan coming out of the summit is a broad-scale campaign that addresses behavior and respect towards officials. It is vital that everyone involved including players, coaches, parents, administrators and the media do their part in changing the normalized negative behavior directed at officials. This change will not happen overnight, but stakeholders are confident that change can happen and that positive and respectful behavior towards officials can become the norm once again.

            The shortage of officials across the nation has many causes and has resulted in an unstable youth sports landscape, the recruitment and retainment of new officials has never been more important that right now. This shortage has been happening for years and the pandemic only accelerated the problem. Couple that with the increased amount of verbal and physical abuse directed at officials and it is easy to see why we are in crisis mode at the moment. In every state across the country games at all levels and in all sports are being moved, postponed and even canceled due to the shortage of officials. Now, more than ever we must recruit and retain new officials. We need parents, teachers, coaches and athletes who are finished with their playing careers. Anyone with a passion for sports and a desire to give back to our youth will make a great candidate to be an official. The time is now, the game must go on.

Works Cited

“Cost of Youth Sports Delaying Retirement for Parents.” Bloomberg.com, Bloomberg, 15 May 2019, https://www.bloomberg.com/press-releases/2019-05-15/cost-of-youth-sports-delaying-retirement-for-parents.

Fawcett, Dave. “Referee Shortage Disrupts High School Friday Night Football Schedules for Local Teams.” INSIDENOVA.COM, 24 June 2022, https://www.insidenova.com/sports/prince_william/referee-shortage-disrupts-high-school-friday-night-football-schedules-for-local-teams/article_90262a84-f18d-11ec-af25-dfba1e97e73b.html.

Hegarty, Aaron. “Omaha NCAA Basketball Ref: Youth Sports Fan, Coach Behavior Drives Referee Shortage.” KMTV, KMTV, 23 May 2022, https://www.3newsnow.com/news/investigations/omaha-ncaa-basketball-ref-youth-sports-fan-coach-behavior-drives-referee-shortage.

Karissa, Niehoff. “Behavior Campaign Planned in High School Sports as Many States Report Increase in Officials.” NFHS, https://www.nfhs.org/articles/behavior-campaign-planned-in-high-school-sports-as-many-states-report-increase-in-officials/.

Karissa, Niehoff. “With Loss of 50,000 Officials, NFHS Organizes Consortium to Find Solutions.” NFHS, https://www.nfhs.org/articles/with-loss-of-50-000-officials-nfhs-organizes-consortium-to-find-solutions/.

Medina, Eduardo. “Bad Behavior Drove a Referee Shortage. Covid Made It Worse.” The New York Times, The New York Times, 21 Apr. 2022, https://www.nytimes.com/2022/04/21/sports/referee-shortage-youth-sports.html.

“Our Data - Officially Human: Behind the Stripes -.” Officially Human | Behind The Stripes -, 11 July 2022, https://officiallyhuman.com/our-data/.

Referee. “The Largest Officiating Survey Ever.” Referee.com, 23 Mar. 2020, https://www.referee.com/17487-officials-something-say/.

Skiba, Jeremy. “Nebraska Faces Referee Shortage.” NORTHEAST, https://northeast.newschannelnebraska.com/story/45404595/nebraska-faces-referee-shortage.

USA TODAY High School Sports. “Shrinking Pay, Age, Abuse among Factors Driving Referees Away in Public High Schools.” USA TODAY High School Sports, USA TODAY High School Sports, 10 May 2017, https://usatodayhss.com/2017/shrinking-pay-age-abuse-among-factors-driving-referees-away-in-public-high-schools.

“Who Wants to Ref? Schools Dealing with Shortage Concerns.” McCook Gazette, 11 Aug. 2022, https://www.mccookgazette.com/story/2960446.html.

A note about Transgender Participation in Sport

While the world is swirling around the potential for participation of transgender athletes in competition, many debates are entering into every aspect of the sports world to provide clarification and fairness all athletes.  In reviewing the requirements being applied to those who have entered competition in sport as a transgender athlete, there have been several policies that have developed and are currently being implemented by the National Collegiate Athletic Association. The policies, though in their incipient stage, will influence much decision making as eligible trans and non-binary athletes enter sport competition with competitors according to their validated gender designation.

Myron Genel, M. D. refers to the difficulties in enacting policy by noting that “clinicians and politicians have struggled with how to integrate transgender individuals”. (1) However, in 2003 initial recommendation were a start to addressing the issue through the development of clinical criteria that can be verified.

