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The Game Changers
In this award-winning podcast Sue Anstiss talks to trailblazers in women sport. These are the individuals who are knocking down barriers and challenging the status quo for women and girls everywhere. Along with openly sharing their historic careers, what drives them and how they’ve dealt with tough challenges, each episode explores key issues for equality in sport and beyond.
We’re incredibly grateful to Sport England who support The Game Changers through a National Lottery award.
You can find out about all the guests at https://www.fearlesswomen.co.uk/thegamechangers
Fearless Women in Sport
The Game Changers
Professor Kirsty Elliott-Sale: Revolutionising Women’s Sports Science
“Women’s physiology isn’t a problem to be solved - it’s an opportunity to innovate.”
In this fascinating episode of The Game Changers podcast, I speak with Professor Kirsty Elliott-Sale, one of the world’s leading researchers in female physiology, about the critical need for women-focused sports science.
From her unconventional journey into the field, to leading ground-breaking research, Kirsty challenges outdated approaches and highlights why women’s health must be at the centre of performance science, not an afterthought.
We cover:
➡️ Bridging the research gap – why we must innovate rather than simply adapt male-based models
➡️ The Centre of Excellence for Women in Sport – how the Manchester centre is dedicated to advancing research and collaboration
➡️ ACL injuries in female athletes – does oestrogen play a role, or are we missing the bigger picture?
➡️ Menstrual-cycle-based training – the scientific evidence (or lack of it) behind tailoring training to cycle phases
➡️ Pregnancy & performance – how attitudes are shifting, and why more female athletes are competing as mothers
➡️ The future of women in sports science – how young women can break into the field and drive change
Kirsty’s message is clear: women’s physiology isn’t a limitation—it’s a strength that should be studied, understood, and embraced.
“If we only ever research men, we’ll only ever understand men. It’s time to stop playing catch-up and start leading.”
Thank you to Sport England who support The Game Changers Podcast with a National Lottery award.
Find out more about The Game Changers podcast here: https://www.fearlesswomen.co.uk/thegamechangers
Hosted by Sue Anstiss
Produced by Sam Walker, What Goes On Media
A Fearless Women production
Hello and welcome to The Game Changers. I'm Sue Anstiss, and this is the podcast where you'll hear from trailblazing women in sport who are knocking down barriers and challenging the status quo for women and girls everywhere. What can we learn from their journeys as we explore key issues around equality in sport and beyond? I'd like to start with a big thank you to our partners, Sport England, who support the Game Changers podcast through a national lottery award. My guest today is Professor Kirsty Elliott-Sale, Head of the Centre of Excellence for Women in Sport at the Manchester Metropolitan University Institute of Sport. In 2024, Kirsty was named as one of the 50 most influential women in sport by the Telegraph.
Sue Anstiss:Following a PhD that examined the effects of female reproductive hormones on muscle strength. Kirsty's work is primarily focused on female athletes in areas that include the menstrual cycle, hormonal contraceptives and menopause. Kirsty's also been involved in designing and implementing exercise interventions during and following pregnancy for a variety of populations, including women in the military athletes and women with obesity. Kirst is hugely respected in the sports industry, having worked with high-profile organisations across a wide range of sports, including the UK Sports Institute, the FA, uefa, the European Club Association, Arsenal Women's Football Team, British Rowing, WTA, the ECB, Manchester Thunder and the Matildas. Kirsty's work is extensively published, which is actually how I first came to discover her, when I was researching my book back in 2020, and I'm delighted to say that our paths have crossed many times since then. So, Kirsty, can I start by perhaps asking you to share your journey into sports science? So where did it all start for you, oh my?
Professor Kirsty Elliott :Goodness, let's rewind. It's a long time ago, Sue. I accidentally fell into sports science. I'm not sure if I should admit that so clearly. Listeners will have guessed already from my accent that I'm Irish, and so there I was at secondary school, hugely influenced by I had a PE teacher, Mrs Kane. I can still remember her, clearly huge impact on me. And I had a PE teacher, mrs Kane. I can still remember her, clearly huge impact on me, and I loved my PE sessions. Now I should say I went to a convent Catholic school, the women in my family and my school setting. It wasn't sporty at all Not, you know, this is Ireland in the late seventies, early eights, and so my only interaction with sport was through PE and through this PE teacher who was amazing, and so I wanted to be a PE teacher.
Professor Kirsty Elliott :That's what I wanted to do. I wanted to leave home in a big way. I wanted to spread sort of my wings, and so I thought, oh well, I'll go abroad. I mean, I'm from Ireland, I took a huge step to England, but I wanted to go somewhere new, wanted to go abroad. So I essentially had applied for PE everywhere in England, or so I thought I put down the wrong code in my UCAS form and that led me to Liverpool, john Moores, and to actually not sport science in its purest sense, but I had applied for a coaching science degree. So you can see how, on the UCAS brochure, coaching science might've been quite similar to PE, you know, in the same sort of bracket.
Professor Kirsty Elliott :And so Liverpool, John Moores, invited me for an interview and I loved it. I loved the city, I loved this coaching science because it seemed a little different, because I had science in it and I happened to love science. I was doing biology and chemistry and so this idea of putting together sport and coaching with science seemed like the perfect fit. And the rest is history. So there I went to Liverpool, john Moores, studied coaching science, which is really sport and exercise science, but with sort of, I guess, a speciality in sports coaching. And then I was really fortunate that Liverpool, john Moores asked me to stay on and do a PhD and I did and I loved it and I think you mentioned in your very kind introduction, you know, that my PhD started.
