OBJECTIVE:Risk management in sports aims to minimise injury and illness risks while optimising athlete performance through systematic identification, assessment and mitigation strategies. Existing frameworks offer theoretical guidance, but practical tools for consistent implementation are not available. Our objective was to develop, identify and evaluate the implementation feasibility of a practical tool for identifying, prioritising and mitigating injury and illness risk in male professional football clubs in Qatar. METHODS:All 18 professional clubs in Qatar participated in a league workshop introducing the risk management plan (RMP) tool before the 2022-2023 season. Teams then engaged in structured risk assessment workshops involving medical and technical staff, identifying risks categorised as team, player or season related. Risk priority was determined using a standardised scoring system, and tasks were allocated among the responsible parties to reduce risk. RESULTS:All 18 clubs implemented the newly introduced RMP tool. A total of 809 risks were identified across all teams (45 risks per team), with player-related risks accounting for the majority (72%). Teams prioritised 265 (33%) of the identified risks for mitigation, with individualised training programmes, communication strategies and load management being the most frequently planned interventions. Task implementation involved a collaborative approach to risk mitigation, including 58 individuals (4.2±2.1 per team) across medical and technical roles. CONCLUSION:The Aspetar RMP tool was adopted by all Qatar's clubs, facilitating a structured approach to injury and illness risk identification and management. Identifying risk profiles and planning mitigation tasks reflected a mix of player-specific and team-level actions, and a collaborative approach involving both medical and technical staff.

Returning to a high level of performance after injury is a significant challenge for athletes. However, current best practices for return-to-performance in competitive snow sports are not well understood due to a lack of research evidence and international harmonisation. The International Ski and Snowboard Federation commissioned this consensus statement to provide recommendations for the safe and successful return of competitive alpine and freestyle skiers and snowboarders to competitive performance. An international consensus panel was formed to contribute their knowledge and perspectives on return-to-performance. The panel included experts with extensive experience in return-to-performance. The panel consisted of 23 experts (7 women and 16 men) from various skiing and snowboarding disciplines and levels of competition. It included 16 researchers, 6 snow sports or International Olympic Committee officials, 9 physicians, 6 physical therapists, 2 sports psychologists, 2 coaches and 2 former athletes, some of whom had two backgrounds/functions. However, it was disproportionately European (78%) and North American (13%), with minimal representation from South America (4%) and Africa (4%) and no representation from Asia or Australasia. The RAND-UCLA Appropriateness Method was adopted for the underlying consensus process. First, the panel discussed which topics and questions should be included in the consensus statement before developing an overall structure. The consensus process then involved providing key content based on the literature or statements from experts/panel members. These were voted on three times by all the panel members, resulting in a list of 196 statements. The jointly developed overall structure and the final statement list then formed the basis for preparing the manuscript. This consensus statement aims to assist athletes, coaches and medical staff of international and national federations in planning and implementing safe and successful return-to-performance strategies for competitive alpine and freestyle skiers and snowboarders.

OBJECTIVES:Prep to be PRO is a comprehensive, module-based educational program for young athletes attending sport high schools, focusing on injury and illness prevention, long-term development, and health literacy, delivered by the school's coaching and teaching staff. Guided by the TRIPP and RE-AIM frameworks, this study aimed to evaluate the final development phase. We explored early coach and athlete experiences and examined the implementation process using Durlak and DuPre's eight dimensions of implementation quality to identify factors that may facilitate or hinder future integration of the program into routine practice. DESIGN:Mixed-methods case study. METHODS:Data were collected from school administrator and coach workshop evaluations, athlete feedback following an instructional session, and observational field notes generated through researcher participation. Quantitative and qualitative analyses were combined, with qualitative data first analyzed thematically and then interpreted through RE-AIM and Durlak and DuPre's framework to identify relevant factors. RESULTS:In total, evaluations were collected from 174 school administrators and coaches and 986 athletes. Key factors that facilitated program uptake included the perceived relevance of the content, robust training support, engaged leadership, and structured mechanisms for feedback and fidelity monitoring. The primary challenges were limited time and resources, variability in coach readiness, tensions between program standardization and local adaptation, and competing institutional priorities. Together, these factors shaped initial adoption and highlighted the need for purposeful infrastructural support to sustain the program over time. CONCLUSIONS:Effective scaling depends on strengthening the implementation infrastructure, especially by boosting coach support, clarifying roles, and striking the right balance between fidelity and flexibility yet preserving the program's core elements.

