Tug-of-war (TOW) is an internationally played activity including professional and amateur athletes, defined as early as 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 of TOW. To the best of the authors’ knowledge, no previous information has been published on this topic. Anthropometric parameters for competitors are near 83.6, lean body mass 69.4, and body fat 16. The VO2MAX is 55.8 mL/kg/min. In terms of relative strength, the dynamic leg power is 4659.8 N. Endurance TOW elicits minimal muscle damage. Injured strains and sprains comprised over half of all injuries: back (42%), shoulder–upper limb (23%) and knee (17%). Pulling movement in TOW contests can be divided into three phases, namely the “drop”, “hold” and “drive” phases. The maximal pulling force was 1041.6 ± 123.9 N. The percentage of dynamic pulling force in the static maximal pulling force was 75.5 ± 14.4% and the dynamic ranged from 106.4 to 182.5%. There are two gripping styles: indoor and outdoor. The friction characteristics between surface and shoe in TOW is important in determining a suitable shoe for indoor TOW. A waist belt might be a useful piece of equipment for TOW sport. The EMG technique in TOW entails a high degree of dorsal muscle activity during the pulling. The factor of force vanishing was the coordination among athletes. The force vanishing percentage goes from 8.82 ± 5.59 for two contenders to 19.74 ± 2.22 for eight athletes, 6.4% in the sum of two pullers. However, in the drop phase, for female elite TOW team, only the 0.5% of the pulling force was wasted. Future studies are need in order to understand better this historical sport activity.