Sue Anstiss:You know that's where my sort of work with women started, so yes, I love the way you just casually go and they asked me to stay and do a PhD, as if it's just like, yeah, I hung around a bit in the right places, but how fantastic that it was almost a accidentally finding that course or something that you wouldn't have done. It's interesting, isn't it? We think about the challenges now of getting more women into coaching, and yet that was a coaching course. What was the gender balance like at the time that you did that course?
Professor Kirsty Elliott :um so actually there were only seven on that degree program, so it's a very small sort of degree program. As I say, that sort of boils on and sits alongside sports science. Um, now I'm trying to do the mental math.
Sue Anstiss:There were three women and four men and was coaching an option that you would have taken a pure coaching route rather than more of a your kind of movement into science?
Professor Kirsty Elliott :yeah, so so built into to the degree, um, you know, you had to do coaching placements. So I was an athlete at the time myself, and then through my, my sport, I was obviously coaching within the, the clubs that that I um, the club that I trained in. What did you play? Oh, I was a kickboxer. Sue Were you From a martial arts background and so, yeah, so I was obviously training and competing with my club and a part of the GB kickboxing team at the time, then also coaching, you know, younger children and lower belts grades. It was quite active in that space. But, to honest, I wasn't thinking about women at that point in my degree. That wasn't a specialism of mine, it wasn't on my radar. Where I became interested was right at the end of my degree and again, it's probably not the route people are going to think. But I took a chronobiology module. Chronobiology, most people would know, is around circadian rhythms. 'm gonna I promise I'm gonna explain all the tech jargon around how time of day usually affects people. So people might say you know, there's a time of day where temperature, body temperature, peaks and that's good for strength training or whatever, and so that's what chronobiology is is well known for sort of daily rhythms and hourly rhythms and so on. But but there was one lecture in that module on what we call a circummental rhythm, and I don't know how your Latin is, but circummental means around a month. And now everybody's thinking, oh, what happens around every month? And it was the menstrual cycle. And so the menstrual cycle appeared in this chronobiology module and that's where I first sort of encountered it and I loved it. I thought that was really fascinating, this repeating patterns of hormones in women that occur over typically around a calendar month. And so that sort of whet my appetite. And then, as I said, hanging around in the right place at the right time, and Liverpool, john Moore said would you stay and do a PhD? And at that time they'd already had a really fantastic researcher, julie Greaves. She'd not long finished her PhD in women's physiology and she'd done some really nice studies on the menstrual cycle and menopause and so on. And so the idea was is that I would stay, I would work with Julie, we would continue this line of work together. And at that point John Moores, you know, were really, I guess, trailblazers, you know, prioritizing women's physiology at a time when nobody was. And so then suddenly it all came together the idea of you know the coaching and the sports science and the physiology and endocrinology, and and then, sadly, I because life took over and research took over, I stopped competing and stopped coaching. But now I'm really lucky. I feel like I'm having several careers. I'm now in a position where I can now start to influence again in the sort of direct athlete space and the coach space. So I've maybe come full circle.
Sue Anstiss:I can't believe it's my first question. I've already learned so much about you and I thought I already knew a lot about you already. Um, what, what was it? Do you think about Liverpool, john Moores at that time? So was it a specific person in place? Why were they such a trailblazing university then? Do you think?
Professor Kirsty Elliott :Oh, that is a good question. Well, um, I'm thinking about Tim Cable. Professor Tim Cable is in my mind because Tim was my PhD supervisor At Liverpool, oh, wow, and I did my PhD between 1998 and 2001. And then, if you were to fast forward to now, I joined the Institute of Sport at man Met just over two years ago. And who's the director of the Institute of Sport? But Tim Cable. And so here we are.
Professor Kirsty Elliott :The band is back together 20 something years later.
Professor Kirsty Elliott :And you know, tim is still a trailblazer and you know, not only is he very good at identifying areas of, you know, worthy areas of investigation and innovation, he's very good at bringing people together. So, you know, when Tim calls you, you sort of pick up the phone and go, yeah, I'm there. So, yeah, I think a lot of it, I would have to say, rests with, you know, tim identifying that area as being important. And then, as I say, 20 odd years later, he's still championing that women's agenda. And so when he called and said, would you join the Institute of Sport? And he said, said, and if you come here, what, what could we build in this space? And then you know, sort of within the first year of being here, we recognize that. You know we've a lot of expertise within the institute and man at university, and then you know, slowly, that idea around developing and launching and, you know, sustaining now a center of excellence for women in sport. So I'm going to give Tim Cable the thumbs up for this one.
Sue Anstiss:I do love it because on my path across with him 20, 25 years ago when I worked for Gatorade and he was doing research in terms of, you know, heat, acclimatisation and fluids and all that stuff too. So it's lovely, yeah, that kind of repeating thread of somebody.
Professor Kirsty Elliott :And in his PhD. So you know, and he he wouldn't mind me saying, but even before my time, when he did his PhD, um, some of his work, um, his cardiovascular work, was in menopausal women. So you know he himself was contributing to that area. Um, you know, right back in the day. And you know, maybe one of the things we'll come on to discuss is, I know that women are in the spotlight right now, and absolutely as they should be. But you know, people have been working, you know, hard in this area. You know, and even though they may not have been noticed and picked up and it wasn't mainstream, I think it is worth acknowledging. You know a legacy. You know I'm standing on the shoulders of giants. You know it's through lots of great people. You know that laid the foundation for my PhD and then, in the interim 20 odd years that we've been working together. Lots of good people out there.