Importance:Repetitive head impacts (RHIs) are associated with later-life neurodegeneration. Because soccer is the most widely played sport among youth worldwide, identifying early changes associated with RHI is important. Objective:To determine whether participation in 1 season of youth soccer is associated with changes in cognition, behavior, balance, brain structure or function, or blood biomarkers compared with noncontact sports. Design, Setting, and Participants:Prospective longitudinal cohort study at European centers (Munich, Germany; Leuven, Belgium; and Oslo, Norway). Male adolescent soccer players and noncontact athletes were each studied across a single competitive season with assessments at preseason, postseason, and 2 months later. Data were analyzed from January 2023 to March 2025. Exposures:Soccer players were compared with noncontact athletes. In addition, self-reported heading of a soccer ball was assessed among soccer players as a measure of RHI. Main Outcomes and Measures:Cognition, behavior, balance, magnetic resonance imaging (brain structure, function, and biochemistry), and plasma biomarkers. Results:Male adolescent soccer players (n = 82; mean [SD] age, 14.8 [0.6] years) did not differ from noncontact sport athletes (n = 47; mean [SD] age, 14.7 [0.7] years) in cognition, behavior, balance, cortical thickness, brain volumes, white-matter microstructure, or functional connectivity. At preseason, soccer players had higher total N-acetylaspartate (tNAA; β, -0.379 [95% CI, -0.627 to -0.131]; P = .003), glial fibrillary acidic protein (GFAP; β, -0.055 [95% CI, -0.103 to -0.006]; P = .03), and neurofilament light chain (NfL; β, -0.071 [95% CI, -0.122 to -0.020]; P = .01) than noncontact sport controls. Across the season, tNAA (β, 0.047 [95% CI, 0.020-0.074]; P = .001) declined in soccer players and increased in controls, converging by postseason. Group trajectories of GFAP and NfL did not differ between groups. Within soccer players, heading exposure was not significantly associated with changes in any outcome. Conclusions and Relevance:In this cohort study of adolescent males, no statistically significant differences were detected over 1 season between soccer players and noncontact sport athletes in cognition, behavior, or brain structure and function. Group differences in GFAP and NfL may represent early signs of exposure, but lack of association with heading exposure warrants further investigation. These results highlight the need for large, multiyear studies to inform health policy.

OBJECTIVES:To examine the development, stakeholder involvement, and implementation of risk management plans in professional football clubs in Qatar during the 2022-2023 season, with a focus on creation, team awareness, and completion of mitigation tasks. DESIGN:Observational study. METHODS:All 18 professional football clubs were invited to participate. Data were collected during face-to-face meetings with each team's representatives using a standardized questionnaire addressing stakeholder involvement, awareness of the risk management plan within the team, task assignment, and implementation. A total of 324 mitigation tasks were reviewed. Implementation was rated using a six-point Likert scale. RESULTS:Sixteen clubs participated in the study. Across the clubs, 331 risk management plan tasks were identified, of which 324 were evaluated for implementation. RMP development was primarily undertaken by team doctors, physiotherapists, and fitness coaches, with no involvement from managers or players. Implementation levels were highest when tasks were assigned to medical staff or mixed groups that included at least one medical team member. Team-related tasks had higher implementation levels than season-related tasks (p = 0.024), while risk priority did not had an affect on the implementation levels. CONCLUSIONS:In professional football clubs, the presence of medical personnel among the responsible staff was a key determinant of the higher implementation rates for mitigation tasks. Neither the risk category nor the stated priority level predicted implementation. These findings provide empirical insight into how structured risk management is operationalized in elite football and underscore the central role of medical and fitness staff in executing injury and illness prevention.

