ACL tear fears, TikTok myths and the fight for credible women’s health science in sports
admin_news
But mostly Johnson, a postdoctoral bioengineering researcher at Stanford University and a fellow of the Wu Tsai Human Performance Alliance, remembers the intensifying demand for her and the rest of the women’s sport health research community to deliver answers. Answers that, she says, were not yet ready.
“Women across all ages are hungry for true information about vital health decisions, but there’s a lot of grey that we’re living in right now, with a lot of answers that begin with ‘it depends’,” she says. “A year from now, we might have science that says that in this phase of your menstrual cycle, your ACL injury risk does increase by this much.
“But as of right now, we can’t say that.”
The growing participation, visibility and financial heft of women’s sport, coupled with more women breaking into sport science research and decision-making spaces, has ignited the start of a sea change in the world of sport research.
A system of models built almost exclusively on male physiology is becoming less ossified. Investment into female-specific projects — such as Michelle Kang’s $55 million endowment to U.S. Soccer to establish the Kang Women’s Institute or the Wu Tsai Alliance’s partnership with the Women’s Health, Sports & Performance (WHSP) Institute — is swelling.
While the decades-long dearth of data remains, a new era of sport science in which women are not viewed through the prism of “little men” is gradually emerging.
Yet, the time required not only to conduct credible, peer-reviewed scientific research but also to translate and implement it at the ground level has remained the same, say multiple researchers interviewed for this piece. In the meantime, vocal members in the women’s sports space and on social media are rushing to fill the void.
“Good science is slow,” says Kirsty Elliott-Sale, a professor of female endocrinology and exercise physiology at Manchester Metropolitan University with more than two decades of research experience in women’s sport health. “People see a huge increase in the research; they see answers straight away. Some of it isn’t credible. But it’s on social media, it’s providing the answer people have been seeking. It’s really disheartening to turn around to them and say, this fast science isn’t credible. It’s not useful.
“My fear is it’s going to push us back five to 10 years. We’re almost at a tipping point where we’ve got to say we do want more research into female athletes, but we have to call for higher standards.
“Without that, we might as well have nothing.”
While focus and excitement around women-specific health research has increased, such as in the menstrual cycle’s effect on sport performance and injury, it has also engendered competition for funding, says Elliott-Sale.
Consequently, many of the studies, she says, are limited in scope and scale, relying chiefly on qualitative data gleaned from terse surveys and questionnaires and a handful of athletes, which makes it difficult to extrapolate sweeping conclusions.
Advancing research into women’s health relies on getting more stakeholders — researchers, investors, athletes, coaches, and universities — into the same room together.
“You probably see this quote all the time, that there’s only six percent of research done in female athletes, but the research process is really expansive,” says Abbie Smith-Ryan, a professor at the University of North Carolina and a leading researcher and professor in exercise, nutrition and women’s health who is working with the Kang Women’s Institute. “From a female athlete’s perspective, what we do in a lab isn’t necessarily exactly how it should be translated. So it really needs to be two ways: what’s happening on the field, the court or the pitch and how that informs research.”
That is something Wu Tsai’s Stanford arm is doing with its Female Athlete Research Meeting (FARM) event. Begun last November, the multi-day meeting brought researchers, coaches and other stakeholders around the globe under one roof to share the latest research on female athlete health and performance.
“We want to take what is known about physical activity, sleep, nutrition, strength training, injury prevention, and make that available to everybody for free,” says Scott Delp, the director of the Wu Tsai Human Performance Alliance at Stanford University, a coalition of 500 researchers and fellows from Stanford University, Boston Children’s Hospital, Salk Institute for Biological Studies, University of California San Diego, University of Kansas and University of Oregon founded by Clara Wu Tsai and Joe Tsai.
The FARM event also reinforced the challenge of how exactly to implement new information gained from the research.
Delp offers ACL injury prevention as an example. Between 2021 and 2023, multiple elite-level women’s soccer players were afflicted with ACL injuries, with nearly 30 players missing the 2023 Women’s World Cup due to the injury. Numerous media outlets diagnosed the spate of injuries as an “epidemic”. Yet the reasons were more complex, spanning biomechanics, hormonal factors, neuromuscular control issues, as well as outside influences such as increased workload, match intensity and travel.