Sue Anstiss:Absolutely. Yeah, right to give them credit too, isn't it? There's a positive picture that you've painted there of being a woman in academia and that progress. What has that been like? Have you faced challenges as a as a female a female in the sports science space, would you say or does it feel like it's always been very equal and you've had opportunities?
Professor Kirsty Elliott :um, oh, that's a good question, isn't it? Yeah, it's hard to know sometimes if you have missed out on something. No, I'm. I'm going to say that I think you know my, my journey has been a good one and I am fortunate that I found my people quite early on and you know, when you have a mentor like Tim to start with, it does sort of put you on a certain track. Of course, no journey is without its bumps and and that sort of thing, but I think, no, I'm going to say that you know, I've enjoyed my journey and I think my hard work has been rewarded.
Professor Kirsty Elliott :In the main, what I would say is the challenge possibly for me in my career which maybe is a little bit different than, say, my male counterpart was probably when I had my children and just sort of trying to balance the, you know, a career break, that re-entry. I chose to work part-time when I came back. That was the way that I could balance sort of everything. So I guess my, my top level answer is no, I've enjoyed myself. I found my sport and exercise community to be a good one. There have been a couple of bumps, maybe no more or less than anybody else, and possibly the only real challenge was just navigating motherhood.
Sue Anstiss:And in terms of that bigger sports science piece that we talked about, some of the work that you've been doing, but historically it has. The women's sports science has been under research, and we hear that kind of discussed a lot at the moment, don't we? But what does that kind of mean for female athletes? Are we still seeing female athletes today that being trained using the data that's based on primarily male physiology?
Professor Kirsty Elliott :Yeah, I think that there is certainly there's no disagreement. You know, the focus has not been on female athletes. Sport and exercise science has been largely, you know, developed and the data that's been derived in this area have been from males. And yeah, I think that data is still being used. I guess there's a nuance here. Two really points to make. Is one, some of that data derived from men will be relevant to women. So, you know, that's important to say.
Professor Kirsty Elliott :I don't feel that we need to repeat every study that we've done in men, in women. I think what's been overlooked and under-researched and under-resourced and so on, is the female-specific considerations. So, you know, looking at that sport or that athlete, so you know a footballer, and seeing what are the female-specific considerations for female footballers, and that's been largely overlooked. We've just been looking at them as footballers or we've been defaulting to men. So I think that's the area that's been overlooked and I think, you know, as we've said, it's coming into its own now. Better late than never. But I know people can't see my face. There is a disdain for look on my face because it did take longer than it should have done. You know this should have happened a long time ago.
Professor Kirsty Elliott :I don't know if joke is the right word, but you know, sometimes it's mentioned that women were invented sports. Women were invented in the last Olympic cycle because, of course, in for Tokyo, it was the intention to reach parity in participation at the games. That didn't quite happen, it was close, but then obviously that was achieved in Paris and so often people, as I say, joke not sure that that's the right word that women were invented in the last Olympic cycle and that's a little sad because clearly we weren't. And the drive for medals you know it took a drive for medals to become the drive for, you know, sort of a focus on women and female specific considerations.
Professor Kirsty Elliott :So I think, you know, again, I'm always trying to be glass half full, so I'm glad the lights have come on. That's how I always describe it. The lights are on now and you know it's what we do moving forward. I think we should innovate in this space and do something new, and so you know, I think, trying to incorporate and embrace and empower and all of those things around female specific considerations to to develop women's sport, let's do something new here and let's do it using the knowledge that we got maybe elsewhere. So so yeah, it's. It's not a linear journey, is it? But hopefully we can now accelerate in this space and come into our own.
Sue Anstiss:That's such an interesting point. I had never, never really thought about it in that way. But we talk a lot about in other areas of women's sport, don't we? In terms of funding and sustainability, we don't just want to be like what we've seen in men's sport because it hasn't worked in many cases. So let's build it better and, you know, more sustainably, in a positive way, and I hadn't really considered. That is also the case in the science, in the sports science area too, isn't it?
Professor Kirsty Elliott :yeah, absolutely. I mean that that's the thing, isn't it? Um, you know we've got great people, as we've said, and you know I'm hoping that in in science, in the science space of this, you know bigger overall picture of women's sport, that we will get the opportunity to to do something new and to write and, you know, develop something new and exciting. And you know, of course, we always talk about, you know, this taking, you know this imprint or blueprint that we have for men and taking it into women's sport. I am looking forward to a time where men are taking things from women's sport and you know a time where men are taking things from women's sports and imprinting that and embedding it into their space. So, yeah, I mean, maybe I'm naive, but I think that the future is hopeful.
Sue Anstiss:And it does feel, doesn't it? Even in the last few years, there's been this huge jump in progress in terms of new organisations being established, new university centres of innovation and we're going to come on to talk about Manchester more and also more investors, and female investors, in the space too. So do you feel we've gone? Is there no going back now? Have we? We're not. I don't really like the phrase tipping point, but do you feel we're? We're there now.
Professor Kirsty Elliott :Yes, and again, I know no people can see my face. It looks a little twisted because you know, I think this, this change, certainly in my career, has been coming the last five or so years and it's gaining momentum. And up until recently, if you'd asked me that question, I would have said no, I felt like somebody might turn the lights out again. But no, I do feel like you know, it has been a sustained momentum. You know the opportunities are increasing, all those things that you said. So no, I think I think there would be a revolution across all sectors if anybody tried to turn the lights off now. So no, I think this is the tipping point and I think you know we've made it over the brow of the hill. Don't get me wrong, there's a lot of work to be done, but I don't think that we can ever.