The absence of agreed methods to diagnose Achilles tendinopathy impedes research and clinical practice. This gap results in heterogeneous and/or poorly described study samples, making it challenging to apply findings in clinical practice. The aim of this Delphi study was to define consensus on (1) diagnostic domains; (2) differential diagnoses; and (3) conditions requiring further medical attention, when assessing for Achilles tendinopathy.We conducted a sequential three-stage process which included: (1) identifying diagnostic domains, differential diagnoses and conditions requiring further medical attention based on existing scoping reviews and clinical practice guidelines; (2) developing Delphi survey questions; and (3) administering a five-round Delphi online survey. Consensus was defined as ≥70% agreement.52 participants completed the surveys. Four diagnostic domains were deemed essential and reached consensus (pain location (93%); pain during activity (97%); tests that provoke pain (87%); palpation to assess pain (83%)). 15 differential diagnoses reached consensus: 2 for both midportion and insertional (partial tear (80%); posterior ankle impingement (78%)), 6 for midportion (plantaris tendinopathy (84%); tibialis posterior or flexor hallucis longus tendinopathy/tenosynovitis (72%); flexor digitorum longus tendinopathy (77%); accessory soleus muscle (74%); paratendinopathy (86%); sural nerve neuropathy (81%)) and 7 for insertional (superficial (88%) and retrocalcaneal bursitis (86%); Haglund's/calcaneal exostosis (80%), intratendinous calcifications (73%); Sever's disease (78%); calcaneal stress reaction/fracture (80%); subtalar/ankle pain (71%)). Six conditions requiring further medical attention reached consensus: (Achilles tendon rupture (83%); systemic inflammatory joint disease (86%); metabolic syndrome (75%); familial hypercholesterolaemia (77%); endocrine and hormonal disorders (80%); drug reactions (77%)).This consensus identified essential diagnostic domains, differential diagnoses and conditions requiring further medical attention that should be considered when assessing for Achilles tendinopathy.

OBJECTIVE:To describe the proposed biomedical effect mechanisms in research on exercise-based injury prevention programmes in football (soccer) and handball. DESIGN:Scoping review of randomised controlled trials (RCT), cohort studies and case studies. DATA SOURCES:MEDLINE via PubMed, SPORTDiscus and Web of Science databases were searched from 2000 to 2024. ELIGIBILITY CRITERIA:Studies were included if they described exercise-based injury prevention programmes in football (soccer) or handball and provided a biomedical rationale or proposition of effect mechanisms. Peer-reviewed studies of all ages and both sexes at elite, subelite or amateur level were eligible. RESULTS:We included 104 studies (78 RCTs, 25 cohort studies, 1 case study) with sample sizes ranging from 10 to 4556 participants. Most studies (83%) were published after 2010, and interventions were reported to have an effect in 82% of the studies. Four main themes emerged describing the proposed effect mechanisms: neuromuscular control (47%), strength (39%), range of motion (11%) and physical fitness (3%). Definitions of key terms related to the intervention were provided in only 19% of studies, measurements of specific biomedical effect mechanisms were conducted in just 59% of studies. CONCLUSION:Neuromuscular control and strength were the predominant proposed effect mechanisms for injury prevention programmes in football and handball. To better establish effect mechanisms of exercise-based interventions, future research should consistently define key terms related to the interventions and strive to identify and test causal mechanisms to optimise injury prevention programmes.