While the risk of ACL injuries will always remain, Delp says years of research have provided more preventative solutions, such as tools to analyze videos of female athletes running or pivoting to assess the alignment of their limbs and how they control their torsos. How an athlete’s torso lags, he says, can speak to the risk of injury. Training athletes on how to align their torsos is one avenue of injury prevention.
However, that requires not only stripping down and recalibrating decades’ worth of strength and sports conditioning models at a grassroots level based on male physiology but ensuring those coaches, parents and athletes on the ground have the tools to do so.
“There’s not a comprehensive guidebook or standardized checklist for the start of each season that states ‘this is what your athletic director needs to do, here are the pathway requirements or the dietician standards’,” says Johnson.
Wu Tsai’s female athlete-focused program, Female Athlete Science and Translational Research (FASTR), is one initiative actively working in this area by providing educational programs directly with athletes and coaches, either in person or via video call.
“We try to meet the team where they are, understand what resources they have or don’t have, provide the infographics that we’ve created or bring a dietician to co-present with us, so they can field questions from the coach and athletes,” says Emily Kraus, a clinical assistant professor at Stanford Children’s Orthopedic and Sports Medicine Centre who leads the FASTR program.
“It’s like we’re stepping in before they go to TikTok,” she says. “We provide these inquiry forms that they can fill out and provide the topics that they want to talk about.”
The creation of a guidebook is also a key component of the newly-founded Kang Women’s Institute, which is bidding to develop a “best practice framework” based on research gleaned from the U.S. women’s national soccer team and other professional and non-professional teams, to disseminate nationally and globally by the 2031 Women’s World Cup.
The framework is not attempting to be a comprehensive one-stop sport research shop, but rather a base from which to work, says Smith-Ryan, who is working with the Kang Women’s Institute on the project.
“Really the motto is: from the U.S. women’s national team all the way down to grassroots,” says Smith-Ryan. “What’s the bare minimum standard of care for our female athletes? How do we modify that with available resources?”
While Elliott-Sale welcomes the efforts of the Kang Women’s Institute and coalitions such as Wu Tsai — which has no commercial partnership, according to Delp — she notes that adequate funding remains an obstacle for many researchers, especially when they need to include costly hormone analyzes in studies.
That creates a fractured research ecosystem with many competing, small-scale projects rather than a few large-scale projects working with pooled resources, says Elliot-Sale.
“The research that’s being conducted today — and this is a hill I will die on — is not great quality. It’s not scientifically robust or credible,” she says
And in an age of instant gratification, of artificial intelligence in our pockets and self-help TikTok buffets, athletes and coaches are not only searching for those answers but more often finding them — or what they believe to be them, much to the growing alarm of researchers.
According to a KFF Tracking Poll on Health Information and Trust conducted in July last year, of the more than 1,200 people surveyed, more than half (55 percent) of adults, including larger shares of young adults and Black and Hispanic adults, said they use social media to find health information and advice at least occasionally. About one in six social media users (14 percent of the public overall) said they regularly acquired health information and advice from social media influencers and more than one-third (36 percent) said there was a particular influencer whom they trusted.
The findings are not revolutionary. A 2023 study, which surveyed more than 1,000 women in the U.S, between 18 and 29 years old, found 92 percent who used TikTok obtained health information from the platform, either intentionally or unintentionally.
Swelling access to and use of AI further complicates the landscape. A 2024 Healthwatch England poll found that nine percent of men and seven percent of women in England use AI chatbots for health advice and information.
According to a new study from Elliott-Sale, which surveyed 320 elite female players and 46 coaching/medical staff across top European women’s clubs about menstrual‑cycle knowledge over two years, found that the average of players and coaching staff’s knowledge of menstrual cycles fell below 50 percent, with athletes scoring lower than staff members.
The conditions contribute to a mounting concern among sport health experts about social media and AI becoming a primary source for health advice for women. Returning to the 2023 study, 95 percent of the 1,000 U.S. women analyzed said they obtained information from influencers without medical credentials as often as they did certified health practitioners.