Sue Anstiss:You know it will ever be pushed back or hidden as it has, has been and you mentioned the centre of excellence for women in sport so established, launched in march 2024, last year in manchester. Can you tell us a bit more about it and and and why it was needed? But you have alluded to, but the kind of history behind its establishment?
Professor Kirsty Elliott :yeah, so our centre of excellence for women in sport, I guess physically housed in in manchester, mesh, so in in Manchester, but in collaboration with the UK Sports Institute. And so there are our partners in this endeavour and of course they are I'm sure everybody knows already but they represent Olympic and Paralympic and Commonwealth sports in the UK and although the Centre goes beyond just Olympic Paralympic sport and we do professional sports and we do health and we do society, you know it's really a continuum, I guess, from that elite space right down to, you know, girls and women who have maybe never exercised before, and so people often go. So why did you make this relationship with the top end then? But actually we can learn a lot, but actually we can learn a lot we can learn from athletes, and that information is applicable right through our system or our timeline or our spectrum of the girls and women that we hope to work with. So it is, it's a really great sort of relationship.
Professor Kirsty Elliott :We have lots of other partners and collaborators too. We work a lot with Arsenal Women's Football Club, who've made a huge investment into not just their women's team in you know from what the public sees, but you know behind the scenes into facilities and resources and actually into research. So you know the relationship with us. We have a PhD student embedded at the football club. The club, the players, the staff there.
Professor Kirsty Elliott :They're generating what we would call the research questions, and I guess in applied sport they would say the challenges faced by women and they discuss those with us and we design some studies to interrogate that further, to generate some data and that data goes straight back to the players, to the club, to the staff there and then hopefully will improve for the players and for the game in general. So yeah, we've got partners in football and netball and rugby and lots of different sports. And again, we're really fortunate that UKSI are fantastic partners because they don't ever try and limit us, because they recognize as well that Olympic sports can learn from professional sports. The center, as I say, these two organizations have come together with a willingness to amplify and accelerate the development of women's sport and we do that with a wide network and it's not just through research, it's through advocacy, it's through looking at policies, it's about spreading that dissemination with the media. We have a wide remit.
Sue Anstiss:You mentioned that kind of flow down almost from that very top level of science and we often hear that example that we have the NASA researchers and everything that's done in space. It impacts day to day households. But how long would you say it generally takes for that cutting-edge research that you're doing at the very top to work its way down through organizations, through coaches and trainers, to to the athletes that's?
Professor Kirsty Elliott :a good question. Um, I'm not sure I I have an answer, because the reason why I say that is because I'm thinking about, like, the different organizations I work with, and sometimes the invitation from the organization is you come in and you work at the organizational level and and that's where your question would be applicable how does it get down? But with the other organizations, they, the invitation is to come straight in and talk to the athletes themselves, and so you know that bottom down and top up it's different sort of sport by sport and country by country. So I'm not sure there's a universal answer. But I guess what I could maybe speak to is, you know, from that initial invitation where somebody within the sport and organization says you know, would you come in and work with us in whatever aspect you are, how long does it take to make a change? Not very long, because actually sometimes the very first visit I'm a bit cheeky I'll always ask to use the toilet and then I'll come out and I'll say to somebody oh, there's no free sanitary products in your toilet, and the next time I come, that would be really great if that was changed. And so there's a change instantly, you know, and there are small, quick wins, and I know people call it low-hanging fruit.
Professor Kirsty Elliott :I don't really love that term, but actually you know change can happen quickly. The size of the change, yeah, that's another thing. But there are ripples and you know, I see that, you know even organizations I've been into once. The ripples go long, you know way beyond your visit and you know we can't take the credit for it, but I think once an organization invites anybody like you, like me, to come in, something has happened in the mindset. They know they need something, they want something and and not they can't always put their finger on it. Some organizations do, they know what it is they want and some organizations don't, but they know that they want to do something in this space.
Professor Kirsty Elliott :And so I think change can happen quickly and have ripples and have legacy. But if you were asking me and maybe you were and I diverted but if you ask me from a purely research perspective, you know you come up with a question, you design a study, you do the study, you publish the study, you hope somebody reads the paper and changes something. That's a slow pipeline and I don't, personally, in my experience, I don't think you're turning that around in quicker than 18 months and that would be somebody working fairly flat out. And so you know, I think the minimum research project that I'm sort of accepting is with a 12 monthmonth timescale and knowing that there'll be probably another six to 12 months after that to really operationalize sort of the findings from that project.
Sue Anstiss:I think when I wrote the question, I think my thinking was almost of a when I think of an everyday coach coaching a young female athlete. But my thinking is how long things take to get from that a discovery of something to come through, especially someone that's coached for many, many years, and there's certain protocols and there probably isn't an answer to it. But it's just an interesting piece, isn't it? Of how the we're seeing this change over here. But is it actually reaching the everyday coach with athletes today?
Professor Kirsty Elliott :probably yeah, no, and then I will amend my answer to actually answer the question you asked me. I still think that's taking quite a while. Yeah, I do you know. We know that we talk about it being under research, but we we can also talk about being under resourced and so on and so on and so on, and so when you have very little, you know, it's hard to dilute that even further and expect people to stay at the cutting edge of everything. And so often in women's sports we know that people are just trying to keep their heads above water. So I think it's taking a long time to really, as you say, filter through the entire system and often down to the people and the places where actually it probably has the biggest impact.