Sports injury surveillance programs have been vital in advancing the understanding of injury epidemiology across various athlete populations. Surveillance-based epidemiological measures of injury occurrence are ubiquitous in the sports medicine literature, and the injury rate is one such commonly used measure. Traditional approaches to calculating injury rates have predominantly relied on frequentist methods, which, while informative, have limitations in addressing certain practical questions. We explore an alternative Bayesian framework for analyzing injury rates, highlighting its potential to enhance sports medicine practice. We delineate the practical implications of adopting a Bayesian approach, contrasting key analytical outputs such as credible intervals with their frequentist counterparts. Through simulated and real-world examples, we demonstrate the types of analyses and inferences that are only possible within this framework. We particularly discuss how Bayesian methods allow for direct calculation of probabilities for specific outcomes and provide intuitive interpretations of uncertainty. We discuss the computational and inferential advantages of the Bayesian approach, illustrating how it can offer more nuanced insights into injury incidence in sport injury epidemiology.

Background:Out-of-hospital cardiac arrest (OHCA) in the young is a tragic event. Regular exercise reduces cardiovascular disease (CVD) risk but, at certain intensities and volumes, is associated with increased OHCA risk. Understanding symptoms, risk factors and aetiology is central for primary prevention. Objective:Assess symptoms and risk factors related to OHCA aetiology in young Norwegians, and the role of exercise volume. Method:We obtained data from the Norwegian Cardiac Arrest Registry (2015-2017), medical records, autopsy reports and questionnaires. Inclusion criteria were ages 12-49 years and OHCA of presumed cardiac aetiology. Results:Data from 134 individuals (81 survivors, 53 deceased) showed that CVD symptoms were present during both rest/everyday activity and exercise in most victims, and were reported by more survivors than by next-of-kin of the deceased (78% vs 60%). Only 12% had symptoms just during exercise. Ischaemic heart disease was the leading cause (58% in males vs 38% in females), followed by structural, non-ischaemic heart disease. Sudden unexpected death syndrome (SUDS) was most common in individuals aged ≤35 years. Risk factors were present in 74%, with family history for CVD most prevalent (51%) and overweight in at least 33%. There were no significant differences in symptoms, risk factors or OHCA aetiology related to exercise volume prior to OHCA. Conclusion:Symptoms and CVD risk factors were prevalent in young Norwegians suffering OHCA regardless of exercise volume. Ischaemic heart disease was the leading cause of OHCA. We suggest evaluating symptoms carefully and addressing risk factors to prevent OHCA in young Norwegians regardless of exercise habits.

Prospectively collected injury surveillance data are essential for designing and implementing injury prevention programmes. We investigated the incidence, characteristics and patterns of professional football injuries in Qatar, providing details on the most observed injuries' burden. We prospectively recorded individual time-loss injuries and training/match exposure from 17 professional football teams in Qatar during 8 seasons (2014/15 to 2021/22). Injury definitions and data collection procedures followed the 2006 consensus statement and results reported according to the 2020 IOC consensus statement on football injuries and methodology of epidemiological studies on injuries, respectively. In total, 1466 players with 4789 registered injuries were followed. The overall injury burden was 129 [95% CI: 128-130] days/1000 h. Over the 8 seasons there was a significant decreasing trend in the incidence of gradual onset injuries (p = 0.0012) and a non-significant decreasing trend for suddenonset match injuries (p = 0.063). The injury burden for match injuries was greater than the burden resulting from training injuries (460 [95% CI: 460-460] vs 56 [95% CI: 55-57] days/1000 h, p < 0.0001). There was no difference in time loss between index and recurrent injuries. Hamstring muscle strain represented the most frequent injury with a median of 11 (inter-quartile 5-20) days to return to play (RTP). ACL complete tear was the most impactful injury, in term of return to play, with a median of 200 (116-253) days to RTP. Re-injuries constituted 10.8% (4.7% of exacerbations). Mean illness incidence was 1.1 (SD = 0.4) illness/1000 hours, representing 5 illnesses per squad per season, with no variation over time. Qatari professional football is characterized by an overall injury pattern and risk similar to Asian and European norms. There was a significant decreasing trend in the incidence of gradual onset injuries and a non-significant decreasing trend for sudden-onset match injuries.