Further, guidance regarding the right of a trans/non-binary athlete to participation was provided by 12 years of policy by the National College Athletic Association and its more recent policy clarifications in 2022.  The original “2010 NCAA Policy on Transgender Student-Athlete Participation” included the following:

“The following policies clarify participation of trans student-athletes* undergoing hormonal treatment for gender transition: 1. A trans male (FTM) student-athlete who has received a medical exception for treatment with testosterone for diagnosed gender dysphoria for purposes of NCAA competition may compete on a men’s team but is no longer eligible to compete on a women’s team without changing that team status to a mixed team. 2. A trans female (MTF) student-athlete being treated with testosterone suppression medication for gender dysphoria for the purposes of NCAA competition may continue to compete on a men’s team but may not compete on a women’s team without changing it to a mixed team status until completing one calendar year of testosterone suppression treatment. Trans student-athletes who are not taking hormone treatment related to gender transition may participate in sex-separated sports activities in accordance with their sex assigned at birth. • A trans male (FTM) student-athlete who is not taking testosterone related to gender transition may participate on a men’s or women’s team. • A trans female (MTF) student-athlete who is not taking hormone treatments related to gender transition may not compete on a women’s team. *

(*This policy may also apply to student-athletes who identify as non-binary. The same policy requirements apply to student-athletes who identify as non-binary and wish to compete on a men’s or women’s team.)” (2)

The current policy was updated in 2022 to align with Olympic Movement policy and specify three phases as follows:

“Phase One – 2022 winter and spring championships

For participation in 2022 winter and spring championships, transgender student-athletes must provide documentation to the CSMAS within four weeks before the selections date for their championship. 

The documentation must demonstrate compliance with the 2010 NCAA policy (PDF), which calls for one year of testosterone suppression treatment. It should also document a one-time serum testosterone level that falls below the maximum allowable level for the sport in which the student-athlete is competing within four weeks of championship selections for that sport. This means that student-athletes who have already fulfilled the 2010 NCAA policy need only provide one validated serum testosterone level in this time frame.

Transgender student-athletes who are participating in regular season competition (including conference championships) for the remainder of academic year 2022 remain subject to the 2010 NCAA policy only.

Phase Two – 2022-23 regular season and championships

Beginning Aug. 1, 2022, participation in NCAA sports requires transgender student-athletes to provide documentation that meets the above criteria for the 2010 NCAA policy (PDF), plus meet the sport standard for documented testosterone levels at the beginning of their competition season and again six months later. This means that student-athletes who have already been competing do not need to demonstrate the newly adapted sport-specific testosterone levels for the entire prior year if they are not available.

For participation in NCAA championships, transgender athletes must additionally provide documentation of testosterone levels to the CSMAS with laboratory work completed within four weeks of the championship selections.

Phase Three – 2023-24 full implementation

Beginning Aug. 1, 2023, participation in NCAA sports requires transgender student-athletes to provide documentation that meets the sport-specific standard submitted twice annually (once at the beginning of competition season and the second six months following) for one year. This process will continue annually for eligible student-athletes.

For participation in NCAA championships, transgender athletes must additionally provide documentation of testosterone levels to the CSMAS with laboratory work completed within four weeks of the championship selections.”

Now with guidance from international and national policies that affect sport federations and universities, other entities are providing new decision making in the form of either recognizing gender issues or banning participation altogether. (2)

In studying the issue of transgender/non-binary athletic participation, the position expressed in this article is as follows:

Rachel McKinnon

1.     Student athletes, regardless of their gender orientation, have a right to participate in competition that best represents an accurate definition of their physicality through medical descriptions such as those already presented in current policy.  It is important to note, however, that a standard for sport-specific testosterone levels may not eventually be the only evidence that one is indeed female or male.  Other factors may be required as scientific methods show more accurate testing.

2.     While there is great concern over a perceived unfair advantage that male to female transitioned athletes may have over cisgender female athletes, and evidence, indeed, shows that newly entered athletes have broken many records above other athletes, it is suggested that there will not be a great number of athletes who will make transitions for the purpose of breaking records. These athletes deserve to compete in the proper environment related to their gender.

3.     Given the over 20 years of attention to this topic, it is suggested that sport organizations give due time and patience in addressing these rights and responsibilities to ensure fairness and ultimate benefit to all athletes and avoid a knee-jerk reaction to banning athletes from entering a sport area as a trans/binary athlete.

It has taken a long time for policy to begin to develop to accommodate trans and binary athletes, and there needs to be time for the newer policies to be evaluated and modified.  Simply banning these athletes from competition is not a solution, it is a delaying tactic that will continue to deny participation from a group of athletes who have already made the hard decisions about how they wish to live their lives.

Of course, while policy development has been helpful in directing transgender athletes into their inclusion with appropriate opportunities for competition, this author believes that much more needs to be done on the part of parents and policymakers to ensure that gender transforming methods are carefully and appropriately applied in the first place, and that policies that develop to support a widening class of competitors be accomplished with due consideration of the ultimate safety and risk factors associated with potential misidentification of athletes. 

 References:

1.     Genbel, M. (2017).  Transgender athletes: How can they be accommodated? Current Sports Medicine Reports, 17(1), p 12-13.

2.     National Collegiate Athletic Association (2022). Transgender Student-Athlete Participation Policy. Retrieved August 19, 2022, at https://www.ncaa.org/Transgender%20Student-Athlete%20Participation%20Policy%20-%20NCAA.org.html.