Professor Kirsty Elliott :But I would say I'm encouraged because, again, if I took a football example, there are more and more invitations now to go in and speak at more of a grassroots sort of, you know, sort of academy level and influence there. Because I guess, if I went really specifically to my area that I'm interested in, which is a varying hormone profile, so menstrual cycles and hormonal contraception and pregnancy and so on Actually I would love young girls to have this body literacy and then they take it throughout their entire careers. And you know, so often now, by the time we're in an elite organization, at the very top end, a lot of the athletes are saying, gosh, I wish I knew that sooner. I really did, you know. And they're gracious because they're still taking part in research and they're leaving a legacy for those that come behind them. So I think, if we can sort of flip flop and try and concentrate and again we're still, we're getting more funding and more opportunities, but we're still looking to dilute a relatively small part. But yeah, focused and target attention, that's what's needed, right.
Sue Anstiss:Very interesting. And what does success look like for you as the institute itself? What's you know? You look back in five years time. What will you have have changed? Or, you know, is there a volume of work? Does it depend on the funding that's coming in as well too, I imagine?
Professor Kirsty Elliott :I'm going to be. I'm going to be selfish and talk, I guess, about my particular sort of stream of work within the center, because obviously the center is such a wide remit. But I think success for me personally and and you know, obviously as part of the center, would be a legacy where girls and women understand the those female specific topics, you know the things that make them different, and understanding that there's as many positives as there are negatives to these differences. And I do worry a little bit that when we start talking about female specific considerations it's always in a negative way. Oh, you know, girls and women menstruate and that's very challenging and you know that will limit their ability to train and to compete. And suddenly, you know, women may be in some areas then seem less than. And how can we change that and say to these girls and women actually your menstrual cycle is a marker of health and you know, your body is fantastic because obviously these are really, in the first instance, they're reproductive functions, right, and and it's not, it doesn't matter whether you go on or not to have children, but that reproductive function, that system, when it's working well, that's such a marker of of good health and your body's ability, that that's brilliant and should be celebrated.
Professor Kirsty Elliott :If it comes with some challenges, as it does for many women, again, rather than well, how do we sort of deal with and sort of you know, how do we change the training to accommodate these adverse symptoms, I would challenge and go actually, rather than again asking women to suck it up and just cope with them and deal with them and maybe make small changes, because, let's be honest, a lot of sports structures and programs and all of that, they're quite rigid, especially at the elite level, and there's not much bend and you can't just take three days off, you know, or not compete at the Olympic final, because it's not the right time for you, I think you know. Again, a positive way to look at it is if you face challenges, what can we do within sport and exercise, science and medicine to what can we do within sport and exercise, science and medicine to alleviate and to mitigate against those adverse symptoms? And that's where I would like to see us going. Oh, my God, I don't even remember the question.
Professor Kirsty Elliott :I was very excited about that, but I think I was saying about, you know, my legacy. What would be the legacy and what would success look like? Body literacy, understanding the positives, understanding that the challenges and there are, I'm not trying to hide that, I'm trying to re-redress the current narrative. But the challenges we face, how do we overcome them in a positive and acceptable and appropriate way? And I think if I could influence around menstrual cycles, hormonal contraception, menopause, as maybe some of the big hitters of those sort of ovarian hormone profiles that women will encounter throughout their lifetime, then that would be a job well done.
Sue Anstiss:There's a lovely part in the Abby Ward documentary made where she's at home filming herself when she's had the baby and talks about her body and her body changing, and it gives me goosebumps even now when I think back to it. But how this body was, you know, she was an athlete, it was an athlete's body, and then it's a body that's been built to house a baby and that and it's done an amazing job of doing that, and now she's kind of trying to change back to being an athlete. But it it's a really important part, isn't it this? What the remarkable, incredible things that female bodies can do and should be celebrated for that.
Professor Kirsty Elliott :Absolutely, you know, and it's hard, isn't it, when you're trying to drive change quickly. And you know we're asking the right questions now and I think we've moved away from, as I say, those shadows and those taboos. But I think we still have to be careful of of of the narratives and shaping them to be empowering and not to be limiting. You know, it would be awful that, now that we're talking about these things, that we accidentally end up weaponizing them and making women seem, seem less than, and so I think the challenge here is to raise awareness and then to be able to shape the systems within sports to accommodate for those things.
Professor Kirsty Elliott :And you know it's funny because you know I'm a researcher and you know, obviously traditionally from a university, but once, I think, particularly in the women's space, once you're working here, your job doesn't stop at the university door because you know you take with you into you know policy and into into you know policy, and into you know resources and, as I say, the free sanitary products and all of these things. And and I think it's really nice that we are able to have that, that domino effect and that you know it, it goes, it goes out and it comes back in and it's top down and bottom up and meeting in the middle. I think it's really important that, yeah, we're all pulling in the same direction Fabulous.
Sue Anstiss:You're a member of UEFA's research panel leading a pioneering project investigating the effect of menstrual cycle on footballers performance, so can you tell us a little bit more about that? And I also just, I guess, taking on to that, we talk a lot about ACL injuries and that's been very much of a news and that link of hormones. But I'm and I know I'm we've had this conversation before but kind of what your findings have been in in that area.