Women's premier league footballers have a high risk of injury. Risk management has been proposed as a framework for improving athlete health, through describing, assessing, and addressing potential risks. This article aim to describe the risks and risk factors for injury and illness that stakeholders in women's football perceive as important, their priorities and how they plan to address them. All key stakeholders in the 11 teams playing in the Norwegian women's premier league participated. They created a tailored risk management plan targeting the 2024 season, describing potential risks for injury and illness and their risk factors, as well as seasonal risks related to their training and match calendar. The risks were assessed individually, and a plan with preventive measures was created to address the prioritized risks. The teams identified 104 risks (49% team, 51% seasonal). Most risks were categorized as Training & match load (42) and Musculoskeletal (42). For these, 248 risk factors were identified; most were categorized as Training & match load (66), Staff & player-related (55), Social/behavioral (52) and Equipment & facilities (47). Of the 104 risks, 61 were prioritized, and 231 preventive measures were planned to address them. The physiotherapist was responsible for 55% of these measures, while the remaining 45% were assigned to other team stakeholders. This study highlights the diversity of risks, risk factors, and planned preventive measures for injury and illness in Norwegian elite women's football. Addressing these issues requires a broad focus beyond physical factors and adopting a holistic approach involving all relevant team representatives.

In diverse sports, warm-up (WUP) and cool-down (CD) activities are highly effective at improving performance-relevant factors and reducing the risk of injury when applied systematically; however, scientific evidence is widely lacking in snow sports. Similarly, there is a lack of international harmonisation with current best practices; this especially applies to prevention efforts targeting younger athletes. This International Ski and Snowboard Federation (FIS) consensus statement aims to develop and promote recommendations regarding physical and psychological WUP&CD in competitive alpine and freestyle skiers and snowboarders. The selected panel members represented a group of experts diverse in terms of gender, expertise/background, level of competition and skiing and snowboarding discipline. They included researchers, officials, physicians, physiotherapists, coaches or former athletes with extensive experience in the subject area. However, there was a gender imbalance in the composition of the panel (7 women and 13 men) and certain freestyle disciplines (eg, aerials and moguls) were under-represented. Most importantly, there was a strong over-representation of European members (85%) on the consensus panel. For the consensus process, the RAND-UCLA Appropriateness Method was used. The panellists were asked to rate, discuss and rerate statements derived from the literature or expert/panellist opinions. The process was based on three online consensus sessions with different preparatory and follow-up tasks and three rounds of an online survey to vote on the statements. The final version of the FIS consensus statement was developed and approved after two iterative rounds of manuscript revision by the panel members. It is intended to guide athletes, coaches, medical staff of international and national federations and other entities who can promote and support appropriate WUP&CD practices for competitive alpine and freestyle skiers and snowboarders by providing support, resources or infrastructure.

Little is known about early tendinopathy in elite athletes. This study aimed to investigate changes in clinical and ultrasonography outcomes over 1 year and assess the prognostic values of these outcomes at baseline with respect to tendinopathy progression. Sixty-two elite athletes (24 ± 5 years) with early phase (symptom duration < three months) Achilles or patellar tendinopathy (AT and PT) were examined at baseline and after one year. Pain-guided activity modification was the only intervention. Clinical outcomes were assessed using Victorian Institute of Sports Assessment questionnaires (VISA) for function and symptoms, pain scores (1-10 numerical rating scale (NRS)) and ultrasound tendon morphology (thickness, echogenicity and power Doppler (PD) flow area). A linear mixed-effects model analysed changes from baseline to 1 year. Athletes showed clinical improvements in VISA-Achilles (baseline: 66 ± 5 vs. one-year: 87 ± 2, 95% CI: 13-30, p < 0.0001 and effect size d = 3.8), VISA-Patella (baseline: 69 ± 3 vs. one-year: 86 ± 1, 95% CI: 10-26, p < 0.0001 and effect size d = 3.6) scores and most NRS pain scores (≥ 2 points). Tendinopathic Achilles tendons' peritendinous thickness was reduced (-0.79 mm, p = 0.0188 and effect size d = 0.5), whereas patellar tendons remained enlarged. For both AT and PT, lower baseline PD was associated with a greater reduction in thickness over time (p < 0.001) and higher baseline VISA scores were linked to greater increases in echo intensity over time (p = 0.0363). In conclusion, elite athletes with early phase AT and PT showed clinical improvement over 1 year, with morphological changes in tendinopathic Achilles tendons only. Lower baseline PD and better initial VISA scores represent a better prognosis for tendinopathy morphology and symptoms.

