Tug-of-war (TOW) is an internationally played activity including professional and amateur athletes and defined as early (4000 years ago as a rope less version) in the artwork on Egyptian tomb engravings and is played as per the rules laid out by TWIF, which has 73 member countries and administrative headquarters in the USA. Typically, two teams of “pullers” participate and apply enormous contra directional forces on the pulling rope. Originally, two types of competition are used: knockout and points. This narrative review describes the scientific state of the art about of TOW. For the best of the author’s knowledge no previous information has been published.