Professor Kirsty Elliott :Yeah, so, so really fortunate to to be working with an amazing team at UEFA. So they're driving many projects. They had their medical conference last week and a whole day dedicated to the women's game, which was was fantastic. So again, more trailblazers.
Professor Kirsty Elliott :So, yeah, I've been really fortunate to be part of the UEFA panel and we're working on a consensus statement. It's written to you know, land in elite women's in football, but actually they won't mind me saying this it would be useful to any sport really, and you know any organisation. So it's bringing together lots of different people from whether it's sports science, medicine, policymakers, you know, funders, and trying to write down what it not just how we look at menstrual cycles, so like physical measurements of menstrual cycles within football. But you know why are we looking at them? You know what's important, how do we measure them, who accesses that data, how that data is used. So it's actually a really sort of holistic wraparound and so so, as I say, we're working on this consensus. It's it's almost done and we took a really robust approach to that. So we we generated what we call statements and then we all voted on them. So it's really been quite a rigorous scientific process and then the idea is, of course, that this will go out, and we've done it with, again, a spectrum in mind of, we understand, in women's sports, and the same is true for women's football Some football clubs have a lot of money and some less so, and so, again, you don't want to come in with policies or recommendations that require, you know, a lot of money, resources, et cetera, et cetera. We want to be able to make sure that we can offer something to everybody across the women's game. So, yeah, so it's coming soon and hopefully will be really useful. Of course, the job is not done because, not least, we know that not all women have a menstrual cycle, so there are other, you know, guidelines to be made for those with menstrual dysfunction or, you know, during pregnancy, and so on and so on. So it's part of a wider agenda. So that's exciting. And then it'll be interesting to see how that's received, how the clubs deal with it, what the player feedback is, and so on. So that's interesting.
Professor Kirsty Elliott :And then you mentioned about ACL injuries and first and foremost, I'll say that, whilst I've been really fortunate again to be involved in quite a few studies relating to ACL injuries, I'm not a physiotherapist over medicine, so I don't have genuine expertise in the ACL itself. But where I always come in, know, come in, is, as you said, you know, there's been a lot of talk around whether or not estrogen is obviously one of the most prevalent and potent female hormones, whether or not that is one of the key contributors to a non-contact ACL injury. And here we could just go off and for the first time in this interview I'm actually going to be. I'm going to be concise. There's a dichotomy.
Professor Kirsty Elliott :Right now, the research evidence speaks to an increased risk of ACL injury associated with the peak in estrogen, and that is usually around the mid cycle. That's one sort of school of thought. Then, if you ask about the lived experiences, those firsthand experiences of whether they're football players or athletes who are other athletes, who who ACL injuries are prevalent for, they would say no, no, that that it's happening when you're menstruating and that's actually when estrogen is really low. So both cannot be true and you know so it's. It's really really interesting to look at that and say OK, in controlled laboratory settings it seems to be one school of thought and in the field, if you pardon my football pun, it seems to be at an entirely different time.
Professor Kirsty Elliott :What would I say I would say that, having worked with some football clubs who have had ACL injuries, unfortunately certainly their players have not sustained them in the same phase or all in the one phase being menstruation. So even that sort of what we're hearing, that more anecdotal or sort of applied data that didn't hold up in in some of the instances I've seen. And then, if I was to be really critical of the research evidence, there are many, many papers talking about that high estrogen risk. But the frustrating thing here is so you can find as many papers that about that high oestrogen risk. But the frustrating thing here is so you can find as many papers that say there isn't, and so all in the answer is we just don't know. And if you were to ask me my opinion based on theoretical you know what's the physiology here or the endocrinology here? I personally don't think that your oestrogen concentration is going to be the biggest predictor or your highest risk factor for an uncontacted ACL injury. But watch this space. Who knows what's going to come next?
Sue Anstiss:It's like we're looking for a silver bullet, aren't we? I think people want to find that thing because we want to find the solution and share that, and that's it isn't it, it's the quick fix or the quick solution or the quick answer.
Professor Kirsty Elliott :And again, where I have seen some really eloquent work and papers recently is around that gendered environment. And again, not my area of expertise but could share, I think, broadly what's really resonated with me in this space. And you know it's around looking at that whole environment. You know we understand that there's a higher risk right now in women than in men for these ACL injuries and of course you go, oh, that's a sex difference. What's the difference between sexes? Oh, ovarian hormones.
Professor Kirsty Elliott :But actually if you forgot about that, really zoomed in, approach and you zoomed out and went well, hang on a minute, if we looked at how we train women footballers and when did they start playing and what coaching did they have and facilities and so on and so on, I think there are answers there bigger, bigger influences there in that particular space and bigger challenges. But again, they're going to take money and long-term plans to to make it equitable. And I do again, if you were asking me to theorize and not now as a scientist and as a physiologist, but my best guess if the experience of boys and girls and men and women was more equitable, I think that risk factor for women would come down and wouldn't be far off the risk in men. But that's just a personal opinion yeah, no, it's fascinating, isn't it?
Sue Anstiss:and I I spoke to um laurie youngson on the podcast as well too, from ida boots. So there's the kind of piece around shoes and the grip and the playing surfaces and, as you say, so many different components. But it's fascinating and it'll be interesting if we can look back in 30 years, when things have equalized more in terms of training and the categories and protocols, to see where we are. We'll come back and listen, see if you're right, kirsty See you in another two decades.
Professor Kirsty Elliott :That'd be lovely.