To enhance performance, increase resilience and prevent injuries, training and testing (T&T) are the most important strategies for preparing athletes for the demands of their sport. However, for competitive snow sports such as alpine skiing, freestyle skiing and snowboarding, there is little evidence and a lack of international harmonisation of current best practices. This consensus statement, commissioned by the International Ski and Snowboard Federation (FIS), aims to provide recommendations for the physical and psychological T&T of competitive alpine and freestyle skiers and snowboarders within National Ski and Snowboard Associations. A diverse international consensus panel was selected to represent the subject matter regarding gender, nationality, expertise/background, level of competition and skiing and snowboarding discipline. Researchers, officials, physicians, physiotherapists, coaches and former athletes with extensive experience in the field were among the experts. However, the panel had a limited gender balance (seven women and 13 men) and was over-represented by European members (65%) and North American members (20%), whereas there was limited representation of perspectives from South American (5%), Australasian (5%) and African (5%) experts and a lack of experts from Asia. In the first step, the panel established an overarching structure of topics and questions to be addressed by the consensus statement. Following the RAND-UCLA appropriateness method, the consensus process subsequently included panellist ratings, discussions and revisions informed by statements derived from the literature or expert/panellist opinions. These two outcomes served as the basis for manuscript writing, which was finalised through two iterative rounds of manuscript feedback and revision. This consensus statement aims to help athletes, coaches and medical staff of international and national federations plan and implement effective T&T activities for competitive alpine and freestyle skiers and snowboarders.

Objective Most studies examining the time to return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) do not account for the athlete’s physical readiness. This study aimed to investigate the status of male athletes at 2 years after ACLR, the factors affecting a return to pivoting sports, and the association between time to RTS and subsequent knee injury risk for those athletes who met discharge criteria. Methods We prospectively followed 530 male athletes (mean age 26.7±7.7 years) participating in pivoting sports throughout rehabilitation and at 2 years after ACLR. Pair-wise analyses were conducted to compare athletes who returned to pivoting sports and those who did not. We performed a Cox regression analysis to assess the association between subsequent non-contact or indirect contact knee injuries and time to RTS. Pearson’s χ 2 test was used to compare athletes who RTS in ≤9 months to those who RTS in >9 months after ACLR. Results In total, 379 (72%) athletes returned to pivoting sports at 2 years after ACLR. Athletes who completed rehabilitation and met discharge criteria (n=190) were almost 6 times more likely to return to their preinjury sport (OR 5.71; 95% CI 3.39 to 9.62). Of those who did not complete their rehabilitation (n=340), 132 (39%) did not return to pivoting sports. For athletes who met discharge criteria, time to RTS was not associated with the risk of new knee or ACL injury. There was no increased risk for new knee (HR 0.892, 95% CI 0.39 to 2.07, p=0.79) or ACL (HR 0.718, 95% CI 0.24 to 2.17, p=0.56) injury whether athletes returned before or after the 9-month mark following ACLR. Conclusions Completing rehabilitation and meeting objective criteria significantly increased the odds for male athletes to return to pivoting sports. Time to RTS did not impact the risk for a new knee or ACL injury if athletes met objective criteria.

