Influence of selected cognitive performances on musculoskeletal injury occurrence in adult male professional Slovenian PrvaLiga football players in a prospective cohort study

Evidence suggests athletes with lower baseline cognitive performance are at higher risk of musculoskeletal injuries. This prospective cohort study investigates basic and executive cognitive functions in predicting injuries in 78 professional male football (soccer) players from four Slovenian first league teams. Data were collected during the 2018/2019 winter break, and injuries recorded in the second half of that and the 2019/2020 season. Cognitive functions assessed by computerized tests (PsyToolkit) included psychomotor vigilance (simple, choice reaction time) and visuospatial memory (Corsi-block-tapping-test), while pen-and-paper tests assessed motor speed, visual scanning, and executive functions (TMT; Delis-Kaplan-Executive-Function-System). Forty-two players sustained at least one musculoskeletal injury (9 contact injuries), 36 remained injury-free. Logistic regression analyses indicated that none of the cognitive measures significantly influenced injury occurrence (p > 0.05). However, non-significant trends were observed for the TMT ratio score (p = 0.065, OR = 1.64), reflecting cognitive flexibility, and for TMT-A (p = 0.05, OR = 0.60), reflecting visual scanning. Specifically, players with lower cognitive flexibility showed a 64% increase in the odds of sustaining an injury, while better visual scanning performance was associated with a 40% reduction in injury odds. No significant association was found between basic or executive cognitive functions and musculoskeletal injuries in professional male football players. However, a non-significant trend suggested that lower cognitive flexibility may be associated with increased injury risk. These findings underscore the need for larger studies to better clarify the role of executive functions in assessing injury risk in football.