While some misinformation can be spread maliciously, oftentimes it is unintentional, with social media users passionate about offering advice and sharing their own experiences but inadvertently disseminating the information erroneously, says Smith-Ryan.
On TikTok, for example, the hashtag #cyclesyncing (a menstrual health trend that involves aligning exercise and diet with the four menstrual cycle phases, criticized by the researchers spoken to for this piece) garnered 285 million views in 2023. A vast majority of the videos, according to a 2024 study, boasted the health benefits, despite “no previous research on the benefits or outcomes of cycle syncing”.
“I love that there’s more conversation about it, but I do worry,” says Smith-Ryan. “We need women to be empowered with knowledge and education. But when it comes to research credibility, there’s so much room for interpretation. That’s where we’ve landed in a bit of a sticking point because women are desperate for information and science, but we can’t use new information as a Bible.”
Increasingly, researchers say they are being confronted by athletes, coaches and students with faith in information gleaned from social media, even if in dissonance with their own experiences.
“We’ve worked with athletes who have said: ‘I don’t really have any problems with my menstrual cycle, it doesn’t affect me. But I saw this on TikTok and it says it’s in charge of everything’,” says Elliott-Sale. “We wanted to rewind. Where is the disconnect between the athletes themselves and universities, researchers, sciences, academia? And what do athletes believe and what do they know?”
Locating and addressing the disconnect sits at the heart of the Wu Tsai Human Performance Alliance’s Female Athlete Program and its partnership with Women’s Health Sports and Performance Institute (WHSP), which opened in January in Boston, as well as U.S. Soccer’s newly-launched Kang Women’s Institute.
“The gap to bridge is how to take rigorous science and make it accessible and for users to know what’s validated,” says Delp.
Part of the challenge, he says, is the traditional process of research itself. Scientists might embark on a five-year study, culminating in a rigorous peer review with the journal, the editor and the reviewers. Yet, the information isn’t often easily accessible by the people who most need it.
“That’s on the researchers to ensure it’s distilled, communicated and disseminated to the public much better than is typical,” he says.
Of course, stepping into the very space that more athletes and coaches are congregating is another option. Smith-Ryan has nearly 25,000 followers on Instagram, where she shares most of her research while also being a regular voice on women’s performance health podcasts.
“We can get into the trenches in research,” Smith-Ryan says. “That’s the hardest part. If I do this amazing study, ultimately, it just leads me to my next study.
“There’s some obligation as a scientific community to do a better job of (dissemination). It’s hard. How do I do that, run a lab, get funding and all the things?
“But my optimist side argues: what a huge opportunity we have to not only share this information but educate more people, get this information out there.”
Both Elliott-Sale and Smith-Ryan emphasize the quality of research still needs to be top of the priority list, from better access to female athletes to conducting more nuanced studies. “For example,” says Elliot-Sale, “does your menstrual cycle affect your performance? You might say ‘yes’, because of cramps. Another person has to wear white shorts and they’re distracted or anxious. You’ve both said yes, but for two very different reasons.”
“The next phase is asking better questions. Otherwise, you get headlines and viral social media posts about 100 percent of female athletes’ performance being affected by their cycle that don’t discern why.”
Women’s sport science is far from the only institution to face a reckoning of authority in the 21st century’s social media age, say researchers. But they do not vilify those who attempt to disseminate scientific research online, or share their own experiences to foster community or expunge stigmas around speaking about female health topics.
“But the devil is often in the details that get missed in that 30-second or 10-second soundbite,” says Johnson. Understanding that scientific research is not a series of immovable bricks but rather an eddy in constant flux is critical, she says, particularly at the onset of a new research zeitgeist.
“For me, it comes back to empowerment,” says Smith-Ryan. “The only sample that matters is you. We need to be better about giving women the knowledge and education so that they can be empowered to ask more questions, but to also say: ‘I know what my body is.’”
This article originally appeared in The Athletic.
NWSL, Women's Soccer, FIFA Women's World Cup
2026 The Athletic Media Company