Sue Anstiss:And in terms of other kind of major misconceptions around female athletes that exist in sport today. Are there other things that you, if you had a huge pool of funding, is there anything you'd really like to go and research?
Professor Kirsty Elliott :Yeah, I think one of the sort of biggest misconceptions right now is around menstrual cycle phase based training. We're hearing a lot around. You should train a specific way at a various phase and point of your menstrual cycle, and there isn't a body of high quality research evidence that supports that, and so obviously you can imagine the scientists are sort of behind the scenes wringing their hands saying how has this become a thing? Because where has it come from? What is it based on? And so we'd very much like for that to go away. And so if you had a blank check and you were giving me lots of money, I'd certainly be looking to undertake high my study. What I will stress and is super important is I will change my opinion. If that study then shows we should be doing face based training, I will absolutely change my opinion.
Professor Kirsty Elliott :So there's two points to this. One, it needs to go away right now because there's no evidence to support it. But two, we must always, as scientists, stay open to the possibility that if we were to get funding and independent labs again, we would love to see that replication of data from independent labs. You don't want to just see it once and go. Every woman should do this because this happened in one lab in 10 women. So I think if we did get the funding and we could do it and take a high quality approach, and we could do it in multi-centres and see about replication of data, then if there's still no evidence to support it, it really needs to go away.
Professor Kirsty Elliott :And if there is evidence, then of course we all need to change our narratives. I don't think it's worth the risk of doing it now, just on the off chance. There is because I think adopting this approach is again we talked about limiting women's capability. If you adopt this menstrual cycle phase-based approach right now, you're limiting your potential, because there are actually better training principles that women could do to accelerate their health, their performance and so on. So I would say stick with the good principles of training right now. Let us investigate this and we'll come straight back to you. Let you know one way or the other. But I don't think we should be chasing that down in real time now when there's no evidence to support it.
Sue Anstiss:Yeah, very interesting. You talk there about replicating studies and I know collaboration has been really important to you and at the Institute as well too. So I'm interested to explore that whether obviously we all want more funding in this space, but how much is it important to have that collaboration between different institutions and sports bodies?
Professor Kirsty Elliott :I am a huge fan of collaboration. I think we're better together. You know, I do think there's strength in numbers all the cliches that you can think of, I mean. Of course, you have to find good partners who've got a similar sort of ethos. Don't get me wrong. I don't think we should collaborate in an echo chamber. I welcome collaboration that is challenging. I love a good check and challenge. So I think diversity of mindset is really important, but I think we need to have a common set of standards and goals and morals. And so, no, I'm a big fan of collaboration, and collaboration either on sort of projects where we're sort of data collecting and that sort of thing, but also collaboration in terms of developing and building a trusted network, whilst I, you know, think our centre of excellence is brilliant.
Professor Kirsty Elliott :Of course, I'm going to say that I'm biased and you know we're very, as I say, fortunate to work with UKSI and all the staff and expertise that brings in. You know we're a big group and we've got lots of cool, good stuff happening, but we can't do it all and we don't know everything. I'm going to give you one specific example. I hope it's okay and name check In our center, we don't do anything around breast health or bras, and we know that our colleagues, our lovely colleagues at University of Portsmouth, are experts.
Professor Kirsty Elliott :You see you're nodding, you knew what I was going to say. So therefore, you know, part of for us at the center is about building that trusted network and if somebody happens to land in with us they've heard about us and they ask and they want whatever, I am absolutely signposting them. That is true collaboration. To say no, we don't do that, but our colleagues at University of Portsmouth do that brilliantly and let us connect you. So you know, collaboration can look different, you know, depending on the setting, but I do think it's so important and again, if we're truly to accelerate and amplify the development of women's sport, we cannot do that in silos. Excellent.
Sue Anstiss:I mentioned in the introduction, didn't I, that you've been involved with designing pregnancy exercise interventions for many, many years. So I'm interested in where you've seen the biggest changes in kind of attitudes and approach to women exercising in pregnancy. And I know you. You have worked with different populations too, so any advice that you might share today for active women. Uh, you know exercising during pregnancy and how that's changed, I feel even in my own lifetime lifetime, but you know, in the last 20 so years or so that's really changed yeah, absolutely no.
Professor Kirsty Elliott :There's been a huge change recently, and you know I would probably start my answer the same way as you did. I was thinking about, you know, when I had my boys, and my boys are 17 now and it's very, very different landscape. And again, I guess my own experience and and it's that duality that you're just talking about earlier is, you know, there was a version of me as an athlete, then as a researcher in sports science and then as a pregnant woman and all those sort of mindsets coexisting, going. What should I do? 17 years ago, the attitude was sit down and put your feet up like don't move, and so, um, you know, and there was no advice on anything right through from acceptable weight gain, you know what was a healthy weight gain, you know that weight management afterwards, you know what should you lose and how should you lose that, how do you stay active during pregnancy, all those things. So actually there was nothing, and so couple that with my, I guess, researcher career, which is slightly longer than my motherhood. I think the change has been rapid and quite recently, and so now I think there's been a real change in mindset that women who were active before they became pregnancy shouldn't be told to go home and sit down because they're pregnant, and I think that's a huge leap. You know, I see the research coming out of Canada as being world leading, with Margie Davenport Individually. Margie is a great researcher based out of Canada and is obviously shaping the field worldwide. But equally, canada as a country have put out some great resources to their athletes, you know, before most other countries. So, no, it's great to see that change of mindset around.
