FOOTBALL carries a heavy burden of musculoskeletal injury, averaging about 8.1 injuries per 1,000 hours of exposure, with roughly four in five affecting the lower limb. While neuromuscular and biomechanical risk factors are well known, especially in largely non-contact ACL injuries, the role of cognition has been less certain. This study examined whether pre-season cognitive performance predicts in-season injury among professional male players.
Players completed a battery of computerised and pen-and-paper tests spanning visual perception, visuomotor vigilance, visuospatial short-term memory and executive functions (cognitive flexibility, working memory, inhibitory control). Overall, results suggested possible but statistically non-significant links between cognition and subsequent musculoskeletal injury; the primary hypothesis was therefore not confirmed.
An exploratory trend stood out. Higher Trail Making Test (TMT) ratio scores, indicating poorer set-shifting when basic processing speed is accounted for, were associated with 64% greater odds of injury. In an open-skill sport where athletes must re-plan actions in milliseconds and suppress outdated movement programmes, reduced cognitive flexibility could delay motor adjustments and worsen landing or cut-and-run mechanics in match play. This signal is biologically plausible but requires confirmation.
Age also mattered. Older or longer-tenured players showed higher injury risk, highlighting the need to interpret any cognitive effects alongside accumulated load, slower recovery and age-related neuromuscular change.
Findings for “basic” processes were similarly tentative. Faster visual search (shorter TMT-1) and quicker hand motor speed (faster TMT-5) each trended towards reduced injury odds (≈40% and ≈36%, respectively), yet neither reached significance. Contrary to prior reviews in younger cohorts, simple and choice reaction time, as well as CORSI-based visuospatial memory, did not predict injury here. Differences in task ecology (seated key-press tests versus standing, target-seeking tasks), and the relatively homogeneous, elite sample may partly explain this.
In practice, executive-function-sensitive indices such as the TMT ratio show promise but are not ready for screening or return-to-play decision-making. Larger, adequately powered studies should test whether training executive functions meaningfully reduces injury risk and clarify how cognitive and age-related factors interact in professional football. Until stronger evidence accumulates, clinicians should treat cognitive testing as complementary rather than decisive.
Reference
Giesche F et al. Influence of selected cognitive performances on musculoskeletal injury occurrence in adult male professional Slovenian PrvaLiga football players in a prospective cohort study. Sci Rep. 2025;15(1):30828.