Background The Aspetar Sports Injury and Illness Prevention Programme introduced the Aspetar IP2 NetWork, a customizable injury prevention programme for professional football clubs in Qatar during the 2020/2021 season. It includes 23 focus areas selected by stakeholders to prevent sports-related health issues.Objective To assess the real world implementation of the IP2 NetWork preventive focus areas during the first season after introduction, focusing on team adoption and player compliance.Methods A survey was conducted among team physicians, physiotherapists and fitness coaches from the 18 professional football clubs in Qatar. The survey examined the implementation of the IP2 NetWork focus areas and the roles of the different professionals in managing these areas.Results 17 out of 18 clubs reported using IP2 focus areas, applying an average of 11.4 areas (range 4-21). The most commonly used strategies were the Nordic hamstring exercise, cold water immersion, taping and concussion prevention. Team physicians led 38% of the focus areas, followed by physiotherapists (25%) and fitness coaches (24%), with 11% managed collaboratively. Fitness coaches primarily handled exercise-based areas like warm-ups and load monitoring. Preventive measures were applied to the full squad in 81% of cases, with 19% targeting at-risk players. Player compliance was high, with 86% of focus areas adopted by all or most players, rising to 97% for players identified to be at greater risk of injury or illness.Conclusion Implementing the IP2 focus areas was widespread among teams in Qatar, with strong collaboration between medical staff. Player compliance, especially among at-risk players, was excellent, demonstrating the programme's feasibility and effectiveness in real-world settings.

IntroductionRepetitive head impacts (RHI) in sports may represent a risk factor for long-term cognitive and neurological sequelae. Recent studies have identified an association between playing football at the top level and an elevated risk of cognitive impairment and neurodegenerative disease. However, these were conducted on men, and there is a knowledge gap regarding these risks in female athletes. This study aims to investigate the effect of head impacts on brain health in female former top-level football players.Methods and analysisThis is a prospective cohort study, enroling female former football players and top-level athletes from sports without an inherent risk of RHI. All participants are born in 1980 or earlier. We plan to perform follow-up assessments at least three times over 20 years.The protocol includes neurocognitive assessments, self-reported neurocognitive outcomes, neurological examination, advanced brain MRI, and fluid biomarkers.Ethics and disseminationThe study has been approved by the South-East Regional Ethics Committee for Medical Research in Norway (2023/178330) and the Norwegian Agency for Shared Services in Education and Research (SIKT). A Data Protection Impact Assessment was developed by the research group and approved by SIKT and the Norwegian School of Sport Sciences. We will disseminate the results through peer-reviewed publications, academic conference presentations and webinars. We will communicate with the public and key stakeholders in football worldwide to inform and promote the development and implementation of potential preventive measures based on our study findings.

Injury and illness surveillance (IIS) systems play a crucial role in professional sports by monitoring athlete health, informing preventive strategies, and enhancing performance. Although international bodies, such as the International Olympic Committee, have established comprehensive guidelines, implementing these standards across diverse sports environments and specifically in football (soccer), remains challenging. This paper reflects on the experiences gained from implementing IIS systems in various football settings, including the Qatar Stars League and the Asian Football Confederation. It explores the successes and challenges encountered while adapting surveillance protocols to specific contexts and introduces a framework aimed at standardizing and optimizing IIS implementation. The findings underscore the importance of centralized oversight, routine data collection, and stable staffing to ensure consistent data quality. The integration of electronic data tools and real-time monitoring has further improved data accuracy and reporting. However, maintaining engagement across large geographical regions and addressing regulatory variations continue to pose challenges. We propose a step-by-step framework for IIS implementation that addresses these complexities while providing a strong foundation for expanding surveillance across other sports settings. This framework seeks to promote a more consistent approach to injury prevention and health management, with the potential for universal validation through collaboration with experts worldwide.