Background There is a gap in understanding how to use wellbeing and load measures in football, particularly in women.

Objective To describe the association of wellbeing and session-rating of perceived exertion (sRPE) with injury risk.

Design Prospective cohort study.

Setting Elite football team from the Spanish first division.

Participants 28 elite female players were followed during the 2017–2018 and 2018–2019 seasons.

Assessment of Risk Factors Fatigue, sleep quality, muscle soreness, stress and mood (questionnaire from 1-worst to 5-best), exposure time in training and matches, RPE (0–10) and injuries were daily recorded. Daily and 7-day rolling z-scores were calculated for wellbeing items; and rolling 7 and 28-day sums, uncoupled 7 to 28-day ratios and week-to-week changes for sRPE [time x RPE in arbitrary units (au)]. In addition, the median sRPE of each session was estimated to account for the load of sessions where injuries occurred.

Main Outcome Measurements The association of wellbeing and sRPE variables with non-contact injuries requiring 4 or more days of absence occurring on a given session was investigated using linear mixed models.

Results The probability of injury was higher in matches (1.36%) than in training (0.44%, p=0.001). In training, sessions with high median sRPE (>525 au, 0.87 vs. the rest 0.35%), high 7-day loads (>2095 au, 0.76 vs. 0.31%), low 28-day loads (<5020 au, 0.71 vs. 0.32%) and worse than usual (<-1 z-score) 7-day fatigue (0.82 vs. 0.35%) and muscle soreness (1.19 vs. 0.28%) were associated with higher injury risk (p<0.05). Moreover, pre-match worse than usual daily sleep quality (3.03 vs. 0.85%), stress (4.55 vs. 0.92%) and mood (2.74 vs. 0.95%) showed higher injury probabilities (p<0.05). Interactions between wellbeing and sRPE were also observed.

Conclusions This information in combination with other relevant factors and expert knowledge can be helpful to guide player monitoring and decision making.