Professor Kirsty Elliott :If you're active beforehand, then we're going to try and find solutions to keep you active, you know, during your pregnancy, and then again to look at and interrogate more what the return to sport is. And so again, that idea of please, you know, sit down for six weeks after you've had a baby. You know, realistically, what does that look like. And of course, there are exceptions to every rule. We're not being flippant or glib. There will be contraindications, there will be people who absolutely need to and must sit down and put their feet up, but in the main, I think we've got to swap, you know, the exception and the rule type balance. I'm really glad to see that shift in. You know, those who are active continue to be active at quite a high level and those boundaries are being pushed all the time, but in the right settings. Settings and maybe those who are inactive starting some activity during pregnancy. So they're the two biggest things but, yeah, they're big strides and I think that's really exciting.
Professor Kirsty Elliott :And, of course, the number of at the elite level sports women having babies during their career yes, please, more of that. That that's fantastic. And you know we're really fortunate to work with faith pro around pre, during and post pregnancy sort of guidelines, um, across the football community, and part of that work was the athlete voice and to hear from these women you know, who've had children during their careers and have come back. Yes, more of that. And you know we talk about research and labs and all of that sort of thing. That's research, hearing from the women, from their experiences. You know we talk about research and labs and all of that sort of thing. That's research, hearing from the women, from their experiences. You know that's really important research and making sure their voices are heard and those things are actioned and those changes are made is so important.
Sue Anstiss:You've clearly had an extraordinary career within the world of sports science, but I wonder how would you encourage more young women looking for those careers today coming into sports science?
Professor Kirsty Elliott :oh, that's a big question and I feel it's a really important one. Um, go for it, you know, absolutely go for it. Find your people, make the connections, find your people and I don't know if this is a good way to describe it, but elbows out, you know. Stand in this space and take up the space and and and recognize and advocate for yourself and and your career in your space within, within sports science, but if that work is also around, you know, developing women's sport, yeah, elbows out, go for it. I think now, gosh, I hope, I hope there are less barriers, I hope some of those you know barriers have been broken down. But I just think, hold your ground, find your people and be visible.
Sue Anstiss:Yeah, be visible it does feel like it's a positive time. I meet amazing young women at universities and it does feel in terms of PhDs I'm constantly hearing about PhDs, and not just on the physiology and the sports science side, but in all areas of women's sport and researching that equality piece it does feel like it's not a good time to be in in science, but that does feel like it's the case it is, there are undoubtedly more opportunities.
Professor Kirsty Elliott :So, yeah, I think, embrace them, but it comes with some responsibility as well and be ready for that responsibility.
Professor Kirsty Elliott :Still now, we don't tend to embed a lot of content within our sport and exercise science degrees on women's physiology or these key anatomical or physiological or sociological or psychological female specific considerations, and so what I would say is, you know, find your people, find your space, take the space, but that comes with responsibility and it is probably going to involve some upskilling. And you know, I think certainly my PhD students have found that, you know, they're prepared in some aspects for their PhD journey, but, you know, the first six months or so they are going back to textbooks for their physiology and endocrinology and maybe that was a little unexpected to them. So there's going to be, I think, some upskilling because it's not yet, you know, really embedded in our sort of, you know, degree and master's training, and so, yeah, it is extra work, but, as I say, of course, of course this goes without saying it's so worth it. And you know, I think you know, we need more people with expertise and experience in that. So, yeah, please come in, fill a space, level up and keep going.
Sue Anstiss:And finally, kirsty, if there was one key message that you'd hope people might, take away from the big body of work that you've done.
Professor Kirsty Elliott :What would that be? It would be that women's physiology is different from men's physiology. That's the obvious. But those differences are interesting and they shouldn't be avoided. They shouldn't be avoided, they shouldn't be written off as too complicated or too time consuming. It's interesting and it's impactful and it's so worthy. That would be it. It would be. Come into this space and embrace it. This is a great area to work in and don't be distracted by the challenges. Every area of science, every area of life so know this comes with its own challenges. So I think, come in and embrace it, dive in with both feet and I think that people will find it a really interesting area. And, sticking up onto the other question that you asked me, in a really interesting career.
Sue Anstiss:Thank you so much to Kirsty for such a fascinating conversation. If you'd like to hear from more trailblazers, there are over 200 episodes of the Game Changers that are free to listen to on all podcast platforms or from our website at fearlesswomencouk. Along with leading sports scientists and academics like Kirsty, other guests have included elite athletes, coaches, entrepreneurs, broadcasters, journalists and CEOs all women who are changing the game in sport. As well as listening to all the podcasts on our website, you can also find out more about the Women's Sport Collective, a free, inclusive community for all women working in sport. We now have over 10,000 members across the world, so please do come and join us.
Sue Anstiss:The whole of my book Game On the Unstoppable Rise of Women's Sport is also free to listen to on the podcast. Every episode of series 13 is me reading a chapter of the book. Thank you once again to Sport England for backing the Game Changers and the Women's Sport Collective with a National Lottery Award, and to Sam Walker at what Goes On Media, who does such a fantastic job as our executive producer. Thank you also to my lovely colleague at Fearless Women, kate Hannan. To my lovely colleague at Fearless Women, kate Hannan. You can find the Game Changers on all podcast platforms, so please do follow us now to make sure you don't miss out on future episodes. Do come and say hello on social media or you'll find me on LinkedIn and Instagram at Sue Anstis the Game Changers fearless women in sport.
